This paper gave an overview and analysis of epidemiological and public health journals, databases and professional education represented in three Western European languages: French, German and Italian. The historical development of the profession of epidemiology and public health and their respective journals, databases and professional education in these linguistic communities followed different paths due to differences in historical, social and political circumstances.
Bibliographic databases are gateways to the vast quantity of medical literature. There is evidence that many non-English medical journals are not indexed by major English-based bibliographic databases like PubMed and Web of Science, and that alternative databases like EMBASE provide more comprehensive coverage of non-English literature (please refer to the following papers, all available in this thematic series: papers on Chinese bibliographic databases [87, 88], on LILACS and SciELO databases for Spanish and Portuguese [10, 11], and on how EMBASE enhances access to randomised control trials ). While bibliographic databases that cover medical and scientific journals are available in French and German, their absence in Italian may reflect the relative dearth of Italian academic journals, but is possibly more likely a function of a lack of funding or commitment from the Italian government. However, various online databases and web resources are available in all three languages to provide interfaces through which epidemiological and public health information can be further disseminated in a national or regional context.
Academic literature in a given language presupposes a professional community who will read and contribute to it. The strength of a language as a medium of communication in epidemiology and public health is reflected, to a certain extent, in professional education in the respective language. France and other French-speaking countries or territories have a long tradition of public health professional education in French. Thus, they have fostered a community of French-speaking epidemiologists and public health practitioners who in turn can contribute to the professional literature in French. The relatively late development of professional education in modern epidemiology in the German-speaking countries and Italy may have contributed further to the contemporary dilemma of epidemiology and public health journals published in these languages.
Against the backdrop of English being the contemporary lingua franca of the global scientific community today, both practitioners and researchers in these fields face the difficult dilemma of switching to English and forsaking their native tongues as their means of scientific communication, or holding onto their national scientific heritage and in the process possibly losing out in the race of competitive international scientific research. However, it would be biased to ignore the fact that a globalising world, not least the scientific community at large, demands a global language so as to break down linguistic barriers and foster international communication in a more effective and efficient way. As a legacy of the British Empire and the current status of the USA as the leading superpower, English has overtaken French and German as the global language . In a nutshell, it is a matter of prioritising efficiency versus equity .
In a market economy, it is the size of readership that determines the circulation and thus the survival of a journal. The larger the size and the more international the potential readerships are, the more likely a journal is to survive. As a legacy of the French and Belgian colonial empires, French is an official language in 30 countries [92, 93], and may survive the globalisation of English as a means of scientific communication. However, given the continual growth of English as a language of international communication and the fact that publication in English gains a wider circulation and a better chance of being cited, the trend of even French-speaking scientists now switching to publish in English in order to compete in the international scene is obvious and difficult to reverse . (The Appendix provides a brief analysis of English-language epidemiological and public health journals indexed in PubMed.)
Sources of funding may also be a related issue. Given that many international epidemiological and public health research programmes are now funded by international agencies and foundations as well as governments of some Anglophone countries, it is likely that research outputs from these programmes will be required to be published in English in order to appeal to as wide and international an audience as possible.
In addition, it is important to take notice of the trend of a growing division between researchers and practitioners and the corresponding classification of journals into international and local focus. It seems that in all three linguistic communities mentioned in this paper, researchers tend to read and publish in English, unlike practitioners who mainly read in their native languages. This dichotomy of international English language research journals and local native language journals for continuing medical education has made an impact on the practice of the profession itself, e.g. by making it necessary to facilitate the publication of reviews in the native language 'local' journals of the latest studies published in English in international journals. Indeed, the publication of reviews in the native language should have the function of encouraging physicians, other health-care or social services professionals, policy makers and stakeholders (e.g. patient associations, coalitions against environmental risks and trade unions, etc.) to access the latest research outputs. Incidentally, this phenomenon of two tiers of journals is observed in Russia as well (cf. the paper by Vlassov and Danishevskii  in this thematic series).
Nevertheless, as Ofori-Adjei et al. argue, local journals in native languages are a health resource and are important for the contextualisation of evidence on which public health practices are based . Thus as epidemiologists, it is important to ensure that data published in non-English journals (especially when we conduct meta-analyses and systematic reviews) are not overlooked. Furthermore, the importance of channelling the knowledge of research outputs published in English into our respective linguistic communities through writing reviews and summaries in the local native language journals should be appreciated and encouraged. Considering the information presented in this article, it can be ultimately stated that language does matter a great deal in epidemiology today.