As we continue to address health inequities, we must also consider underlying structural issues. If I am to deliver care focusing on equity, the basis for my treatment must be grounded in science. However, if my science is flawed due to underlying systemic biases and flaws in study design, we will never progress.
Since inequities are pervasive and deeply embedded in every aspect of life, academic medicine, and scientific publications are not exempt. The problems are deeply rooted in our cadre of researchers, scientific approach to study design, and evaluation of publications for review.
Unfortunately, the study designs are not geared towards asking the question of whether health inequities were considered. Magnifying this situation even more, is when a study shows benefit, we translate that benefit to all populations, regardless of the representation within the study design. These circumstances attest to the lack of focus during the design phase and the implementation of results.
Our researchers need to represent the communities of focus. Implementing this will require attention throughout our academic approaches. Additionally, we must move away from our “Ivory” tower model and address the biases that result in the continued underrepresentation of minority groups. The editorial boards of our journals fall into the same distinction of inequitable distribution. If they do not have an inclusive representation of the population studied, it will be tough for our journals to focus on the issues at hand.
Every institution and journal have their core pillars. Therefore, let’s expand these values to actively include health equity and racism in all components of our scientific process. We must recognize the prevalence of an issue, be transparent to the facts, own up to the problems, and rectify the situation. Denial will only worsen the situation. Let us be willing to change our culture in our scientific methodology at all levels, from who is performing the research, to the areas of study, to how publications occur.