Improving Public Health Via The Information Superhighway

The world is becoming healthier. Since the end of World War II, life expectancy in most developed and developing countries has increased by almost 25 years. This increase is the greatest seen in the history of the world. It has been estimated that almost 24 years of the 25-year increase are the result of improvements in public health and disease prevention. Such activities include improving sanitation, immunizing more people, bettering maternal and child health, and promoting healthier lifestyles. We in public health have been doing something right. How can we maintain these advances and improve public health in the 21st century beyond what has been achieved to this point? The answer lies in the information superhighway (R.E. LaPorte et al., British Medical Journal, 308:1651-2, 1994). A major component of public health and disease prevention is information exchange. Almost all public health preventive actions-such as undertaking surveillance of infectious and chronic diseases, educating people in ways to alter their diet, improving water supplies, and promoting behavior modification to stop smoking-require getting information to the public. The problem is that our primary methods of information transfer-word of mouth, the postal system, and the telephone system-are far from state-of-the-art. However, the revolution in information technology and the widespread use of the Internet have greatly increased our ability to exchange information with a precipitous decline in costs. If public health prevention efforts could harness this electronic revolution, a new era of improved global health could result. The Global Health Network (GHNet) aims to usher in the new health information age. The network is an alliance of health and telecommunication professionals who aim to develop an infrastructure to network everyone around the globe involved in public health and prevention efforts. The use of telecommunications in public health can be considered in two areas: telemedicine and telepreventive medicine. Telemedicine is the use of expensive technology to send information that requires high bandwidth-for example, X-rays for use in clinical treatment and diagnosis-to benefit a small number of sick individuals. Telepreventive medicine, in contrast, uses relatively inexpensive technology and low bandwidth to transfer disease prevention information to healthy populations. If a nation were to spend $5 per person to improve health, it would obtain a greater pay-off by focusing on telepreventive medicine. However, in the United States and the rest of world, almost all the money spent on telecommunications and health is targeted toward telemedicine (R.E. LaPorte, Brit. Med. J., 13:1383-4, 1996). GHNet was established by representatives from academia, government, and industry to promote the use of teleprevention in public health. It started as a grass-roots effort in the early 1980s as part of the World Health Organization (WHO) Multinational Project for Childhood Diabetes (WHO DiaMond Project Group, Diabetes Care, 13:1062-8, 1990). The WHO project consists of 150 centers in 70 countries that are monitoring the incidence of childhood diabetes. When the program started, the interest was to network these centers to facilitate communication. During this time, members of the WHO DiaMond Project published the first papers to our knowledge describing the use of telecommunication in public health (R.E. LaPorte et al., American Journal of Epidemiology, 128[2]:439-42, 1988; R.E. LaPorte et al., Epidemiology Monitor, 7[10]:2-3, 1986). In 1992, when Vice President Al Gore announced the goal of developing the information superhighway, work on the GHNet accelerated. Individuals from the National Aeronautics and Space Administration (NASA), WHO, the Pan-American Health Organization, the World Bank, industry, and academia formed a task force charged with creating a network designed to improve global health. The goal was to apply the latest cost-effective information technologies to prevent disease. (Biographical information about the people who developed the Global Health Network can be found on the GHNet home page at http://www.pitt.edu/HOME/GHNet/GHNet.html.) Since then, GHNet has won several accolades for its efforts. PC Magazine, for example, identified the GHNet home page as being in the top 100 of the 200,000 home pages in 1996. In addition, the overall project was ranked in the top six in health of the 25,000 health home pages by the Global Information Infrastructure, a government and industry consortium designed to promote the Internet. In addition, there have been 42 publications submitted or published on the GHNet, all of which are listed on the home page. GHNet proposes to use the Internet as an information "glue" bonding together the divergent efforts and multiple individuals promoting global health. The plan consists of eight components: Connectivity: In order to take advantage of the enormous potential of the Internet to improve health, one must first be connected. The GHNet is pressing for Internet connection