Countering helicopter research with equitable partnerships

In April, 2023, we at The Lancet Global Health clarified our aims and scope, to explicitly state that “we are committed to addressing the decolonising agenda in global health.” We strongly believe that control and leadership of global health research should be in the hands of academics, clinicians, and communities in the locations of study. When this power is held elsewhere, the outcome is often helicopter research. Helicopter research—otherwise known as parachute or parasitic research—is when researchers from high-income countries (HICs) arrive in a low-income or middle-income country (LMIC), conduct a study without involving researchers based in that country, then leave. Outcomes of helicopter research include maintenance of historical power imbalances, disregard for the priorities of communities in LMICs in favour of those of the HIC researchers or funders, and poor investment in sustainable research infrastructure in LMICs. At The Lancet Global Health, we have long looked unfavourably on helicopter research,1The Lancet Global HealthClosing the door on parachutes and parasites.Lancet Glob Health. 2018; 6: e593Summary Full Text Full Text PDF PubMed Scopus (63) Google Scholar and we do not consider for publication any studies conducted in a country without representatives from that country on the authorship. However, we are also mindful that authorship can be tokenistic, and inclusion on an author list does not equate to meaningful involvement in the study. For instance, LMIC researchers should not only be included as a means of recruiting trial participants:2Park JJH Mogg R Smith GE et al.How COVID-19 has fundamentally changed clinical research in global health.Lancet Glob Health. 2021; 9: e711-e720Summary Full Text Full Text PDF PubMed Scopus (68) Google Scholar their insight and leadership should be present from study inception to manuscript write-up. Researchers who are based in the area of study are best placed to formulate research questions with local relevance; to be mindful of cultural sensitivities during study design; and to interpret findings within the cultural and research context, such that decision makers receive valid information. Most importantly, researchers and communities should set the agenda in the areas that they live and work. A 2022 paper3Morton B Vercueil A Masekela R et al.Consensus statement on measures to promote equitable authorship in the publication of research from international partnerships.Anaesthesia. 2022; 77: 264-276Crossref PubMed Scopus (43) Google Scholar in Anaesthesia provided an impetus for our further action. This consensus statement, bringing together editors and researchers, defined a set of recommendations for reflexivity statements: structured declarations that authors should submit to journals alongside their studies. Reflexivity statements provide authors with an opportunity to describe how they considered (and prioritised) the concerns of communities in the locations of study, and involved researchers with the necessary contextual knowledge when designing and implementing their work. They advised that journals have a responsibility to leverage their power to promote equitable inclusion. We agree. In response, we are now piloting a new statement to be published as an appendix alongside research Articles: the equitable partnership declaration (EPD; appendix). The EPD form asks detailed questions about the research partnerships in the studies, exploring how the research affects and is shaped by researchers, communities, and environments in the study settings. We will request an EPD for all studies conducted within an LMIC in which at least one named author is based in an HIC. These statements (the completed forms) will be published open-access, and they will include the contact details of an author. Anyone will be able to view and download these statements, for full transparency and accountability on the study partnerships. The EPD is deliberately comprehensive, to ensure that it is not performative. We hope the authors who publish with us will proudly describe the equitable involvement that researchers in the location of study had, and the steps taken to enhance local research and health-care infrastructure and to ensure the buy-in of affected communities. We also hope this statement will inspire researchers to incorporate these practices when designing and conducting future research. Ambitiously, we want to change the course of global health policy and practice, to prompt more equitable partnerships. For now, this is a pilot project. However, if successful, we hope this initiative can go further. For instance, we would like to see similar statements for studies in minoritised or vulnerable groups (such as indigenous populations) or people with lived experience of chronic conditions (such as mood disorders). We must consistently demand contextual and experiential knowledge in the work we publish. If those of us in global health truly wish to serve those in low-resource settings, we can only do so with their direction. We hope that the EPD will push research into following their voices. We declare no competing interests. We would like to thank the authors of the article in Anaesthesia, particularly Ben Morton, Refiloe Masekela, Seye Abimbola, and Angela Obasi for their assistance in developing this statement. Download .pdf (.2 MB) Help with pdf files Supplementary appendix