The case for a regional approach to publication impact.

Healthcare-related research is largely regional. Put simply, this is because disease burdens differ between world regions. Even global burdens, such as ischaemic heart disease and cancer, display distinctive characteristics in certain regions that are not seen in others. Regional differences in infrastructure, resources and human capital further compound the differences seen, as they affect the way in which the local scientific community can interact with the local disease burden. As such, it seems fair to assume that healthcare-related research ought to be regionally distributed. Although translation of research between regions can sometimes be done, the larger the gap in infrastructure, resources or human capital between regions, the less likely it is that it can be adequately bridged. A recent example of this pertains to accepted life-saving treatment for sepsis in high-income settings, which had the opposite effect when implemented and evaluated in low-income Zambia. This regionality of clinical medicine is, however, not reflected in academic publishing; the impact of a journal is measured and understood by metrics that use the world as their denominator. Therefore, top medical journals are perceived to be relevant equally to all contexts and regions. However, there is a strong case to be made that this lack of granularity is deleterious, and that the creation of a regional impact metric would place clinicians, researchers, and libraries in a better position to understand which journals are relevant to their context and practice.