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Q&A: Richard Horton on global health and a “Hippocratic Oath” for editors and publishers

The Lancet’s Editor-in-Chief was the recipient of the Andrija Štampar Medal for Excellence in Public Health

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Richard Horton, FRCP, FMedSci, speaks on Elsevier’s sustainability panel on the eve of the United Nations Sustainable Development Summit, when the UN adopted its 17 Sustainable Development Goals. To support those goals, Elsevier and SciDev.Net released the analysis they collaborated on: Sustainability Science in a Global Landscape. (Photo by Alison Bert)

Recently, Dr. Richard Horton was awarded the prestigious Andrija Štampar Medal, named after one of the founders of the World Health Organization and the founder of the School of Public Health in Zagreb, Croatia. ASPHER (the Association of Schools of Public Health in the European Region) awards this medal annually to a distinguished person “for excellence in the field of public health.” On its 50th anniversary, ASPHER chose Dr. Horton for his work as Editor-in-Chief of The Lancet. In their words:

Richard Horton has worked as a passionate advocate for improving the health of the population, in addition to promoting high-quality research in medicine and public health.

Dr. Richard Horton (center) poses with Dr. Jacqueline Müller-Nordhorn, President of the Association of Schools of Public Health in Europe, ASPHER (left), and Dr, Katarzyna Czabanowska, a member of the ASPHER Executive Board.As an editor, author, and keynote speaker at international medical conferences, Dr. Horton is known worldwide for his advocacy of global health issues. He has served as Editor-in-Chief of The Lancet for 21 years.

“Richard has overseen an unprecedented period of growth at The Lancet,” said David Clark, Senior VP of Health and Medical Sciences at Elsevier, mentioning the upcoming launch of a string of major Lancet specialty titles and the development of The Lancet itself into one of top two leading medical journals. He added:

Richard has seen The Lancet more than double its Impact Factor and overtake leading titles such as the Journal of the American Medical Association. As the longest serving editor of The Lancet since the Second World War, Richard has built upon The Lancet’s long-standing reputation as both an authoritative and highly respected title and an independent and, at times, radical voice within medicine. And he’s taken the publication into new areas as a champion for global health, publishing science to benefit all regions of the world.

In this interview, Dr. Horton talks about his defining experiences in global medicine and whether it’s possible to combine science with politics and advocacy.


First, congratulations on receiving this prestigious award.  

Thank you so much. I believe this award reflects the work of the entire Lancet team over many years. We hope to be a successful medical journal, of course. But we also want to be a little more than a medical journal. We want to be a platform that allows the science we publish to be put to work. In other words, we want to be an advocate for the best evidence in medicine and public health, and for its use. We want that evidence to make a tangible difference to the lives of individuals and communities worldwide. If the work we publish only sits on the shelves or servers of libraries, then we have failed. We don't want to be judged by an Impact Factor. We want what we do to be measured by its very real effects on health and human lives.

What brought you to The Lancet in 1990?

Frustration. Although I always loved medicine and medical science, I also wanted to be part of something that took a wider view of health. I was a subscriber to The Lancet in 1990, and I very much admired its history, what it published and its place in the world of medicine. A mixture of medicine, writing and politics seemed the perfect combination. I believe passionately not only in the power of science and medicine to change human lives for the better, but also the value of writing as one means to do so. The Lancet stood — and I hope still stands — for something very special.

What got you interested in global medicine? Was there a defining experience?

There were two defining experiences, and I owe a great deal to the two people who gave me the opportunity to have those experiences. First, Eldryd Parry was the first person who took me to Africa. Eldryd spent most of his working life as a doctor in Africa, helping to build medical schools in Ghana, Ethiopia and Nigeria. In Africa, he showed me a mission for the journal that I had never understood before. For so many millions of people, their lives are constrained because of a lack of access to healthcare. In the UK, we are privileged to have the National Health Service — medicine available to all, free at the point of demand and delivery. It's not a perfect system, but it has successfully removed the fear of being sick and having zero access to healthcare. Eldryd showed me how important it is to have a global perspective, how important it could be to use The Lancet as an instrument to advance health for all.

Second, Jennifer Bryce. Jennifer is a specialist in global child health. She showed me how to use The Lancet to help achieve the goal Eldryd had revealed. By bringing together the very best scientists to work on some of the most intractable challenges facing societies, The Lancet could successfully combine science with advocacy. We began that mission in 2003 with a series (and campaign) around child survival. Since then, through research, series and commissions, we have tried to provide a foundation of evidence for action across all major domains of disease and ill-health.

