The leading voices of global health policy are primarily drawn from a small, closely connected network of mostly Western, mostly male perspectives. In fact, in the last four issues of the Lancet (May 26- June 16, 2018) the authors of commentaries were predominantly male, white, trained and working in a European or American institution, and in a senior position. We see a similar pattern amongst experts quoted in media articles related to health security.[i],[ii] These experts have distinguished careers, and shape ongoing debates, dialogues and policies. While respecting these voices and experiences, we must also make room in ongoing debates for a more diverse community of scholars and practitioners, able to bring different gender, generational, disciplinary, racial and geographic lenses.
This past year, we set out to explore one of the hard problems in global health policy- the linkages between global health security and universal health coverage. We aimed to develop a research agenda that would contribute an evidence base for the policy directives linking these two initiatives. We knew about the established researchers working in this or a tangential space, but we were unaware of whom else might already be engaged in this research. We put out a call through social media inviting early career researchers to attend a workshop with us, particularly encouraging women and nationals from low and middle income countries to apply. Even though we offered no funding in the announcement, we received scores of applicants from around the world, each engaged in innovative and deep research. Each applicant was scored by six members of the organizing committee, and the top candidates were invited to participate in our workshop with support, held at the University of Edinburgh in May 2018. The resulting workshop was rich, inspiring and productive. Some of the participants were not as experienced in participating in international meetings as more senior colleagues, but that was balanced by new ideas, fresh interpretations, and researchers actively involved in fieldwork around the world.
As energized as we were by the content of our workshop, the event also became a venue for colleagues to share their challenges in global health today during a roundtable dinner discussion. Many- particularly women, women of color, and non-Western researchers- felt they did not have a voice in global health today, were excluded from key networks in global health and were struggling to find reputable avenues to showcase their work and ideas. Here, we propose several recommendations for increasing the diversity of voices and perspectives in global health policy:
1. Increase access to donor funding for early career researchers to attend open international meetings as well as by putting out calls for participation for smaller, closed workshops. Part of training the next generation to contribute to global health policy is to allow them to be physically in the space where decisions are made. Or as Lin Manuel Miranda wrote, to “be in the room where it happens.”[iii]
2. Expand the options for early career funding and mentored research from large philanthropic donors, similar to Wellcome Trust small grants or U.S. National Institute of Health K01 awards.
3. Offer more venues for early career researchers to showcase their work. To that end, we are organizing the first international scientific conference on global health security (GHS2019.com) in part to provide an opportunity for researchers to present their work and interact directly with decision makers.
4. Beyond face-to-face events, build linkages among emerging career researchers and senior researchers through creating virtual networks using email, social media and videoconferencing platforms.
Finally, the global health policy community must realize that global health on the ground is diverse. More than just gender, global health is about skin colours, sexual orientation, class and/or caste, and a range of experiences. We need to better reflect these dynamics in our closed-door sessions and high-profile public events around the world.
We must continue to hear from experienced statesmen, as their experiences and contributions are invaluable. But we also must provide a space for a diverse set of contributors to help shape global health policy. We are both firmly committed to doing this in our respective academic centers and universities, and encourage others to also champion this cause.
 Between May 26 and June 16th, 2018, there were 51 unique authors of commentaries in the Lancet (excluding a commentary by a large author group). Only 38% of the authors were female, 70% were White, 88% were trained in Europe or America, 84% work at a Western institution and 68% held senior positions. If you exclude a commentary on #Metoo and global health, then only 28% of the authors were female and 78% were senior. The rest of the junior or mid-career authors had a senior co-author.
[i] Yong E. “I spent two years trying to fix the gender imbalance in my stories.” Feb 6, 2018 . The Atlantic. Available at: https://www.theatlantic.com/science/archive/2018/02/i-spent-two-years-trying-to-fix-the-gender-imbalance-in-my-stories/552404/
[ii] Leonhardt D. “I’m not quoting enough women” May 13, 2018. New York Times. Available at: https://www.nytimes.com/2018/05/13/opinion/women-sexism-journalism-conferences.html
[iii] Miranda, LM. “The Room Where It Happens”, song from ‘Hamilton: An American Musical’
Professor Devi Sridhar is Professor and Chair in Global Public Health at the University of Edinburgh. She directs the Global Health Governance Programme which researches how global institutions, finance and rules can better serve the needs of people across the world. Devi is also co-author ‘Governing Global Health: Who Runs the World and Why?’
Dr Rebecca Katz is an Associate Professor and Director of the Center for Global Health Science and Security at Georgetown University. Prior to coming to Georgetown, she spent ten years at The George Washington University as faculty in the Milken Institute School of Public Health. Her research is focused on global health security, public health preparedness and health diplomacy.