The missing voices in global health storytelling

In this time of not just poly-but perma-crises, the need for global solutions to global challenges is more apparent than ever.Effective collaboration requires a foundation of mutual trust and respect between individuals, organisations, and nations.However, this foundation is challenged by the colonial legacies that permeate present-day systems and structures and is further eroded by neocolonialism.Thus, in seeking to interrogate barriers to collective action, we must confront not only historical injustices but also the enduring effects of coloniality.The (re)emergence of de/anti-colonial approaches in global health has brought to the fore analytical tools and languages to identify and interrogate power asymmetries, exclusionary structures, and systemic marginalisation of ways of knowing, being, and doing [1].Across the contemporary global health ecosystem, scrutiny has been applied to a range of issues, including how funders select grantees and disburse resources [2], how health research, financing, and policy agendas are set at country-level and by whom [3], and who researchers choose to partner with and why [4].Global health journals-and publishing, more broadly-have not escaped unscathed.From the explicitly colonial roots of journals such as The Lancet [5] to exclusionary structures such as exorbitant article processing charges [6] and a bias towards English proficiency [7], global health publishing is one of many domains in which the coloniality of knowledge and continued amplification of high-income country (HIC) voices remains an active force.In a recent analysis of global health authorship patterns [8], we investigate how colonial notions of who we consider experts continue to permeate knowledge production and, accordingly, who is afforded the opportunity to become a global health storyteller [9].Working with a purposively selected sample of 12 journals encompassing medicine, global health, and infectious diseases, we identified up to 40 eligible articles per year from 2019-2021 for analysis.The inclusion criteria included: primary/secondary research or non-research articles involving at least one LMIC; a focus on human health; and publication in the main journal with named authors visible during title/abstract review.Across our dataset of 1,269 articles, we find a persistent domination of prestigious authorial positions, namely first (71.1%)and last (74.2%)authors, by authors affiliated with institutions in high-income countries (HICs).Within the same dataset, we see the intersecting nature of coloniality as both a racialised and gendered project [1] on full display as men affiliated with HIC institutions form the single largest cohort of both first (40.3%)and last (48%) authors; this cohort unequivocally eclipses that of women affiliated with institutions in low-income countries (LIC), who form the smallest cohort with a representation rate of 0.4% of all first authors and 0.6% of all last authors (see Fig 1).Looking specifically at papers focused on a single low-or middle-income country, we found a slightly less (but nonetheless) disproportionate allocation of authorship; of the 470 papers in our dataset focused on low-and-middle-income countries (LMICs), 47.2% of first authors and 41.5% of last authors were affiliated with an in-country institution.Whilst still untenable for those of us who champion local knowledge production and ownership, this