You’ve always spoken your mind when advocating for public health, and often these issues are intertwined with politics. Should publishers play a role in politics? And if they choose to, how can they draw the line to make sure the research they publish is not unbiased?

The starting point for advocacy and activism in health isn't politics; it's the science, the evidence. But then, once you have the best available evidence, I do believe it is our obligation to step into a political space to ensure that the science makes a difference. Partly, it's simply an extension of what it is to be a physician. Being an editor and publisher doesn't mean that one leaves the professional obligations of being a physician behind. The challenge is to apply those values in the world of scientific publishing.

But also I do think publishing has a special responsibility to be political. Elsevier's success has been built on the work of scientists and physicians who are often funded by the taxes of our fellow citizens. We could not be a profitable enterprise if it wasn't for this tax-funded public sector science. I think we therefore have a responsibility to make the work we publish have an impact on the lives of those whom we ultimately depend upon for our own success. That means we can't avoid being political.

You’ve spoken before about whether it’s possible to be a scientist and an activist. What is your advice for those who choose to? How can they combine science and advocacy without losing credibility as scientists?  

Again, it's about being a scientist first, assembling and publishing the best evidence you can find. And then putting that science to good effect. It's a kind of Hippocratic Oath that all editors and publishers might consider.

You’ve said that gender should play a larger role in public health. Why is that important? Can you give an example?

Most healthcare is delivered by women, and delivered outside the formal health system. But the women who deliver that care are often uncounted and unrewarded. Gender is therefore at the heart of healthcare and its injustices. It's also true that poverty has a woman's face. Women are, on average, much poorer than men. That means that it is women who suffer more from lack of access to healthcare. Whichever way you look at it, women are massively disenfranchised when it comes to health in our societies.

Compared to when you started, are you more are less optimistic about the ability of science to address global health crises?

I'm always optimistic, and I'm very optimistic now. There is a huge demand among policymakers for reliable evidence to improve the quality of their decision-making. We can help to provide that evidence. What we then must do is make sure that the evidence we supply is used, and used appropriately.

What do you view as today’s most critical global health crisis?

Unquestionably, a constellation of environmental threats that jeopardise the future of human civilisations and the ecosystems on which they depend — what we have called planetary health. Climate change, loss of biodiversity, pollution of our freshwater and land resources, and ocean acidification — all of these changes threaten our societies, and our health too.

How have your experiences over the years changed the approach you take as editor of The Lancet?

Appreciating the importance of partnership. When I first joined The Lancet, I think we tended to think of ourselves as a journal alone, with editors keeping their distance from the scientists and communities we served. But for what we do to have any influence demands that we work closely with many different partners — universities, funding bodies, charities and civil society organisations, governments, multilateral UN agencies and the private sector, among others. The power of knowledge to make a difference depends on an alliance among many different groups. If we are all aligned together, with science underpinning our work, there's no limit to what we can achieve together. The Lancet is merely a catalyst to trigger this kind of collaboration and action.

Dr. Richard Horton (@richardhorton1) is Editor-in-Chief of The Lancet. He was born in London and is half Norwegian. He qualified in physiology and medicine with honours in the UK in 1986. He joined The Lancet in 1990, moving to New York as North American Editor in 1993. Richard was the first President of the World Association of Medical Editors and he is a Past-President of the US Council of Science Editors. He is an honorary professor at the London School of Hygiene and Tropical Medicine, University College London, and the University of Oslo. He has also received honorary doctorates in medicine from the Universities of Birmingham, UK, and Umea and Gothenburg in Sweden. In 2016, he was appointed to a High-Level Working Group for the Health and Human Rights of Women, Children, and Adolescents. In 2016, he also chaired the Expert Group for the High-Level UN Commission on Health Employment and Economic Growth. From 2011 to 2016, he was co-chair of the UN's independent Expert Review Group on Information and Accountability for Women's and Children's Health. Richard received the Edinburgh medal in 2007 and the Dean's medal from Johns Hopkins School of Public Health in 2009. In 2011, he was elected a Foreign Associate of the US Institute of Medicine. And in 2015, he received the Friendship Award from the Government of China.

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