This opinion article was written by Jocalyn Clark, Executive Editor at The Lancet. For more like this, see our health and wellbeing newsfeed.
Manel. noun. A panel of experts or participants, for example on a TV quiz show or at a conference, that consists of men only. Macmillan Dictionary
The term “manel” (all male panel) is a social media invention that went viral beginning in 2015, intended to draw attention to the troubling predominance of male speakers on panels, to the exclusion and detriment of women experts.
In 2017 manel was on the longlist for the Oxford dictionary word of the year and, as it entered the mainstream, has also become a part of the global health vernacular. Advocates have used the wave of attention to manels as fuel for broader promotion of equity and diversity within global health.
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Last month, The Lancet adopted a no-manel policy, committing our editors to not serve on panels where there was not at least one woman expert. We also pledged to ensure gender balance in events or conferences that the Lancet helped organise.
We see this as both a symbolic and a substantive step to fostering greater inclusion and diversity in health science. Removing barriers to women’s full participation is fundamental to ensuring their rights and to benefiting from women’s productivity and creativity. Making women more visible as experts and producers of scientific knowledge is also critical to inspire the next generation of scientific and health workers.
Research is dominated by men
Ensuring women’s full participation in the production of knowledge is especially important when it comes to gender and health.
As gender has gained recognition as a fundamental aspect of understanding and achieving universal health coverage, the demand for evidence of the highest quality and integrity is critical. Much of this evidence appears in medical journals. But whose knowledge is it?
Two major new insights highlight the important links between women’s participation in medical science and research outcomes, and show the dual benefits of promoting the scientific advancement of women and the integration of gender and sex analyses into health research.
women researchers are more likely include sex and gender analysis in their research articles, which improves the accuracy and quality of research findings
The first insight is a deeper understanding of inequities within the field of research publishing.
A growing number of studies show women to be vastly under-represented in authorship of articles across scientific and medical journals. In a large global analysis, for example, Vincent Lariviere and colleagues showed that of the 27.3 million researchers who authored 5.5 million research papers published between 2008 and 2012, less than 30% were women.
By comparison, 35% of active physicians and 41% of medical school faculty in the USA are women, and in the UK 47% of licensed physicians and 31% of clinical academics are women. Looking specifically at the highest impact medical journals, such as the BMJ, Lancet, and New England Journal of Medicine, women’s first authorship of papers increased from 27% of all papers in 1994 to 37% in 2014, but has levelled off or stagnated since then.
Why equality matters
These findings should concern us all.
Ensuring equality in authorship is essential so that women’s contributions are included and recognised, and they are given the credit they deserve. But equity in authorship is especially crucial for readers of the medical and scientific literature. These include policymakers and public servants, who utilise this evidence to plan and develop health priorities and programmes.
Why? Because the second new insight is that the involvement of women as authors leads to better sex and gender-related research. Including sex and gender analysis in research means including appropriate numbers of women and men in clinical trials, disaggregating study samples by sex, and including sex or gender as a variable in data analysis and interpretation of findings.
70% of biomedical research papers do not report outcomes for men and women
Gender and sex analysis is increasingly recognised as fundamental to creating better medical research and health care. Failure to account for sex and gender will limit the ability to reproduce scientific findings, and often can result in less than optimal care of, or even harm to, men and women.
Cardiovascular disease is a prime example: it is a leading cause of death for both men and women, but women exhibit different symptoms of disease, experience treatment delays, and are underrepresented in cardiac rehabilitation programmes. Traditionally, research has included mostly male subjects, which has deprived the evidence base for the best methods of detecting and treating cardiovascular disease.
Even the safety of cardiovascular drugs have been tested in mostly male populations. Tellingly, over the last decade in cardiology research, the percentage of women in first and senior author positions has increased by only 9.5% and 6.6%, respectively.
Curing the blind spot
Indeed, two major recent global studies have shown women researchers to more likely include sex and gender analysis in their research articles, which improves the accuracy and quality of research findings. Mathias Nielsen and colleagues showed using 1.5 million medical research papers, a robust positive correlation between women’s authorship and the likelihood of a study including gender and sex analysis.
Vincent Lariviere and colleagues in another study looked at over 11.5 million medical research papers published between 1980 and 2016, and found that 70% of biomedical research papers do not report outcomes for men and women. But those authored by female authors were more likely to report on sex-differences. This corroborates discussions that diversity in the workforce — as well as in the research population — is essential to produce the most rigorous and effective research.
As a medical journal, we are committed to working with academic institutions, funders, and other organisations and agencies concerned with the production of knowledge to improve the representation of women within research and publishing. Like other journals, including Nature, Science, and BiomedCentral, we have reported on our own internal processes for ensuring a diversity of perspectives are represented.
We continue to advocate for academic institutions and funders to ensure equity in their policies that can help break down barriers to women’s advancement. Fostering women’s participation and leadership in scientific knowledge will improve the evidence base on gender and health. And that benefits us all. — Jocalyn Clark
This article is part of a series exploring the intersection of gender and health leading up to the High-Level Meeting on Universal Health Coverage in New York 23 September 2019. Click here to read the first article in the series.
(Picture credit: Unsplash)