for all public health agencies in the world. NASA's Anthony Villasenor and the World Bank's Eugene Boostrom, who both were involved in launching GHNet, have been working to connect the countries of Africa. GHNet also has determined the connectivity status of public health institutions in Japan and the United States and is starting to connect public health centers. In both countries, E-mail connectivity is good, but home pages are infrequent. For example, about 50 percent of the state health departments in the U.S. have home pages. At the local level, connectivity is poor, and less than 10 percent have home pages. On a worldwide level, GHNet has established a home page to monitor connectivity in Latin America. It is meeting with the Asian Development Bank to focus on networking and health in Asia. In addition, GHNet is actively developing training courses to bring public health workers onto the information superhighway. Disease Monitoring: NASA's Villasenor has developed a plan for WHO to establish a global monitoring system for emerging diseases. This system will connect laboratories and surveillance activities worldwide. Once established, it could also form a backbone for monitoring conditions internationally. Global Health Network University: Thomas Songer, an assistant professor in the department of epidemiology at the University of Pittsburgh, is working with WHO and the Soros Foundation to develop distance education programs to train public health workers. The goal is to be able to teach across the world with low bandwidth, starting with E-mail. The plan is to eventually incorporate higher bandwidth techniques, such as transmitting voice and video over the World Wide Web, which require more resources (R.E. LaPorte et al., Brit. Med. J., 310:1387-90, 1995). Networking Health-Related Nongovernment Organizations: These volunteer health agencies, industry groups, and academic hospitals provide much of the care and health information to people and doctors worldwide. For example, GHNet has helped put the Latin America Diabetes Association on the Internet (http://harris.nis.pitt.edu/~iml1/diabetes/ALAD.html). The home page has been created with information about the organization, and there are E-mail listings for all the members. Research Information Servers: GHNet has been particularly interested in the use of the Internet for research communications (See "Scientists Assassinate Journals" on the GHNet home page). It has argued that in five years most paper journals will be gone. The format of future journals will be that of a "hypertext comic book" (R.E. LaPorte, Brit. Med. J., 309:736-7, 1994), in which the content of the articles will be displayed as multimedia frames. As one moves from frame to frame, hypertext links will allow the reader to obtain additional information. Ronald E. LaPorte is director, disease monitoring and telecommunications of the WHO Collaborative Center for Diabetes Registries, Research, and Training and a professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. He can be reached at RLAPORTE@vms.cis.pitt.edu. Cyberdoc Training: In general, physicians, public health workers, and health workers need to be trained on the Internet. Cyberdocs are individuals trained in epidemiology and telecommunications. This program is part of a plan to establish a Global Health Disaster Network for providing immediate, accurate information in disaster situations. GHNet has set up short-term training courses in Japan as well as in the U.S. In addition, it has four students who are being trained in both public health and telecommunications. Research Communication Availability for Developing Countries: A critical problem for developing countries is that they cannot obtain access to the latest journals. We have developed the architecture for a server that allows people from those countries to access that information. For example, people in Romania can log on to the server site that holds information from the British Medical Journal. With a targeted-access server, the Lancet can be made available gratis to Uganda, Peru, and parts of Mongolia. Five of the 10 most cited medical journals have tentatively agreed to participate. In addition, several other groups representing more than 400 journals have expressed an interest. An Informational Home Page: Aided by seed money from NASA, GHNet has created a home page that is designed to be a one-stop shopping center for public health information. Included on the page are directories of global health professionals, job listings, and medical information from various sources. During the past year, more than 100,000 individuals worldwide have visited our page. While GHNet is in its infancy, its efforts will continue the improvements in public health made in the 20th century. Sanitation and immunization were the primary reasons behind those advances. In the 21st century, improved health will be propelled forward by information, and GHNet hopes to help steer the health information course.

Improving Public Health Via The Information Superhighway

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