Bernard Lown|Frederick Bukachi|Ramnik J. Xavier
Health information in the developing world
Lown Institute|Massachusetts General Hospital
bernard lown emeritus professor harvard school public health senior physican brigham womens hospital boston author 450 scientific articles three medical books lost art healing new york houghton mifflin 1996 developed dc defibrillator cardioverter introduced lidocaine antiarrhythmic cofounder first president physicians social responsibility psrusa subgroup international physicians prevention nuclear war ippnw received unesco peace award nobel peace prize 1985 behalf ippnw professor lown also founder chairman satetlife ramnik xavier graduated godfrey huggins school medicine university zimbabwe trained internal medicine gastroenterology molecular biology massachusetts general hospital boston joined staff 1996 senior medical advisor satel life dr xavier also editor health net news fred bukachi heathnet regional director africa honorary physician kenyatta national hospital nairobi kenya obtained master medicine internal medicine university nairobi medical school published several items local scientific journals newsletters health informatics current research interests telemedicine hypertensive heart disease considering health information needs developing countries one cannot ignore essential fact poverty leading cause poor health across globe1report ad hoc committee health research relating future intervention optionsinvesting health research development summary geneva1996google scholar 2beaglehote r bonita r public health crossroads cambridge university press cambirdge1997google scholar 900 years ago a1 asuli great physician islam living bokhara kazakhstan wrote medical pharmacopoeia divided monumental treatise two parts diseases rich diseases poor passage many centuries made dichotomy obsolete race new millennium divide rich poor wideningwithin industrialised nations developing developed countries 1996 358 billionaires controlled assets greater annual incomes countries representing 45 worlds population25 billion people3crosette b un survey finds world richpoor gap wideningnew york times july 15 1996 a3google scholar age potential abundance hungry ever oxfam reports third people asia africa latin america caribbean malnourished lead fully productive lives4medical news briefsbmj 1993 306 1147crossref google scholar disparities rich poor nations prodigious industrialised countries 21 worlds population account 85 global gross national product world trade energy consumption contrast poorest quintile contribute meagre 14 global gross national product engage 09 world trade5kevany j extreme poverty obligation ignoredbmj 1996 313 65crossref pubmed scopus 11 google scholar formidable divide continues grow according united nations 1960 1990 income per head increased four times among poor nations compared eightfold rise among wealthy ones difference annual income 60 fold6crossette b un world bank imf join 25 billion drive africanew york times march 17 1996 google scholar 1996 89 countries 174 worse economically 1960s 1970s4medical news briefsbmj 1993 306 1147crossref google scholar policies structural adjustment imposed developing countries world bank international monetary fund emphasised debt repayment based maximising exports expense agricultural selfsufficiency domestic social programmes economic strictures curtailed already small funding health services education environment according world bank projections 2005 subsaharan africa back levels income per head 1970s7french hvv africa resentful asia rakes aidnew york times march 6 1998 8google scholar africa regions poor world noteworthy disparity mammoth disease burden small numbers trained physicians east africa less one physician per 10 000 people many african countries far fewer physicians low status women additional contributor morbidity premature death endless drudgery early marriage teenage pregnancy high fertility inadequate nutrition anaemia chronic infections risk factors account inordinate childbearing mortality death pregnancy related womans status reflected level education8harrison ka importance educated healthy woman africalancet 1997 349 844google scholar although science technology promise way poverty difficult optimistic score decade 1970s increase number scientists per million population 637 industrialised countries compared 42 01 developing world tables 6 10 9unesco statistical yearbook 1985 unesco paris1985google scholar 10 us55 billion spent globally health research allocated needs poor countries10world health organization ad hoc committee health research relating future intervention optionsinvesting health research development geneva1995google scholar 90 years potential life lost grim coin also hopeful side northsouth gap widened terms income higher levels education judged basic indicators human development significant advances registered health care past three decades average life expectancy increased 16 years adult literacy 40 per head nutritional levels 20 child mortality halved period developing countries achieved 30 years took industrialised countries nearly century accomplish11state world year book unicef new york1996google scholar basis hope continuing information revolutiona social transformation epic proportions scaffolding place electronic total