High-income countries remain overrepresented in highly ranked public health journals: a descriptive analysis of research settings and authorship affiliations

Abstract

Scientific contribution in high-impact journals is largely from authors affiliated with institutions in high-income countries (HICs). Publication of papers by contribution of individual countries to leading journals can provide a picture of the most influential countries in a particular discipline. The aim of the study was to identify changes in the patterns in authorship and origin of original research articles in relation to countries’ income level in the field of public health in 2016 in comparison to previous studies. A descriptive analysis was conducted based on articles published in highly ranked public health journals in 2016. Based on the inclusion criteria, 368 research articles were identified. Over 80% of these studies were conducted in HICs. Authors were mainly based in HICs (84%), especially in the USA. The majority of first, last, and corresponding authors were affiliated with HICs (over 90%). Our study might serve as a prompt for editorial and advisory boards of the leading international journals to provide more opportunities for researchers based in low and middle-income countries.

Full text

This is an Accepted Manuscript of an article published by Taylor & Francis in Critical Public Health on
February 4, 2020 available at:
https://www.tandfonline.com/doi/abs/10.1080/09581596.2020.1722313?tab=permissions&scroll=top
SHORT REPORT
High-income countries remain overrepresented in highly ranked
public health journals: a descriptive analysis of research settings
and authorship affiliations
Dominika Plancikova
a
, Predrag Duric
b
and Fiona O’May
b
a
Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University in Trnava, Trnava,
Slovakia;
bInstitute for Global Health and Development, Queen Margaret University, Edinburgh, UK
ABSTR ACT
Scientific contribution in high-impact journals is largely from authors affiliated with institutions in
high-income countries (HICs). Publication of papers by contribution of individual countries to
leading journals can provide a picture of the most influential countries in a particular discipline. The
aim of the study was to identify changes in the patterns in authorship and origin of original research
articles in relation to countries’ income level in the field of public health in 2016 in comparison to
previous
studies. A descriptive analysis was conducted based on articles published
in highly ranked
public health journals in 2016. Based on the inclusion criteria, 368 research articles were identified.
Over 80% of these studies were conducted in HICs. Authors were mainly based in HICs (84%), espe-
cially in the USA. The majority of first, last, and corresponding authors were affiliated with HICs
(over 90%). Our study might serve as a prompt for editorial and advisory boards of the leading
international journals to provide more opportunities for researchers based in low and middle-
income countries.
KEYWORD S
Scientific contribution;
publishing; original research;
public health; income level
Introduction
Publishing in high-impact journals is considered to be a measure of scientific prestige (Kupiec-
Weglinski, 2015). However, this prestige is not achievable by every researcher. Among other factors,
the place where the researcher grows up and lives may play a role. It is well documented that
scientific contribution in high-impact journals is disproportionately from authors affiliated with
institutions in high-income countries (HICs) (Ferris et al., 2015; Jacobsen, 2009; Rohra, 2011;
Sumathipala et al., 2004).
A fact that studies about low and middle income countries (LMICs) are more likely to include HIC
authors than vice versa, may be of higher concern with respect to publication ethics. Jacobsen (2009)
pointed out that the majority of epidemiological studies conducted in LMICs included at least one
co-author from HICs, while authors from LMICs were listed as co-authors only on 1% of papers on
research conducted in HICs. In addition, researchers from LMICs may not be part of the writing
process, or even when they are, may not be named as authors of the manuscript (Kohrt et al., 2014).
The reasons for these disparities have been well-rehearsed. Researchers from LMICs are often
constrained by limited access to literature and Internet, and by the time they can dedicate to
research at work (Bezuidenhout et al., 2017). They experience a lack of interest from international

