PLOS Medicine: Poor Health in Rich Countries: A Role for Open Access Journals

"... The US provides a striking but by no means isolated example of how relative poverty remains a powerful determinant of health in rich countries. That other high-income countries outperform the US in health indicators and in controlling healthcare costs [4] does not change the fact that their own low-income populations experience health problems to an extent that aggregate indicators of prosperity (such as per capita income or gross domestic product) fail to predict. Among 20 Western countries, child mortality correlates strongly with the gap between the highest and lowest 20% of incomes, but not with overall health expenditures [5]. Two- to four-fold increases in mortality between highest and lowest socioeconomic strata have been reported in the UK [6]. In Greece and Ireland the implementation of austerity measures after 2007 coincided with substantial increases in suicide rates, providing tragic evidence for the health impact of economic policies that widen the gap between rich and poor [7]. To the extent that socioeconomic disparities constitute a major and growing determinant of health, we believe that general medical journals must take an active role in promoting the care of populations at greatest risk, regardless of the average income of their country of residence. For at least three reasons, Open Access journals should lead the publication of papers on disadvantaged populations in high-income as well as lower-income countries. First, in order to attain their full impact these papers must be freely accessible to the affected public and to advocacy groups, without subscription barriers. Second, to permit adaptation and re-analysis, the results and data must be openly available without copyright restrictions. Third, Open Access journals, by virtue of their business models, are free to prioritize papers on cost-effective, widely accessible approaches to healthcare, because these journals need not depend on the promotion of new, expensive drugs and medical devices. For closed-copyright journals, marketing strategies involving these products can generate lucrative reprint sales [8] and substantial advertising revenue [9]. However, to the extent that a journal's practices establish market demand for costly treatments of minimal incremental value, that journal contributes to the unsustainable escalation of healthcare costs. PLOS Medicine has, since its inception, declined to advertise pharmaceuticals and medical devices [10], leaving the journal free to make editorial decisions without competing concerns over advertising income. We believe that this policy has supported our efforts to serve as a truly global journal, in the sense that 'the global in global health refers to the scope of problems, not their location. Thus… global health can focus on domestic health disparities as well as cross-border issues' [11] ..."