Diversity,Equity,and Inclusion in Biomedical Research and Publishing

Abstract

Diversity, Equity, and Inclusion (DEI) are essential for ethical biomedical research, yet gaps remain in the editorial board, peer review, authorship, and research participation. This editorial examines ways to integrate DEI into global biomedical publishing and highlights the initiatives undertaken by various organizations. It addresses challenges such as underrepresentation and exclusionary practices affecting individuals from low- and middle-income countries and marginalized communities. The piece suggests strategies for incorporating DEI into research and publishing while promoting accountability and meaningful change. To develop a biomedical research landscape that is fair and inclusive, it is essential to advance DEI from mere discussion to genuine structural transformation.

The global scientific community is more interconnected than ever in the 21st century. However, rapid progress in research does not guarantee fair access, representation, or involvement for all groups. Biomedical publishing still faces deep-rooted biases and inequalities that exclude certain voices, regions, and types of knowledge. ¹ As a result, Diversity, Equity, and Inclusion (DEI) has become essential to the credibility and integrity of science, extending beyond mere ethical goals. ²

This editorial emphasizes the importance of incorporating DEI principles into biomedical publishing to advance both science and societal progress. ³ It also explores international frameworks that support change and call for more focused efforts to promote equity in editorial governance, authorship, peer review, and knowledge production.

The Significance of DEI in Biomedical Publishing

Biomedical research has the potential to improve human health significantly. However, not everyone benefits equally from these advancements. Women, ⁴ researchers from low- and middle-income countries (LMICs),^5,6 and individuals from underrepresented racial and ethnic groups,^7,8 remain underrepresented as authors and on editorial boards. ³ Also, individuals with disabilities ⁹ and LGBTQIA+,^10,11 scientists often face underrepresentation as editors, reviewers, authors, and research participants. This lack of representation results in a knowledge base that fails to capture diverse experiences, leading to incorrect generalizations and gaps in medical understanding.^12,13

Research conducted in LMICs, especially in Africa, Latin America, and South Asia, accounts for only a small share of global biomedical research. This is significant given that these regions encompass a large share of the world’s population. ¹⁴ Systemic disparities in academia create barriers to publishing. These disparities include unequal access to funding, training, and opportunities for authorship. ¹⁵ Without intentional efforts to address it, biomedical knowledge may become more limited, less diverse, and less relevant.

The Transition from Diversity to Equity and Inclusion

Diversity refers to “the practice or quality of including or involving people from a range of different social and ethnic backgrounds and of different genders, sexual orientations, etc.” ¹⁶ Equity ensures equal access to opportunities for everyone by recognizing that advantages and obstacles vary among individuals; it starts with identifying disparities and aims to correct inequalities. ¹⁷ Inclusion is a commitment to allowing individuals from diverse backgrounds to participate fully in an organization, including leadership and decision-making. ¹⁷

The terminology around DEI is evolving to include justice, resulting in the acronym JEDI. However, this shift may overlook significant aspects, such as accessibility and belonging. Adding a plus sign (+) to DEI ensures that everyone feels they belong. This evolution highlights the significance of creating environments where individuals from diverse backgrounds feel valued and are encouraged to contribute. Biomedical journals play a crucial role in driving significant changes within the research community. They establish fair policies, enhance the peer review process, use inclusive language, and promote transparency. These journals not only influence their own editorial decisions but also set standards for ethical practices throughout the broader research community. ¹⁸

Why is it Essential to Discuss DEI in Biomedical Research?

Methodological Accuracy: Diverse teams produce research that is more innovative, reproducible, and impactful, highlighting that scientific work benefits from diverse backgrounds and perspectives. ³

Global Importance: Including diverse populations in biomedical research ensures that discoveries meet the health needs of all groups, helping to reduce health disparities. ¹⁹

Moral Obligation: Fairness, openness, and responsibility in scientific publishing demonstrate equity. ³

Trust in Science: Inclusion increases public trust, particularly among marginalized groups historically excluded from biomedical discussions. ²⁰

Global DEI Frameworks in the Publishing Industry

Numerous global organizations have established guidelines to enhance DEI in research and communication. These frameworks offer standards and tools to ensure accountability.

