• values
• value
• performance

Editors of a journal are evidently in a position of privilege. Privileged because often some privilege as well as luck will have helped them become an editor, but also privileged because editors have discretion over what they do and how they shape the role when they take it on. When one of us (JM) joined the team, a longstanding mentor observed: ‘It’s wonderful editing a journal. It’s as if you have a spotlight, and on your watch you can choose where to shine that light’.

We hope we are taking this wisdom to heart and acting on it in a positive way. BMJ Leader exists as a place of scholarship and of learning, of insight and debate which exists to help people whose task—and a very difficult task at that—is leading better in health and care settings (https://bmjleader.bmj.com/pages/about/). No matter what someone’s role, their seniority, their profession, their sector or their geography, we want BMJ Leader to be relevant to the people who lead.

Health systems exist to improve people’s lives and to ease their suffering. And leading well matters in health systems. There is substantial evidence that systems and organisations which are better-led achieve better results across all dimensions that matter.

We know that equity, diversity and inclusion (ED&I) are three dimensions, which are crucial for health services of all types–whatever their governance, specific objectives or financing—in several ways. Some of these reasons focus on the ‘customer’—for example, better understanding and better able to respond to the needs of patients and others for whom the system exists (such as carers). Some reasons focus on the ‘provider’—for example, maximising the chances that the best talent is recruited into an organisation, and when there be put into roles that have the greatest influence on what happens. Happily, over recent years, ED&I has greatly risen in prominence: across academia, in policy, and in how systems and organisations are run.

We believe there is a fourth dimension that matters: social justice. By their very nature, health systems should not be neutral. They should stand for and should model basic human values: helping everyone flourish, freedom of expression and empowering people to take greater control over their lives and communities. (And yes, they should stand for better stewardship of resources, no matter how the system is funded.)

For this reason, the editorial team at BMJ Leader decided in 2022 to put out our first call for a topic collection, with the focus on ED&I and social justice. Over the past months, we are delighted to say we have received over 50 submissions to this call, many from people, teams, organisations and even countries which have not previously submitted to the journal. This is a win in itself: Widening participation is core to what we want to achieve while we have our ‘hands on the spotlight’. Health systems will be better-led if we hear from a wider range of voices and perspectives, and if more people come to believe that their job involves ‘leading’.

Today we publish our first three articles which powerfully illustrate the issues we face and also point to solutions. Lu and colleagues1 with an interview-based study of indigenous people’s health in Canada provide an example of structural racism and offer practical suggestions to help us all be anti-racist in our words and actions. Orkin and colleagues2 describe how collective academic mobilisation across many countries and settings prompted rapid, effective learning that quickly informed practice to combat a novel disease impacting patients and communities who are often marginalised. Finally, Yassaie3 offers a personal, reflective piece centring on what we can all do to combat the climate crisis and move to greater sustainability—describing a transition from victim to activist by harnessing the notion of ‘active hope’.

These three works illustrate two things we are editors of BMJ Leader take very seriously: Whose voices are we hearing (who gets a platform?); and, How do we move from description to learning and then to action which has real and meaningful impact. They also illustrate that thinking of ED&I and social justice in terms of ‘ticking a box’ is absolutely wrong: these themes matter because they are of primary relevance to what health systems and organisations should be trying to achieve, and to their performance—that is, what results are achieved and how efficiently.

We are a Journal, and so our call was of course for classical scholarly articles: original research, brief reports, reviews and commentaries. But it was also for personal perspectives, reflecting on the challenges of leading for greater ED&I and greater justice, and for submissions beyond the written word. Over the coming months as our full collection is published, you will find a very broad range of material becoming available, including drawings and photographs as well as written articles, which aim to inform, challenge and spark debate.

Our intention is that together these pieces will advance our collective understanding of the importance of our leading, and of allowing ourselves to be led, in ways which promotes greater justice so that those working in health systems and those who depend on them benefit. Or put differently, our intention is that these pieces, by focusing attention on leading for social justice, can enable better results through leading better.

We would welcome any and all comments from readers about how BMJ Leader’s spotlight can be better turned to address these areas in future.

And finally, we would like to thank all who have submitted to this issue, and our editor colleagues Jamiu Busari and Ming-Ka Chan for anchoring the issue, and as our publishing team at the BMJ for so ably handing the extra volume.