The central role of reviewers in sustaining this journal
In September, the Public Health Association of Australia held its annual conference in Alice Springs, in the ‘red centre’ of Australia's Northern Territory. Two important public health issues were very visible at the conference. The first was the persistence of those health inequalities that discredit this society. The second was the presence at the conference of committed people who work in the remote areas where conditions are at their most challenging: the clinicians, health administrators, community workers and others. We owe these people a debt of gratitude for providing the interface between those of us who live privileged, urban lives and those who suffer the ill-effects of two centuries of social and cultural disruption. Of particular note was the oration from Patricia Anderson, an Alyawarr woman who has herself worked for many years in Indigenous health. Recently, with Rex Wild QC, the Northern Territory Director of Public Prosecutions, she chaired the Northern Territory's Inquiry into the Protection of Aboriginal Children from Sexual Abuse.1
The annual conference also provides the opportunity for meeting the authors to whom we owe another debt of gratitude for submitting to us research articles and commentaries on a broad range of public health topics. But here we want to focus in particular on those public health researchers and practitioners who provide that often invisible resource in a journal: the reviewers.
We have promoted the idea of critical appraisal of the literature as an important public health skill.2 The importance of critical appraisal lies not only in providing guidance in systematic ways of assessing the literature, but also in the reviewing of manuscripts. Key questions in the assessment are whether an article addresses a significant research problem, whether the appropriate research method has been used, and used appropriately, and so whether the results are trustworthy. But the additional consideration is whether the context of the study has played a role in the use of what might be a less-than-rigorous research design, taking into account the very real constraints that researchers face in some research fields. Sometimes the knowledge base is poorly developed, perhaps because of serious constraints on conducting research in a challenging setting. Sometimes a less-than-ideal research design must be used to protect vulnerable research participants. Thus the question is not whether the strongest research design has been used, but whether the research design is the best possible, under the circumstances, and whether the analysis makes the best possible use of the data collected.
In a broad field like public health, the judgement required to assess the research context of all manuscripts submitted to the journal is a formidable challenge even for a team of editors with divergent skills. This is where reviewers perform an invaluable service. Our practice is to select reviewers to cover all relevant aspects of a study. One reviewer might have expertise in the academic literature on a topic, another might be experienced in the field as a practitioner and a third might have relevant methodological expertise. Without these reviewers' contribution to judging the academic and practice context of a study, the academic quality of this journal would suffer. The alternative of focusing on refinements of research method to the exclusion of context would filter out potentially important and innovative research.
We welcome new reviewers for the journal and emphasise that we value their insights. The journal provides reviewers with anonymous copies of all reviews at the time when we make our final editorial decision. While there may be quite divergent views about a manuscript, we do not see this as invalidating a particular review; rather, we see it as giving us access to divergent views. New reviewers sometimes find the consistency of reviews, or their complementary nature, to be reassuring.
We also should note here that we take seriously the educational role of the journal. We seldom reject an article before review and this usually occurs when we think that an article addresses a topic that is more suitable for a different journal. By sending a high proportion of our submitted manuscripts to review, we place an additional burden on our reviewers. Our gratitude goes to those reviewers who patiently provide careful guidance to authors about how best to rewrite or refocus a paper that has very little chance of being accepted for publication in this journal. Finally, somewhere, perhaps even in this journal, a more complex paper may be published and make its contribution to public health.
We have given consideration to ways in which the contribution of reviewers can be recognised. In this issue, we list the names of reviewers and we have starred those who have made more than one contribution. We had considered listing separately those “five-star” reviewers who provide painstaking reviews, time after time, without complaint. The problem here is that in a relatively small research community in Australia and New Zealand, this may undermine the anonymity of the reviewers. On the other hand, reviewers like this deserve to have their contribution recognised at least in the various assessments of academic contribution. We will therefore be sending to these reviewers a letter of thanks from the editors and our hope is that this may strengthen their efforts to have journal reviewing seen as an important part of academic work.
Lastly, we wish all our authors, reviewers and readers in this hemisphere a well-deserved rest over the holiday season – with perhaps just one or two reviews to help us maintain our standards in 2008.
In this issue
Two highly regarded PHAA members of long standing – and substantial contributions to Public Health – open the batting. Professor Stephen Leeder takes us through the historical background to public health and the substantial gains achieved in public health, before drawing attention to our need to move public health “to the mainstream of politics, social action, medicine and health policy”. He also reminds us that some major and beneficial changes were not implemented to benefit the people but were, in effect, side-effects of other misfortunes. In response to this paper, Professor Gavin Mooney takes a different focus, drawing our attention to issues of social justice and inequalities. He reminds us that poor countries are subsidising industrialised Western countries by about $500 million a year through the migration of health workers. Threats to cultural diversity are also likely to add to problems around social self-respect and public health. Do read, and think about, both these papers.