information environment becoming important source wealth power public imagination information age embodied internet promising new vistas democracy education personal enrichment indeed nothing human history provided potential making readily available information people lower cost a1 asulis pharmacopoeia divide rich poor applies also sphere health information industrialised north awash new information technologies transforming way health care delivered time threequarters worlds population starved basic nutrients mind africas 700 million people 800 000 million 014 users internet services 80 live south africa12 whereas one six people use internet usa europe africa excluding south africa one internet user every 5000 people information poverty substantial impediment better health countries medical libraries supplied worn books dated journals3 whereas medical library usa subscribes 3000 journals nairobi university medical school library kenya long regarded flagship centre medical literature east africa receives 20 journal titles today compared 300 subscribed 10 years ago14bukachi f primary health care health netwhydah newsletter africa acad sci 1996 3google scholar 1960s albert cook medical library makerere kampala uganda boasted 2500 medical volumes journal subscriptions one largest libraries east africa today receives fewer 40 medical journals number libraries received new books past decade computer access databases money stamps write material irene bertrand library geneva major reason sorry state attributed failure parent bodies institutions finance libraries13rosenberg libraries africa ever sustainableinform develop 1994 10 247251crossref scopus 20 google scholar uneven state neighbouring countries striking library university zimbabwe still obtains 600 900 books per year half donations 1996 journal collection 170 titles compared 500 1984 library issues health digest current health information zimbabwechiz containing abstracts relating zimbabwes principal health problems circulated free 1200 health professionals helga patrikios librarian university zimbabwe medical school harare similar digests produced six african countries various programmes beginning make difference among successful african index medicus aim sponsored association health information libraries africa ahila supported regional office africa network organization research development norad programmes define possible constrained scarce resources larger picture however stunted healthinformation systems due inadequate infrastructure lack initiative part governments healthprofessional associations internet connectivity abundant databases reference material journals online librarysearch programmes hold great promise informationstarved poor countries cyber highway may mean acquisition costly traditional medical journals bypassed present internet connectivity growing rapidly developing world countries including africa public access internet services available capital cities 42 54 african nations12leon f use internet growing africaemail protectedneaiegoogle scholar numerous agencies promoting development world banks infodev information development program seeks fully integrate developing nations information economy also un systemwide initiative africa one whose key areas harnessing information technology development group seven many international organisations launching similar programmes computerised technology potential promoting dramatic social political economic change poor countries promise however fraught serious difficulties everyone talking sense nonsense become indistinguishable locate nuggets one needs search needle proverbial haystack cyber highway growing shopping mall becomes ever difficult separate advertising hucksterism relevant information information highway becomes privatised commercialised cost limits access already evident usa country richest global economy estimated twothirds personal computers usa bought annual incomes 40 000 less third american households15lohr great unplugged masses confront futurenew york times april 1996 google scholar problem order magnitude greater poor countries major cities africa direct realtime access internet lines obtained growing number internet service providers however hookup access fees training costs financially reach health professionals direct internet line ministry health example may cost 15 000 35 000 per month16lown b mullaney j macartnur lighting small candle satelifesci med 1996 3 8google scholar far beyond budget allocated communication needs medical schools research institutes hospitals facing oppressive debt burdens poor countries curtailed investment improving healthcare infrastructures upgrading telecommunication networks public sector impact limited fiscal resources reflected experience witwatersrand health sciences library johannesburg south africa serves 30 000 users month one advanced africa although capable delivering electronic information clients cannot connect users urban hospitals kilometres away reasons lack money hospitals networked telephone system inadequate highspeed modems function cables damaged rain theft vandalism glenda myers medical dental librarian witwatersrand health sciences library johannesburg south africa although many capital cities throughout developing world witnessed rapid improvement