Leonard Jack, Jr, PhD, MSc
Editor in Chief, Preventing Chronic Disease
Sumi Sexton, MD
Editor in Chief, American Family Physician
Jesus Ramirez-Valles, PhD, MPH
Editor in Chief, Health Education & Behavior
San Francisco, California
Alfredo Morabia, MD, PhD, MPH
Editor in Chief, American Journal of Public Health
New York, New York
American Society of Clinical Oncology
At the CSE 2022 Annual Meeting, Leonard Jack, Jr, PhD, secured and led a panel of four journal Editors-in-Chief (EICs) who spoke on establishing and sustaining the expansion of diversity, equitable decision making, and a culture of inclusion in scholarly communications and between journal publishing professionals. These four EICs shared diversity, equity, and inclusion (DEI) efforts and approaches, particularly addressing the issues of racism and sexism, being implemented at their respective journals.
Dr Jack, co-chair of the CSE DEI committee, introduced the panel in person, while the rest of the panelists joined remotely. Dr Jack, EIC of Preventing Chronic Disease: Public Health Research, Practice & Policy (PCD), a journal housed in the Centers for Disease Control and Prevention (CDC), introduced himself and the other three panelists, Sumi Makkar Sexton, MD, EIC of American Family Physician (AFP), Jesus Ramirez-Valles, PhD, EIC of Health Education & Behavior (HE&B) at the Society for Public Health Education, and Alfredo Morabia, MD, EIC of the American Journal of Public Health (AJPH).
Dr Sexton started the session off with a presentation on anti-racist publishing in family medicine in her role as EIC at AFP, a continuing medical education journal for primary care physicians; she also manages a private practice caring for patients in Virginia. Given AFP’s wide influence in the practice of medicine, she recognized the great importance of better integrating DEI into journal operations. Dr Sexton began intentional DEI efforts for AFP in 2020 to address racism and social determinants of health, collaborating with 10 other family medicine journals doing similar work. This led to their joint statement for DEI accountability and partnership. Since then, AFP has taken numerous actions, not only engaging in conversations but also hiring a DEI associate editor, recruiting diverse fellows, residents, and students, holding regular DEI guideline development meetings, and putting out calls for papers on both race-based medicine and mentorship. DEI goals for the AFP journal include creating space for dialog and learning, keeping the focus on the patients and communities of the journal’s readers, seeing integration of DEI in clinical practice, focusing on race and racism, diversity of staff, editorial board members, authors, and peer reviewers, and eventually, no longer needing a DEI editor or consultant as it will be ingrained. These efforts have come with challenges including collecting demographic information from and the high learning curve for editors, authors, reviewers, and readers, the lack of specific DEI guidelines or standards, difficulty finding authors and reviewers with expertise to write and/or review, reader resistance, and keeping up the momentum of DEI efforts that started in 2020. Dr. Sexton ended by noting that DEI efforts, while challenging and time consuming, are part of a good struggle for worthy outcomes and the best care of patients.
Dr Sexton introduced Dr Ramirez-Valles, who began by noting the considerable progress made on the issues of sexism and racism since the 1990s. Regarding HE&B’s publications, collaboration with his journal colleagues through conversation has played a major role for Dr Ramirez-Valles in addressing DEI in journal publication. HE&B’s recent work has included editorial board composition, now composed of 50% Scholars of Color (SOC), and 68% women, a stark contrast to its makeup previously. HE&B also uses special issues to open up the journal to SOCs and students, putting out a very successful call for papers by SOCs in 2021. The editorial board of HE&B put out a call for papers for students to address its weak journal pipeline. As EIC, Dr Ramirez-Valles explained that working closely with the editorial board, and the board of trustees who help select them, is crucial for getting their support on DEI initiatives. He noted that an important step is reporting the demographic makeup of the journal’s decision-making body, for example, on editorial board or trustee presentations. Major challenges to HE&B’s DEI efforts include collecting demographic data on authors, without which DEI problems are hard to identify. Also, the pipeline of scholars does not include many individuals outside of large institutions and universities, out of which already relatively few SOCs find their way to the journal. To gather an appropriately diverse and inclusive board, recruitment from universities, societies, and the National Institutes of Health has been considered. The opportunity to join the Coalition for Diversity and Inclusion in Scholarly Publications (C4DISC) has been beneficial for HE&B to participate in the international forum it provides and its work on useful anti-racism guidelines.
Dr Ramirez-Valles then introduced Dr Morabia, who began by presenting the state of AJPH, an independent journal with in-house production services. AJPH received an increased immediacy index and citation rate in 2020 as a longstanding yet unintentional pioneer of DEI publications. During the COVID pandemic, AJPH made the public health message clear that “we aren’t all in this together.” AJPH has been active in addressing DEI issues for many years including publishing on the intersectionality debate, and equity and diversity in HIV/AIDS, social justice, and public health. AJPH has published on race/racism significantly more than competing journals particularly over the last 5 years. Some factors that may contribute to AJPH’s success in this area may be its priority on social determinants of health, editor diversity (regional, and by qualifications), and its collaboration with grassroots and frontline organizations. As DEI efforts can always be improved, Dr Morabia plans to continue to advance DEI in publications by learning and sharing what AJPH is doing right, training reviewers and authors, and exchanging experience with other journals and those who use science.
Dr Morabia introduced Dr Jack, who began his presentation by emphasizing DEI’s relevance to all journal processes, including who reviews submissions and how many papers are accepted. At PCD, his approach to DEI began by opening the journal up to critique, bringing in an external panel to review peer-review practices, article types, and mission statements. The panel identified the need for a shift from being risk factor-centric to focusing on nonindividual determinants of health. Work done to accomplish this shift included creating editorial board focus groups and reviewing journal statistics. PCD issued a position statement as a public commitment in August 2021 that detailed its current state and future goals (Figure).
Dr Jack acknowledged the challenge of putting out content from within a long-entrenched publishing model that has not historically considered DEI. Dr Jack gave the advice to, “Become open to new methodology,” and “think differently and out of the box” regarding DEI initiatives. He noted that “individuals who are courageous enough to do that” have been early career professionals and students, who need to be included in these conversations. He aims to steer PCD to focus more intentionally on racism in all its forms and health. He noted that transparency of intention must be a normal practice, as well as a capacity to receive difficult feedback. He ended his presentation by noting that a journal’s policy may not always cover DEI concerns in practice. Monitoring and acknowledgement of inconsistent policy application should be a constant task for journals. For example, inequitable, often unintentional practices such as referring one author to the website versus another author receiving journal information directly due to a board member or editor connection must be considered. On an ongoing basis, Dr Jack publishes an Editor-in-Chief column to report on DEI progress made with the journal, even when only to acknowledge delays or missteps. He sees the column as an opportunity to be unafraid and committed to doing better in the DEI space.
The presentations were followed by a Q&A session touching on demographic data collection and survey response rate difficulties, as well as the U.S.-based nature of the current racial discourse. The session ended with a reminder to all publishing professionals to keep talking to each other about what works and doesn’t work for journals incorporating more diversity, equity, and inclusion in their publications.