There are three complex papers about Chronic Illness. Jafar Tabrizi and colleagues used two focus groups to develop quantitative instruments for a questionnaire study of service quality. Although the indicators had been derived from a systematic literature review, the people taking part in the groups gave more importance to education, diet, communication, autonomy, choice of care provider and support, and less to confidentiality and availability. Andrew Joyce and colleagues reviewed community pharmacies for their primary prevention role in cardiovascular disease and analysed the pharmacy and pharmacist characteristics associated with the provision of services. Most pharmacies initiated nicotine replacement therapies at least weekly, more than half provided blood pressure screening but few provided regular size measurement and cholesterol tests.
Martin Tobias, with colleagues provides data on the incidence, prevalence and mortality of stroke in New Zealand in 2001 with projections for 2011. At first sight the message is reassuring: there is a reduction in stroke mortality and stroke incidence. The problem is that stroke mortality is falling much faster than stroke incidence. “A progressive and substantial increase in the counts of stroke survivors seems inevitable” This informative study also confirmed that the usual methods for chronic disease surveillance will not work for stroke.
Drugs make up the third grouping. Adam Winstock and Toby Lea, surveyed patients receiving supervised methadone treatment and take-away doses at community pharmacies. The survey identified that the vast majority of participants (93%) stored their methadone in a secure place, with fewer than 10% having no protective mechanism in place. Methadone-related child fatalities are preventable. Wendy Swift and colleagues deal with concurrent use of alcohol and medicines, including complementary and alternative medicines (CAM). A national survey was carried out in December 2005 as part of a quarterly omnibus survey. Almost three-quarters of the respondents (71%) reported use of conventional medicine or CAM in the last 24 hours, 24% had recently consumed alcohol and conventional medicine 17% alcohol and CAM, and 13% alcohol and both conventional medicine and CAM. The authors propose that all health care professionals need to inquire about such use in order to identify and use appropriate safety strategies. Janine Calver and colleagues aimed to describe prescribed stimulant use by Western Australians with Attention Deficit Hyperactivity. Their findings were inconclusive. Improvements to the WA Stimulant Regulatory guidelines were strongly recommended.
Two papers about qualitative research methods come next. Lisa Gibbs and colleagues highlight the importance of sampling and data collection processes as critical to both the quality of a study and the generalisability of the findings. Julie Green and colleagues argue that transparency in the data analysis process is integral to determining the evidence that is generated. They draw our attention to the necessity for an explicit account of data analysis to show how conclusions are reached. Studies that explain themes anchored to data and theory produce the strongest evidence.
The title of Controversy is not common in this journal but the paper by Boshra Yazahmeidi and D'Arcy Holman is likely to generate some strong and divided views. The authors sent a postal questionnaire to 652 academics in 17 institutions to identify how often perceived acts of suppression of research by Australian governments took place. There were 142 suppression events reported. No State or Territory was immune and the government agency seeking to suppress the information mostly succeeded (97%).
The final grouping in this issue looks at both Infection and risk. Nicholas Zwar and colleagues used focus group discussions with general practitioners and practice nurses around barriers to influenza vaccination among high-risk patients who were under 65. There turned out to be multiple barriers and it will be important to see whether their proposed strategies will do better. Katerina Lagios and Frank Deane carried out a systematic review to assess whether severe mental illness was a new risk for blood-borne viruses and sexually transmitted infection marker. Unfortunately it was. Nick Parr and Stefania Siedlecky examined current contraceptive practices in Australia with a focus on the use of condoms with other methods, using Wave 5 from a national longitudinal study: Household Income and Labour Dynamics in Australia (HILDA). Dual protection has become an important factor but education and better access to treatment are still necessary.
The final paper in this group used the Pap smear to establish a recent prevalence of cervical abnormalities within a select population in a developing country (Vanuatu). The prevalence was high when compared with Victoria, with marked differences between rural and urban populations. The authors hope to assist in future planning of relevant programs.
Natalie Edmiston and colleagues from the Newcastle Sexual Health Clinic carried out a retrospective audit of contact tracing for all cases at a regional Health Clinic. The authors note that the results of their audit may be useful for other Sexual health Clinics as a comparison for their own audit activities and the development of a national standard for contact tracing. Knowledge of past partners is crucial but rarely collected and notification to them is difficult.