Committee on Publication Ethics (COPE)

The COPE’s position statement on DEI reads, “COPE is committed to creating an inclusive and equitable culture, where all voices are welcomed and heard, and difference is celebrated. Through our words and actions, we intend to work for real change and to nurture and represent broader and more diverse research integrity, publication ethics, and wider scholarly publishing communities.” ²¹ Journals should gather demographic information, support diverse authorship, and implement inclusive practices in peer review and editorial management. The main principles of COPE emphasize promoting respect, ensuring equal opportunities for submissions, and addressing hidden biases within editorial processes.

World Association of Medical Editors (WAME)

The WAME has not formally addressed DEI; however, its guidelines promote professionalism, fairness, transparency, and the removal of bias in the editorial process.^22–24

Core DEI Principles from ICMJE, CSE, and C4DISC

International Committee of Medical Journal Editors (ICMJE)

The ICMJE’s recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals features a specific segment focused on Diversity and Inclusion. They assert that editors ought to “seek to engage a broad and diverse array of authors, reviewers, editorial staff, editorial board members, and readers.” The ICMJE advises against using images that may promote bias. ²⁵

Council of Science Editors (CSE)

The CSE established a DEIA Committee to incorporate DEI and accessibility into its governance, training, and programs.^26,27 The strategic plan focuses on recruiting diverse members, transforming conference content, and providing toolkits for journals to improve DEIA practices in their operations.

Coalition for Diversity and Inclusion in Scholarly Communications (C4DISC)

The C4DISC, ²⁸ has released a Joint Statement of Principles, confirming that member organizations aim to prioritize accessibility, diversity, and inclusive practices in scholarly communication to encourage participation, support innovation, and expand leadership opportunities, thereby increasing engagement across different identity groups and professional levels. The coalition’s principles provide a shared value framework for academic publishers worldwide. They promote respect, accessibility, and positive change.

Structural Inequality in Authorship and Editorial Boards

Despite the growing discussion surrounding DEI, research indicates that academic journals remain markedly elitist and highly exclusive. Many respected journals have editorial teams composed primarily of men from affluent countries, and women are underrepresented. ²⁹ Early-career researchers, ³⁰ and scientists from LMICs, ³¹ are less often considered for editorial positions.

Obstacles to DEI in the Publishing Industry

Publication Oversight: Editorial boards often lack diversity, raising concerns about decision-making. ³

Linguistic prejudice: The prevalence of English hampers global participation by non-native speakers. ¹⁹

Systemic disparities: Researchers from LMICs encounter difficulties publishing in quality journals due to unequal funding and institutional biases. ³

Reviewer Prejudice: Reviewers may unknowingly favor authors affiliated with prestigious institutions or those from majority demographic groups.^32,33

Implementing DEI: Translating Words into Action

Dewidar et al., ³⁴ propose the following six strategies for journals to enhance EDI principles (the acronym DEI is used to refer to the same concept):

Develop a clear EDI statement that outlines specific steps to achieve EDI.

Promote the use of inclusive and unbiased language.

Appoint an EDI director or leader to oversee the journal’s initiatives.

Establish an EDI-focused mentoring program.

Track and monitor progress in implementing EDI principles.

Publish reports that showcase EDI initiatives and accomplishments.

Policies alone are insufficient; accountability is crucial. To enhance representation, we should actively recruit individuals, develop their skills, and provide mentorship. Journals must take specific steps to monitor progress, such as ensuring equity in gender and geographic representation on editorial boards,^11,35,36 addressing the differences in publication timelines for submissions from high-income countries vs LMICs, providing clear explanations for the reasons behind article rejections, and allowing voluntary and confidential disclosure of demographic information for both authors and reviewers.

Initiatives such as double-blind peer review, inclusive language guidelines, fee waivers for submissions from LMICs, and diversity goals for reviewers can promote DEI.