488
D. PLANCIKOVA ET AL.
journals (Langer et al., 2004), editorial prejudice (Victora & Moreira, 2006), and lack of funding for
research. Other potential reasons for LMICs’ underrepresentation in leading journals include: lack of
researchers and supervisors, weak peer network, poor salaries, no career structure, and targeted
readership (Emmelin, 2001; Jahangir et al., 2011; Pike et al., 2017; Rohra, 2011; Saxena et al., 2003;
Smith et al., 2014; Uthman & Uthman, 2007).
Preference for English language disadvantages non-English speaking researchers in their e
ff
orts
to publish in high-level journals (Green & Speed, 2018), and language bias, affiliation or nationality
bias during the peer-review process may lead to disproportionate publishing between HICs and
LMICs (Lee et al., 2013). Underrepresentation of LMICs on journals’ editorial and advisory boards
(Meena & Chowdhury, 2014; Pike et al., 2017; Saxena et al., 2003) is also likely to contribute.
However, the unequal distribution of research is prevalent not just between countries by income
level and world regions. Di
ff
erences are substantial also within these categories (Jahangir et al., 2011;
Sumathipala et al., 2004; Uthman & Uthman, 2007). Publication of papers by the contribution of
individual countries to leading journals can provide a picture of the most influential countries in
a particular discipline, and the geographical reach of those journals (Boulos, 2005).
The aim of this study was to identify changes in the patterns in authorship and origin of original
research articles in relation to countries’ income level in the field of public health in 2016 in
comparison to previous studies.
Materials and methods
Journals selection
A descriptive analysis was conducted based on articles published in highly ranked journals in
2016. In order to form one journal ranking, journals were scored based on two traditional
bibliometric measures, impact factor (IF) and number of citations, which are annually provided
by the ISI Web of Knowledge (Clarivate Analytics, 2017). Journal ranking was based on the
following formula:
IF value of particular journal
the highest IF value in the category þ
no: of citations of particular journal
the highest number of citations in the category
Journals which received less than half of the highest score (0.777) and which were covered by
Science Citation Index Expanded (SCIE) for less than three quarters of their ‘publication life’ were
excluded from the analysis. For journals founded earlier than 1997, this year was considered as the
first year, since the indexation according to SCIE began in this year.
The journal Environmental Health Perspectives was excluded from the analysis due to its scope,
which also included animal and in-vitro research. We excluded journals published only in an online
form, since these are not as constrained by space as printed journals are, and consequently may
accept more articles. The selection process is shown in Supplementary Material Figure 1. The four
journals included in our analysis and their basic characteristics are provided in Supplementary
Material Table 1.
Selection of articles
Only original research articles were included in the analysis. Articles were excluded if they were not
country-specific, authors were listed in alphabetical order, where more than 25 authors or more than
12 countries were stated, or in the case that collaboration teams were stated as authors. We also
excluded articles from special editions since they might attract specialist authors.

CRITICAL PUBLIC HEALTH
489
Analysis
For each article, the following were recorded: number of authors, affiliations of authors, addresses for
correspondence, number of countries in which research was conducted and list of these countries.
Addresses of correspondence were analyzed separately, because some authors were a
ffi
liated with
more countries of different income levels or different world regions.
Categories by country income level, and by the world regions were created according to the
World Bank (2016). HICs were further divided into the categories as shown in Supplementary Material
Table 2. Research country was de
fi
ned as the country where the research was conducted. Where the
research was conducted in more countries of different income level categories, or authors were
affiliated with more institutions in countries of different income level categories, all countries and
categories were recorded.
Results
Countries of research
Based on our criteria we identified 368 research articles. The research was mainly based in the USA
(46%), and in the UK (6%). More than 80% of the research was conducted in HICs, 8% in upper
middle-income countries (UMCs), 6% in lower middle-income countries (LMCs) and almost 5% in
low-income countries (LICs).
North America (49%), and Europe and Central Asia (27%) contributed together over three quarters
of the research in the field of public health. Over half of the research in HICs was conducted in the
USA (57%), 25% in Western European countries, and 7% in the UK. In total, 70% of HICs in which the
research was conducted were English-speaking countries.
Affiliation of authors
In total, 2643 authors contributed to 368 research articles (average 7.2 authors per article). Of these,
84% were affiliated with institutions in HICs, 2% of authors stated a combined affiliation (CA). In MICs
and LICs 11% and 3% of all authors were affiliated, respectively. Over half (51% + 2% CA) of the
authors were based in the USA, followed by authors from the UK (7% + 2% CA). The majority of first,
last, and corresponding authors (over 90%) were a
ffi
liated with HICs, especially in North America, and
Europe and Central Asia.
For all studies conducted in HICs, first, last and corresponding authors, and addresses of corre-
spondence were based in HICs. The percentage of first, last and corresponding authors, and
addresses of correspondence based in the country of the same income level as where the research
was conducted substantially decreased with decreasing income level. For instance, first authors of
studies conducted in LICs were affiliated solely with LIC in 19%, and last and corresponding authors
in 6% of studies.
In almost all studies at least one author was based in a country where the research was
conducted. Between-country collaboration was recorded in 36% of studies. Of these, 52% was within
HICs, 21% of studies were conducted based on cooperation between HICs and UMCs, 12% between
authors from HICs and LMCs, and 8% between authors from HICs and LICs (see Table 1 and Table 2).
Discussion
Based on our findings, LMICs are underrepresented in the field of public health, over 80% of research
in this field was conducted in HICs. About 10% higher underrepresentation of LMICs was shown by
Paraje et al. (2005) between 1992 and 2001 in the field of health (90% of papers were produced by
HICs), and by Ferris et al. (2015) in 2011 and 2012 in the field of occupational health (89% of papers
were produced by HICs). However, every study applied different inclusion criteria for articles.

