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The use of imagery in global health: an analysis of infectious disease documents and a framework for ethical standards

Published onJun 13, 2023
The use of imagery in global health: an analysis of infectious disease documents and a framework for ethical standards

Background: There are no widely adopted ethical standards for the use of imagery in global health publications. We reviewed imagery used by global health actors in grey literature related to antimicrobial resistance (AMR) and vaccination and analysed whether the imagery used was relevant, ethical, and equitable. 

Methods: Reports produced by key global health actors on AMR and vaccination were retrieved through searches on 1) Google using key MESH terms; and 2) the website of each actor. Reports containing at least one image of person/s, published between 2015 and 2022 were included. Guidelines from Photographers Without Borders, European Non-governmental confederation for relief and development (CONCORD) Code of Conduct on Images and Messages, and the National Press Photographers Association were used to develop an analysis framework. Consensus was reached iteratively on the (qualitative and quantitative) indicators used in the final framework. 

Results: In 118 reports from 14 global health actors, there were 1115 images, of which 859 included people (370 healthcare professionals (HCPs), 402 adult non-HCPs, and 393 children). Of HCP images, 301/370 (81%) included non-whites, 273/370 (74%) included women, and 247/370 (67%) included non-white women. Of the non-HCP images, 346/402 (86%) included non-whites, 321/402 (80%) included women, and 278/402 (69%) included non-white women. Of images including children, 359/393 (91%) included non-whites. Qualitative analysis identified issues of relevance, integrity, consent, and representation from high income versus low-and middle-income countries (LMIC). Inequities in staging, digital manipulation, and breaches of confidentiality were noted in images depicting LMICs. Biased representation of LMICs drives misleading and irrelevant disease associations and power imbalances. 

Conclusions: This work highlights how imagery in global health contributes to representations that are inequitable and unethical. Through the process of enquiry, we have created an ethical framework for appropriate imagery use in global health grey literature to help key actors avoid these biase 

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