Health care research, policy discussions, and debates are notorious for their failure to address the problems of those who suffer the most. Leading medical journals systematically neglect to cover the diseases of poverty that afflict larger humanity (Horton 2003); health professionals from developing countries constitute a tiny minority of research authors (Sumathipala, Siribaddana, and Patel 2004); and major medical journals have few, if any, editorial board members from developing countries (Horton 2003; Saxena et al. 2003; Tutarel 2005). But surely journals concerned with ethics in medicine are an exception to such exclusions and inequities. Or are they?

Scanning 4,029 research articles in nine bioethics journals, Borry, Schotsmans, and Dierickx (2005) found that developing country scholars contributed fewer than 4 percent of publications (the other 96 percent coming from authors working in developed countries). It is no surprise, then, that bioethics pays more attention to esoteric ethical problems facing wealthy nations than it does to issues such as poverty, hunger, and health inequities that are global in nature (Turner 2004). Is this editorial bias (Lancet editor Richard Horton calls this institutional racism) mirrored in the editorial boards of leading bioethics journals?

We analyzed the composition of editorial boards of 14 leading bioethics journals by country (Table 1), as recorded on journal websites, categorizing these countries according to their Human Development Index (HDI).Footnote 1 Approximately 95 percent of editorial board members are based in (very) high-HDI countries, less than 4 percent are from medium-HDI countries, and fewer than 1.5 percent are from low-HDI countries. Eight out of 14 leading bioethics journals have no medium- or low-HDI country editorial board membership. Eleven bioethics journals in our sample of 14 have no board members from any low-HDI country.

Table 1 Composition of editorial and advisory board members of 14 leading bioethics journals
Full size table

This severe underrepresentation of developing countries on editorial boards suggests that institutional racism also infects leading bioethics journals and is clearly a cause for concern. With bioethics increasingly part of the global landscape of health care—more so since the 2005 promulgation of the Universal Declaration on Bioethics and Human Rights—the lack of global representation on bioethics journal editorial boards undermines consideration of developing country experiences and knowledge, impoverishing global bioethics. Citizens of countries in the developing world are thus dependent on those who can envision and empathize with the harsh realities affecting “others” and who are willing and able to muster global social justice resources to remedy them. Global health and ethics are far more effectively served by egalitarian partnerships between local and global experts working together to identify and reduce health inequities in culturally competent ways. Bioethics journals must open their pages to the whole of humanity.