Table 1. International collaboration by country income level.
Corresponding author
Address of correspondence
Number of
articles
From
research
country
HIC
UMC
LMC
LIC
Combination of
countries
In research
country
HIC
UMC
LMC
LIC
Combination of
countries
Countries by
HIC 302
284
301
-
-
-
1
277
302
-
-
-
-
income level
(94%)
(100%)
(0%)
(92%)
(100%)
UMC 25
17
8
15
-
-
2
16
9
16
-
-
-
(68%)
(32%)
(60%)
(8%)
(64%)
(36%)
(64%)
LMC 17
8
9
-
2
-
6
3
14
-
3
-
-
(47%)
(53%)
(12%)
(35%)
(18%)
(82%)
(18%)
LIC 16
3
11
-
-
1
4
2
14
-
-
2
-
(19%)
(69%)
(6%)
(25%)
(13%)
(88%)
(13%)
HIC: high income country; UMC: upper-middle income country; LMC: lower-middle income country; LIC: low income country.
Table 2. International collaboration by country income level.
First author
Last/senior author
Number of
articles
Average number of
authors per article
From research
country
HIC
UMC
LMC
LIC
Combination of
countries
From research
country
HIC
UMC
LMC
LIC
Combination of
countries
Countries by
HIC
302
6
286
301
-
-
-
1
282
299
-
-
-
1
income level
(95%)
(100%)
(0%)
(93%)
(99%)
(0%)
UMC
25
11
17
8
15
-
-
2
17
8
13
-
-
4
(68%)
(32%)
(60%)
(8%)
(68%)
(32%)
(52%)
(16%)
LMC
17
11
9
8
-
4
-
5
10
7
-
5
-
5
(53%)
(47%)
(24%)
(29%)
(59%)
(41%)
(29%)
(29%)
LIC
16
12
6
9
-
-
3
4
4
12
-
-
1
3
(38%)
(56%)
(19%)
(25%)
(25%)
(75%)
(6%)
(19%)
HIC: high income country; UMC: upper-middle income country; LMC: lower-middle income country; LIC: low income country.The last author was not analyzed in two articles from HICs, because they
had only one author.
490
D. PLANCIKOVA ET AL.

