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Dr Krithi Ravi, an Academic Foundation Doctor at the University Hospital Southampton NHS Foundation Trust, shares her latest published work.

Two surgeons performing surgery

2015 was a landmark year for global surgery. The Lancet Commission on Global Surgery report was published, carving a clear niche for global surgery research. The World Health Assembly adopted Resolution 68.15 and committed to "Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage". These actions challenged global health nihilism by calling for the inclusion of surgical and anaesthesia coverage within universal health coverage. 

We wanted to capture global surgery authorship dynamics following these two seminal events, and specifically look at the intersection between author gender, seniority and institutional affiliation. More than 60 collaborators - over 90% of whom were from low- and middle-income countries (LMICs) - collected data on the characteristics of authors of global surgery studies published between 2016 and 2020 and indexed by Pubmed. We analysed the distribution of author characteristics according to study topic, author institutional affiliation and the study's overall authorship network. 

The majority of authors were male (60%), affiliated with high-income countries (HICs) alone (51%) and were of high seniority. A third of first and last authors were affiliated solely with LMIC institutions, but around 40% of first and last authors were affiliated with institutions in the USA. 

Two-thirds of authors in studies related to Anaesthesia and Critical Care, and studies related to Surgery were male, whereas obstetrics and gynaecology studies had equal proportions of male and female authors. 

LMIC authors had a greater proportion of male authors overall - 70% of LMIC authors were male across first, middle and last authors. The percentage of male authors increased with increasing seniority for middle and last authors regardless of institutional affiliation. 

Three times as many studies had HIC first and last authors as LMIC first and last authors. Compared with all studies, there was a greater proportion of female LMIC authors across all seniority levels in studies with only LMIC authors. There was a greater proportion of more junior HIC middle authors in studies with only HIC authors compared to all studies. 

As you go through our study, we would love for you to consider::

  1. The significance of the author characteristics we discussed: gender, seniority and institutional affiliation.
  2. Why there was a different pattern of gender inequity among LMIC authors within studies with only LMIC authors versus all studies. 
  3. The implications of authorship inequity for global surgery academia specifically - how do we interpret these findings in the context of the purpose and reflexivity of global surgery scholarship?
  4. How can we make sure that we advocate and build awareness in a way that does not overshadow important work already being done in a field? 
  5. How can we ensure equitable resource distribution that centres the perspectives and work of those from affected communities when the social capital associated with an academic discipline increases?

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