Intended for healthcare professionals


Unveiling hidden inequalities in diversity and inclusion in medical research

BMJ 2023; 381 doi: (Published 13 June 2023) Cite this as: BMJ 2023;381:p1354

Linked Research

Analysis of peer reviewers’ response to invitations by gender and geographical region: cohort study of manuscripts reviewed at 21 biomedical journals before and during covid-19 pandemic

  1. Khaoula Ben Messaoud, postdoctoral researcher12
  1. 1Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
  2. 2University of Geneva, School of Medicine, Geneva, Switzerland

Regularly evaluating and actively promoting diversity and inclusion in editorial boards and the peer review process can help build a more inclusive, equitable, and global scientific community, writes Khaoula Ben Messaoud

Uncovering inequalities, measuring disparities, and identifying the barriers that exist in healthcare and society were the driving force for me to pursue an academic career. But I was unaware of the burden of these inequalities before I started work on this topic.

Most of us probably think that it’s essential to prioritise diversity, equity, and inclusion in medical research to promote global health and tackle health inequalities. But this can be challenging when editorial boards and the peer review process of medical journals lack diversity. Specifically, there’s a lack of representation of female, African, Asian, South American, and non-white researchers, among other under-represented populations.123 This can limit the perspectives and experiences represented in scientific knowledge.

The views currently represented in research are mostly those of male researchers from high income countries, exploring health issues and economic consequences that primarily affect wealthier countries. Solutions to public health issues introduced by research tend to be focused on high income countries and often don’t consider social and cultural differences before being applied to low and middle income countries. A lack of representation of female perspectives is a huge problem across all medical specialties, meaning that some interventions brought about by research remain unsuitable and impractical for women.

Many editorial boards and pools of peer reviewers lack demographic diversity. With this in mind, how can we provide inclusive and global knowledge and publication? And how can local and global health policies be more equitable and inclusive?

Ongoing evaluation

One of the first steps in promoting diversity and inclusion in medical research is to increase diversity in editorial boards. These boards play a key role in shaping the scientific literature: they select peer reviewers, make editorial decisions, and help to set the agenda for research and policy making. It’s important to actively seek out and recruit individuals from under-represented populations. This can involve targeted recruitment efforts, as well as providing support and resources to help individuals succeed in their roles. Additionally, we need to ensure that editorial boards include people with a broad range of perspectives and experiences, including those from different geographical, racial and ethnic, and professional backgrounds.

Peer review is a critical part of the publication process, as it helps to ensure the quality and integrity of scientific literature. Recruiting a diverse pool of peer reviewers also allows a broader range of perspectives and experiences. They can evaluate research and policy recommendations through multiple lenses, leading to more inclusive, equitable, and global health policies and interventions. The linguistic and cultural barriers that prevent some researchers from participating in the peer review process must be overcome. Providing translation services and resources to support the participation of non-native English speakers can help.

Assessing diversity in the editorial process requires ongoing evaluation and monitoring. This can involve analysing the demographics of editorial boards and the pool of invited reviewers to determine whether they reflect the diversity of the populations that the research is intended to serve. Metrics can be developed to evaluate this. Feedback from authors and reviewers after their participation in the editorial process, especially those early in their careers, can provide valuable insights.

Meta-research that focuses on research evaluation can itself be made more inclusive by promoting international collaboration with researchers from low and middle income countries and by involving researchers from a range of medical specialties.

Finally, intersectionality is a key concept that should be considered when assessing diversity in editorial processes. We need to recognise that gender, sexuality, disability, culture, ethnicity, geographical origins, and other identities intersect in complex ways. A holistic approach is needed to better understand the experiences of researchers from diverse, often overlapping, communities. This will require more detailed and nuanced data on researchers involved in the editorial process, for further research.

We must urgently target editorial board recruitment and invitation of peer reviewers to include under-represented groups, as well as adapting to support them. Diversity in research and the editorial process needs to be evaluated by more inclusive and collaborative meta-research teams. By regularly evaluating and actively promoting diversity in editorial boards and the peer review process we can work towards creating a more inclusive, equitable, and global scientific community.


  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not peer reviewed.