telecommunications infrastructures conditions outside capital cities remain dismal many african countries expenditure health per head less us10 annually yet costs us10 4 min telephone call burundi botswana17mullaney j satellife pioneering path electronic communication health information developing worldclinical prefor quality healthcare 1997 18 3844google scholar affluent travel ever greater speed information highway majority worlds population never even made telephone call donors focused largely conduits network clearly end technical progress demands trainingup cadre individuals master technology rate technical progress invariably depends emergence expertise medical curricula developing countries offer little training informatics result low computer literffcy among health professionals18akinde ad soriyan ha adagunodo er philosophy health informatios education developing countries nigeria case studymeth information med 1997 131133pubmed google scholar furthermore womenessential upgrading health care poor countriesare largely left sidelines problem made intractable absence information chain underdeveloped information culture otherwise medical nursing students many poor countries textbooks little access medical journals sweep internet presents additional anxieties poor countries amassed wealth locally produced health information often highly valued pertinent unique medical problems distinctive countries though inaccessible widely known19shaw jg report brazzavilesatellifenews 1997 14 1google scholar raw information processed outsiders may little appreciation relevance furthermore latest medical knowledge frequently concerned tertiarycare problems may remote needs poor countries lacking primary health care issue appropriate health information gains urgency noncommunicable disease endemic rich countries increasingly takes firm hold poor countries two decades ago warned cardiovascular disease including hypertension stroke coronary artery disease emerging key publichealth issue developing countries20wha 29491976 handbook resolutions decisions world health assembly executive board vol ii geneva1985google scholar first time cardiovascular disease leading cause death globally noncommunicable diseases far behind21christopher jl murray cjl lopez ad global burden disease comprehensive assessment mortality disability diseases injuries risk factors 1990 projected 2020 harvard school public health cambridge massachusetts1996google scholar 1990 twothirds 14 million deaths due cardiovascular disease worldwide occurred developing countries incidence premature death expected continue rise people 35 years age risk factors already prevalent among young22wielgosz decline cardiovascular health developing countriesworld health statist q 1993 46 90pubmed google scholar time tropical disease continues relentless scourge complicated aids epidemic antibiotic resistance breakdown essential publichealth services promotion modern conduits information unlikely reverse changes responding health transition governments developing countries succumb model evolved rich countries pattern seems largely set since publicservice sector poor nations shrinking healthcare facilities rapidly privatised capital cities one witnesses new wellequipped tertiarycare hospitals fully stocked cuttingedge technologies service countrys elites investments consume large proportions health budgets time funds short supply deal elementary publichealth problems safe drinking water nutrition sanitation literacy among women approach less moral failing developing world irresistible pressure global economic system deluge information pressures new technologies23woolhandler himmelstein du labar b lang transplanted technology third world options first world sciencen engl j med 1987 317 504crossref pubmed scopus 20 google scholar nonetheless experience industrialised world highly relevant cardiovascular disease wealth epidemiological observations points role clearly identified risk factors modified publichealth policies individual lifestyle changes thereby reducing burden well outcome cardiovascular disease24reddy ks yusuf emerging epidemic cardiovascular disease developing countriescirculation 1998 97 596601crossref pubmed scopus 954 google scholar 25cooper rs rotini cn kaufman js muna wft menash g hypertension treatment control subsaharan africa epidemiological basis policybmj 1998 316 614617crossref pubmed scopus 111 google scholar lessons especially pertinent relation role tobacco consumption gaining substantial foothold poor countries available health information obviates need reinvent proverbial wheels however medical journals rich countries necessarily mirror healthcare practices unsifted information sources could distort already strong tendencies away populationbased health policies many medical journals already posted worldwide web need new information institutions closely tuned health problems poor countries tuning requires partnership equals health professionals two worlds shared information scientifically sound reliable pertinent affordable among novel institutions satellife though tiny organisation measure already making dent information poverty afflicts developing world bostonbased nonprofit organisation founded 1987 provide communication links among physicians health workers developing world constitute source