Jocalyn Clark: Global health in medical journals

Jocalyn_Clark1Last week in London we had a lively and enjoyable reunion of The BMJ’s editorial registrars. In 2002 I was registrar number 13 of the now 25 year old scheme (editor in chief Fiona Godlee was number two), and wanted to reflect on my editorial career and to provide a view of The BMJ from Canada, England, and Bangladesh—the three countries in which I have lived and worked. I chose also to share some remarks about why I think The BMJ is the world’s original global health journal.

Nowadays it’s common to see diseases of poverty, evidence of inequity, and international health challenges (HIV/AIDS, malnutrition, climate change) grace the headlines and pages of newspapers and journals alike. Terms like “learning from the south” and “reverse innovation” are understood in a rapidly globalizing world.

We now have weekly general medical journals the Lancet and PLOS Medicine looking a lot like global health journals. Specialist titles such as The Lancet Global Health, Global Health Action, Journal of Global Health, and others have been launched to meet the needs of a diverse and growing global health community of researchers, policymakers, and students. Even the very clinically inclined US based weeklies, JAMA and the New England Journal of Medicine, have introduced sections on global health in recent months.

Ten years ago this was not the case. Medical journals were dominated by research and commentary on rich world medicine (stents, cancer drugs, rare diseases, managed care), and it was not uncommon (in fact it was the norm) to find that research on, and the experiences of, people living in poor countries were reported by authors from Johns Hopkins and Harvard University and other wealthy “Northern” universities. The BMJ helped change all that.

Firstly, a series of high profile theme issues made visible the health problems of developing countries, as well as our collective responsibility for improving the world’s health. The 2004 South Asia and 2006 Middle East theme issues brought together health professionals from regions with long histories of conflict to discuss a wide range of shared health challenges and solutions. A 2004 issue on “Learning from low income countries” declared that developed world health researchers and policymakers had much to learn from the innovative, cost effective health initiatives and interventions in the poor world—long before the message of “turning the world upside down” to garner lessons from the Global South became popular and accepted.

Secondly, was a strong commitment on The BMJ’s part that the reporting be done by authors from the regions affected. International editorial board members told us that journals’ coverage of low income countries was limited, and we tried to change that. For the Africa theme issue I edited in 2005 with Jimmy Volmink and Lola Dare, this meant content would be “by, for, and about Africa.” The importance of learning from the Global South and of dispatching the old model of Global North authority and expertise are lessons and a commitment I carried with me to PLOS Medicine, where we explicitly defined our mission and priorities to align with the top causes and risk factors of disease and disability in the entire world.

The BMJ does a great many things well, but its early leadership in global health coverage stands out as having set the scene for what we must now ensure is a thriving and abundant field led by the Global South.

Our next responsibility as medical journals and editors —general journals and specialist titles alike—is to broaden our lens on global health to cover the political economy. Whether it’s the challenge of immunization coverage, addressing growing burdens of non-communicable disease, or stemming recalcitrant rates of maternal death and childhood illness, there is a political and economic context that influences our ability to deploy and deliver proven interventions. Conflict and violence, trade policies, donor priorities and agendas, the interests of industry—these (among many other features) comprise the politics of global health, and these will make or break the success and impact of our health efforts.

Just look at the case of polio eradication: constrained not by money, technology, or health worker coverage, but by politics and religious power. Ditto for the paltry funding commitments to fighting non-communicable diseases—arguably the largest threat to health and economies around the world. Here effective market driven solutions are available and known, but neither fit the interests of governments, nor inspire the attention of major global health funders like the Gates Foundation.

Examining such elements of the political economy of health will complement research and commentary on the biological and medical determinants of health that now so frequently comprise the global health literature. Leading medical journals are good at pushing the boundaries, and we need to continue to expand our view and coverage of global health.

My recent series on the Medicalization of Global Health was inspired by this broader view. I argue that the global health agenda and its framing of problems (global mental health, NCDs, universal health coverage) have become too medicalized—tilted toward medical and technical solutions, which neglect the social, community, and political action that is necessary.

As I remarked in London last week, being an editorial registrar at The BMJ changed my life, literally. I had been on a traditional academic health sciences path, but my registrar year (during which I was the first non physician and first North American editorial registrar at The BMJ) set me on the right course: to become a professional journal editor and to embark on an eye-opening global health journey that continues today.

Jocalyn Clark (@jocalynclark) is executive editor of the Journal of Health, Population and Nutrition, and other external publications at icddr,b (a global health research organization in Dhaka, Bangladesh). She was a former senior editor at PLOS Medicine (2008-13), and a former editorial registrar, assistant editior, and associate editor at The BMJ (2002-08).

Competing interests: The author has no further interests to declare.