CRITICAL PUBLIC HEALTH
491
When compared by world regions, and countries, the dominance of North America, and Western
Europe, speci
fi
cally the USA, and the UK, is prevalent. These
fi
ndings are in concordance with a study
based on the SCImago Country & Journal Rank (a publicly available portal that includes the journals and
country scienti
fi
c indicators that can be used to assess and analyze scienti
fi
c domains (Scimago Lab,
2019)), conducted for the years 1996–2011. North America and Western Europe produced over 60% of
public health, environmental and occupational health research. Speci
fi
cally, the USA contributed 32%
and the UK 8% (Zacca-González et al., 2014). In 2016, contribution of the USA to public health research
was even higher (46%); however, the contribution of the UK was slightly lower in our study.
The leading position of the USA persists, or it is even more dominant, among first authors.
According to a study Soteriades and Falagas (2006) conducted between 1995 and 2003, an US first
author was stated in 61% of articles in the field of public health. In 2016 the situation in the field of
public health remains similar, with 59% of first authors stating an affiliation and another 3% a CA with
the USA. In related health fields, a lower percentage of the US first authors was reported, over 40% in
epidemiology, in preventive and occupational/environmental medicine (Soteriades & Falagas, 2006),
and over 30% in the field of occupational health research in 2011 and 2012 (Ferris et al., 2015).
The underrepresentation of LMICs among first authors in the field of epidemiology was reported
by Victora and Moreira (2006), and Jacobsen (2009). Only 11% of first authors of published articles in
2000 and 2001 were from LMICs in the International Journal of Epidemiology, and 6% in the
American Journal of Epidemiology (Victora & Moreira, 2006). Fifteen years later, the situation has
not improved. According to our research, in which both these journals were included, only 7% of first
authors were affiliated solely with a LMIC.
In this study, we have analyzed the patterns of scientific contribution in the field of public health
according to income level categories, and world regions of countries and authors. Overall contribu-
tion of an individual country was not assessed only by the affiliation of the first author of a particular
study, but we have studied scientific contributions according to all countries and all affiliations
stated within one study.
In comparison to previous studies, we found out higher representation of LMICs in research in the
field of public health. However, despite initiatives of many journals, the percentage of first authors
from LMICs has not increased. These initiatives include providing a discount or a waiver on open
access publication charges (Smith et al., 2014; Siriwardhana, 2015) or offering educational institu-
tions in LMICs free online access to their content (Soteriades & Falagas, 2006). Other initiatives, such
as providing editorial assistance to non-English speakers, writing editorials to raise awareness of
these issues, reserving some space for papers from LMICs (Emmelin, 2001; Rohra, 2011; Smith et al.,
2014), might help to improve this situation.
Furthermore, we have provided an analysis on collaboration between countries of differing
income levels. Our findings point to a kind of ‘parasitism’ of higher-income countries in countries
with lower income. Researchers from higher-income countries were commonly involved in research
conducted in lower-income countries, which was only rarely seen in reverse. Similar results were
documented by Jacobsen (2009) in the field of epidemiology. This pattern was especially visible for
positions of first, last, and corresponding authors, which were occupied by researchers from higher-
income countries. We are aware of some limitations of this study, which was based on a descriptive
analysis of research articles published in a one-year period. The scientific contribution of LMICs may
vary by the type of article. Finally, we have selected only the top four leading journals, which may not
be representative of all top leading journals.
Conclusion
Our results demonstrate not only a significant underrepresentation of LMICs in research in the field
of public health, but also a lower representation of non-English speaking and non-Western European
countries. Further research is needed to include more journals, an extended time period, and an
analysis of other characteristics, such as type or country of funding.