relevant information26lown b dream deferred final plenary session fifth congress international physicians prevention nuclear war ippnw v congress report hungary budapestjuly 1 1985google scholar 27groves information highway satellifebmj 1996 313 14crossref pubmed scopus 7 google scholar focused lowcost yet appropriate highly functional technologies capable delivering critical information needed electronic network healthnet initially based lowearthorbit satellite leo technology providing costeffective reliable technology reaching remote areas inadequate telecommunication infrastructures leo satellites surrey satellite technologies ltd uk launched 1991 1993 arianspas european space agency satellite roughly size small television set circles earth polar orbit altitude 800 km passes every point earth least four times daily circumnavigating globe 100 min since telephone lines improved health information moved quickly efficiently standard telephone dialup networks highspeed modems today 95 healthnet information flows telephone lines however leo satellite remains indis pensable communication number remote sites lack adequate telephone services healthnet serves 4000 health professionals 25 countries programmes structured cooperative interactive driven needs resources users local users council works satellife define healthinformation needs develop appropriate communications solutions country network manager oversees operations email electronic conferencing electronic publications healthnet become critical link many frontlines major publichealth battles waged poor countries basic tenet sustainability relates sophistication technology developing human capital satellife world bank support currently sponsoring regional centre nairobi kenya training health professionals information technology subscribers receive electronic publications weekly heahhnet news provides current abstracts leading peerreviewed medical journals well fulltext articles selected basis sound science relevance health problems developing countries royaltyfree arrangements 18 leading medical journals including lancet afford wide range highquality communications special software package relying simple email enables subscribers engage remote electronic searches 21 abstract databases national library medicine washington receive relevant abstracts satellife recently developed getweb electronic tool retrieve documents worldwide web health professionals developing countries direct internet connection collaboration american physiological society aps programme configured interact weekly online notice research articles abstracts scheduled publication aps journal service 30 000 documents obtained monthly health workers worldwide email access expertmoderated international electronic conferences mainstay healthnetinformation services internet storeandforward satellife network promedmail founded directed jack woodall cooperation federation american scientists monitors emergence infectious disease man animals plants28mitchell p pro medmail outbreak intelligence rash reportinglancet 1997 350 1610summary full text full text pdf google scholar procaare launched cooperation harvard aids institute provides communication peerreviewed information diverse aspects hivaids particular emphasis meeting needs practitioners afronets conference dedicated african health research development deals capacity building resource mobilisation application research east south africa recent addition procor partnership lown cardiovascular center boston addresses emerging epidemic cardiovascular disease poor countries29lown b health technology developing world satellife procor februarywwwhealthnetorgdate 1997google scholar novel programme aims raise global consciousness surge cardiovascular disease major focus tobacco wars next century increasingly waged among vulnerable populations developing countries illequipped cope slick marketing techniques dirty tricks perfected tobacco industry procor also intends promote dialogue experience industrialised nations translate populationhealth costeffective prevention communication revolution affords opportunity bringing ordered structures reliable information internet especially essential poor countries enter global dialogue wiring poor world however close information gap haves havenots improving information access require far equitable global world order prosperity industrialised countries longer stretches history relates small measure cheap products obtained poor countries transfer wealth europe north america continues expanding live affluence deplore situation turn away moral challenge tolstoy complained state dispossessed serfs russia century ago sit mans back choking making carry yet assure others sorry wish ease lot possible means except get ting back must 1886 annual servicing africas debt 300 billion exceeds funds available health education combined aidsafflicted country uganda spends us250 per person per year health 15 debt servicing30logie de benatar sr africa 21st century despair turned hopebmj 1997 315 14441446crossref pubmed scopus 13 google scholar usher new millennium cancellation colossal debt poor rich countries would improving health care providing free subscriptions leading medical journals every health professional developing countries time appropriate health profession speak