Although the highest burden of disease is concentrated in low- and middle-income countries (LMICs), data from the Institute for Scientific Information show large gaps in scientific production between industrialized and developing settings (1). In the fields of medicine and public health, the overwhelming majority of publications originate in the United States and Western Europe. Scientific papers where researchers from developing countries are the sole authors represent a very low proportion of published manuscripts.
Over the past few years, several articles have analysed various aspects related to the underrepresentation in international journals of public health problems and research conducted in LMICs (2-5). Complex and interrelated contributing factors have been identified; five are elaborated below.
Poor research production. Scientific production is poor in developing settings, both in terms of quantity and quality, because of a critical lack of continuous support for research and development activities including basic infrastructure from both local governments and international agencies, and lack of incentives for research activities. Furthermore, professional researchers are undervalued and their salaries are low, a situation that reflects the lack of status accorded to scientific production and contributes to a scarcity of full-time researchers ad hoc.
Poor preparation of manuscripts. Even manuscripts exhibiting high-quality research may not meet the requirements of peer-reviewed international public health journals in terms of language and scientific presentation. Although some journals' policies include assistance for writing and language editing, this support does not meet the needs. Language proficiency remains a fundamental barrier for scientists whose mother tongue is not English. Poor presentation may also result from a lack of the skills required to develop coherent arguments. Indeed, unlike developed countries where writing skills are an essential component of higher education, writing abilities in LMICs are usually acquired informally on an ad hoc basis, at a later stage in a professional career.
Poor access to scientific literature. Authors from developing countries are often not adequately prepared to participate in the international scientific debate, as they have limited access to the published literature. Out-dated and insufficient or underresourced library stocks, high journal subscription fees and poor Internet access and computer availability represent serious limitations.
Poor participation in publication-related decision-making processes. Developing country experts are seriously underrepresented on editorial boards and review rosters of international journals. Editorial boards of journals devoted to diseases that mostly occur in developing country settings (e.g. tropical medicine) where local experts are not proportionately represented are an example of this situation. As a result, submissions from poor countries are usually evaluated by experts who may not be knowledgeable about the constraints associated with conducting research in these settings and, therefore, do not have a positive attitude to provide the guidance that may make the work publishable.
Bias of journals. Editors, editorial boards and reviewers of international medical journals may be insufficiently interested in the areas to which most researchers from developing countries devote their work, and may consider them unoriginal or irrelevant for their readership. The existence of a bias against the so-called "diseases of poverty" has also been suggested (6). This lack of interest may also reflect the preferences of the readership or the advertisers. In addition, researchers from poor settings have a limited capacity to buy reprints, which constitute a substantial source of income for scientific journals. Finally, international journals are usually more willing to consider papers that originate from prestigious research centres in developed countries than those from lesser-known academic entities, particularly when the authors are exclusively researchers from developing countries. …