The Significance of Funders and Organizations

Funding organizations increasingly require recipients to demonstrate their DEI efforts. For instance, the National Institutes of Health (NIH) has guidelines promoting diversity in research participation.^37–39 Academic journals can accomplish these goals by including equity statements in the studies they publish and by selecting and analyzing samples that are fairly represented.

The DEI in Methodological Approaches and Reporting Practices

Inclusion should also encompass decisions regarding research methods. Clinical trials often exclude pregnant individuals, ⁴⁰ older adults, ⁴¹ and people with disabilities, ⁴² due to concerns about differences or associated risks. This exclusion limits the application of findings to the general population. Journals should require researchers to justify their exclusion of certain groups and to promote studies involving underrepresented populations. Transparency regarding demographic information—such as race, gender, socioeconomic status, and disability—ensures accountability and prevents the marginalization of underrepresented groups. ⁴³

Approaches for Integrating DEI

Enhancing editorial board diversity: Journals should establish clear policies to promote diversity in gender, location, and academic disciplines. ³

All-Encompassing Language Framework: Editorial guidelines should use respectful language appropriate to various cultures. ¹⁹

Strengthening skills: Collaborating with institutions in LMICs can enhance access to publishing resources for more individuals. ³

Transparent Metrics: Journals should provide statistics on diversity in authorship, the peer-review process, and editorial leadership. ⁴³

Attribution of Contributions: Using contributor taxonomies such as CRediT can help reduce ghost authorship and elevate the voices of underrepresented individuals. ¹⁹

Implementing DEI in the Journal Operations

The Journal of General Internal Medicine, ³ The BioMed Central, ¹⁹ and The Journal of the American Medical Informatics Association, ⁴⁴ have implemented the DEI guidelines into their editorial workflows.

The Indian Journal of Psychological Medicine aims to integrate DEI principles into its day-to-day operations. ⁴⁵ We have a Diversity, Equity, and Inclusion (DEI) Editor position aligned with international publishing guidelines. Additionally, Editorial Trainees, Early Career Editors, and scholars from underrepresented regions. These demonstrate our genuine efforts to diversify our editorial and journal board to ensure fair representation across gender, geographic location, academic discipline, and career level.^46,47 To enhance transparency, we plan to publish annual reports that summarize submission and acceptance trends by demographic categories (when voluntarily disclosed), highlighting diversity and equity in our editorial decisions. We have inclusive language guidelines for authors and reviewers. To ensure a fair share of publishing opportunities for residents and prevent their exclusion, ⁴⁸ we have a Residents' Corner that provides a platform for residents. The goal is to help them share their ideas and experiences related to training, clinical practice, research, and career paths with others in the field. Our commitment is to foster a safe, respectful, and representative scholarly environment within our journal.

Moving Forward

Biomedical publishing needs to progress from mere intentions to concrete actions that can be measured. This involves:

Periodic evaluations of editorial boards and peer review processes will emphasize fairness, diversity, and inclusion. ³

Encouraging journals to adopt open-access models that lower financial barriers for readers and researchers. ¹⁹

Integrating DEI training into the editorial and peer review procedures. ⁴⁴

Utilizing technology to enhance access to services for everyone, including platforms that support submissions in various languages. ¹⁹

Conclusions

The commitment to DEI is more than just a checkbox; it is not I am a formality. We must transform biomedical publishing to better serve humanity’s diverse needs. Journals have both a moral and scientific obligation to help eliminate inequities in the field. They can achieve this by establishing clear policies, ensuring diverse representation at all levels of publishing, and measuring progress with specific indicators. Organizations such as COPE, WAME, ICMJE, CSE, and C4DISC demonstrate that DEI has become an ethical necessity rather than simply a preference. To make progress, we need to collaborate, be courageous, and consistently reflect on our actions. As stewards of scientific knowledge, we cannot disregard exclusion as a mere coincidence. DEI must be an integral part of biomedical publishing, fostering fairness in both content and processes. The biomedical community must focus on eliminating barriers and creating publishing environments that welcome diverse human experiences.