492
D. PLANCIKOVA ET AL.
However, we have demonstrated continuing inequalities in publishing in the highest-ranking
journals in the field of public health. Further effort is needed to narrow the gap in research between
LMICs and HICs, but also within HICs. Our study might serve as a prompt for editorial and advisory
boards of the leading international journals to provide more opportunities for researchers based in
LMICs. Continuous underrepresentation of research conducted in LMICs might result in bias in
research and its duplication by experts in the same research field.
Disclosure statement
No potential conflict of interest was reported by the author(s).
ORCID
Fiona O’May
http://orcid.org/0000-0003-4417-2819
References
Bezuidenhout, L., Kelly, A. H., Leonelli, S., & Rappert, B. (2017). ‘$100 is not much to you’: Open science and neglected
accessibilities for scientific research in Africa. Critical Public Health, 27(1), 39–49.
Boulos, M. N. K. (2005). On geography and medical journalology: A study of the geographical distribution of articles
published in a leading medical informatics journal between 1999 and 2004. International Journal of Health
Geographics, 4, 1–6.
Clarivate Analytics. (2017, October 10). InCites journal citation reports website. Retrieved from https://jcr.clarivate.com/
Emmelin, M. (2001). Challenges for publishing medical and public health research in the 2000s. Scandinavian Journal of
Public Health, 29, 1–4.
Ferris, M., Hirst, A., Sanati, N. A., & Sanati, K. A. (2015). The international contribution to occupational health research.
Scandinavian Journal of Work, Environment and Health, 41(3), 294–298.
Green, J., & Speed, E. (2018). Critical analysis, credibility, and the politics of publishing in an era of ‘Fake News’. Critical
Public Health, 28(2), 129–131.
Jacobsen, K. H. (2009). Patterns of co-authorship in international epidemiology. Journal of Epidemiology and Community
Health, 63(8), 665–669.
Jahangir, E., Comandé, D., & Rubinstein, A. (2011). Cardiovascular disease research in Latin America: A comparative
bibliometric analysis. World Journal of Cardiology, 3(12), 383–387.
Kohrt, B. A., Upadhaya, N., Luitel, N. P., Maharjan, S. M., Kaiser, B. N., Macfarlane, E. K., & Khan, N. (2014). Authorship in
global mental health research: Recommendations for collaborative approaches to writing and publishing. Annals of
Global Health, 80(2), 134–142.
Kupiec-Weglinski, J. W. (2015). Journal Impact Factor (JIF): The good, the bad, and the ugly. Nowotwory, 65(6), 481–482.
Langer, A., Diaz-Olavarrieta, C., Berdichevsky, K., & Villar, J. (2004). Why is research from developing countries under-
represented in international health literature, and what can be done about it? Bulletin of the World Health
Organization, 82(10), 802–803.
Lee, C. J., Sugimoto, C. R., Zhang, G., & Cronin, B. (2013). Bias in peer review. Journal of the American Society for
Information Science and Technology, 64(1), 2–17.
Meena, S., & Chowdhury, B. (2014). How international are the leading orthopedic journals: A look at the composition of
the editorial board members of the top orthopedic journals. Archives of Orthopaedic and Trauma Surgery, 134(5),
619–622.
Paraje, G., Sadana, R., & Karam, G. (2005). Increasing international gaps in health-related publications. Science, 308(5724),
959–960.
Pike, K. M., Min, S. H., Poku, O. B., Reed, G. M., & Saxena, S. (2017). A renewed call for international representation in
editorial boards of international psychiatry journals. World Psychiatry: Official Journal of the World Psychiatric
Association (WPA), 16(1), 106–107.
Rohra, D. K. (2011). Representation of less-developed countries in pharmacology journals: An online survey of corre-
sponding authors. BMC Medical Research Methodology, 11. doi:10.1186/1471-2288-11-60
Saxena, S., Levav, I., Maulik, P., & Saraceno, B. (2003). How international are the editorial boards of leading psychiatry
journals?. Lancet, 361(9357), 609.
Scimago Lab. (2019, October 20). About us. Retrieved from https://www.scimagojr.com/aboutus.php
Siriwardhana, C. (2015). Promotion and reporting of research from resource-limited settings. Infectious Diseases:Research
and Treatment. doi:10.4137/IDRT.S16195

CRITICAL PUBLIC HEALTH
493
Smith, E., Hunt, M., & Master, Z. (2014). Authorship ethics in global health research partnerships between researchers
from low or middle income countries and high income countries. BMC Medical Ethics, 15, 42.
Soteriades, E. S., & Falagas, M. E. (2006). A bibliometric analysis in the fields of preventive medicine, occupational and
environmental medicine, epidemiology, and public health. BMC Public Health, 6. doi:10.1186/1471-2458-6-301
Sumathipala, A., Siribaddana, S., & Patel, V. (2004). Under-representation of developing countries in the research
literature: Ethical issues arising from a survey of five leading medical journals. BMC Medical Ethics, 5, 1–6.
Uthman, O. A., & Uthman, M. B. (2007). Geography of Africa biomedical publications: An analysis of 1996–2005 PubMed
papers. International Journal of Health Geographics, 6, 1–11.
Victora, C. G., & Moreira, C. B. (2006). North-South relations in scienti
fi
c publications: Editorial racism? Revista de Saude
Publica, 40, 36–42.
World Bank (2016, July). World Bank list of economies. Retrieved from http://iccmoot.com/wp-content/uploads/2016/
08/World-Bank-list-of-economies_July2016.pdf
Zacca-González, G., Chinchilla-Rodríguez, Z., Vargas-Quesada, B., & de Moya-anegón, F. (2014). Bibliometric analysis of
regional Latin America’s scientific output in Public Health through SCImago Journal & Country Rank. BMC Public
Health, 14, 632.