World Civil Society Forum:
Health and the Internet
World Health Organization
July 2002
Joan Dzenowagis, PhD
Project Manager, Health InterNetwork
Shyama Kuruvilla, MS
Scientist, Research Policy and Cooperation
World Health Organization
Geneva
World Health Organization
July 2002
Health and the Internet: Today’s focus
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Challenges
– Access to ICT
– Quality of health information
– Information environments
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Opportunities
– Policy for quality
– Partnerships and resources
– Knowledge and best practices
World Health Organization
July 2002
Challenges: Access to ICT
Brief overview of what we already know:
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Growing but uneven use of internet worldwide
Uneven access to new technologies widening
existing inequities and creating new gaps e.g. the
digital divide
Blurring of legal and geographic boundaries
Socio-political infrastructure... has not kept pace
with growth
World Health Organization
July 2002
Number of internet users
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World average 1 user per 15 persons
North America and Europe average 1 per 23 persons
Africa average now 1 user per 150 persons,
excluding SA
World Health Organization
July 2002
Source: Mike Jensen, Africa Online 2002
Is the world on-line?
Number of internet
users (million)
Total population
Approximate %
people on-line
World
544.2
+6 billion
9
Canada & USA
181.23
314 million
57
Europe
171.35
727 million
24
Latin America
25.33
519 million
4.8
Asia/Pacific
157.49
3.7 billion
4
4.15
794 million
<1
Africa
World Health Organization
July 2002
Internet use estimates: http://Internet.nua.ie/surveys/how_many_online/index.html
Population estimates: http://www.un.org
Problems with access
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Cost of access is still a major factor
Limited telecom infrastructure
ISP regulation and monopolies
Irregular or no electricity
Wide variations caused by a range of factors:
policy, market trends, consumer knowledge and
behaviour etc.
World Health Organization
July 2002
“Our hospital has a library, but it is full of
old book that published from the 1980s and
the outcome is doctors disappointed about
that information!
There is a computer but no (CD-ROM),
internet account or email address in that
library.”
Dr Nguyen Tan Hai
Danang Hospital, Viet Nam
World Health Organization
July 2002
Challenges: Health information quality
Health information online
Search for “health” on search engine Google
today yields nearly 60 million pages
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Estimates of the number of health-related
websites range from 10,000 to over 100,000
World Health Organization
July 2002
Source: www.google.com
Sources of health information
Numerous and varied
Academic institutions
Biomedical publishers
Governments
Public and private health institutions
Health industry - drug companies, businesses
Individuals - citizens, professionals and
patients
“Pseudo” health and wellness interests
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World Health Organization
July 2002
Use of internet for health is rising
Millions
US adults online
120
100
80
60
40
20
0
61%
75%
25%
1997
% E-health consumers
World Health Organization
July 2002
39%
2002
% General online
Source: Cyber Dialogue,Cybercitizen Health, 2000
Information quality
Surveys, studies and anecdotes
Dubious information quality
Widespread practice of fraud
Potentially dangerous claims and
The risk of exposure to harm
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World Health Organization
July 2002
Source: California Healthcare Foundation, Rand 2001
The need for quality
Business
approach
Based on
known and
consistent
quality
Content quality
BRAND
Consumer
behavior
World Health Organization
July 2002
Public health
approach
TRUST
Citizen behavior
Based on
perceived
neutrality,
expertise,
and/or
authority
No real protection
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To date there is no credible and enforceable
protection of citizens from potential harm in a
large number of websites offering health
information today
Some degree of protection provided either by
national regulatory mechanisms or through selfregulation, BUT modest at best and currently
afforded only a small number of people
World Health Organization
July 2002
Challenges: information environments
Information may be global, but the use of
information is always local.
Key issues across different contexts:
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Felt needs
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Strategic needs
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Unique information environments
World Health Organization
July 2002
Understanding needs
for health information online
World Health Organization
July 2002
Seeking health information online
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World Health Organization
July 2002
Event-driven, e.g. illness?
Curiosity?
Anonymity?
Autonomy?
Lack of other sources?
……?
The health internet environment
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Changing relationships and patterns of
communication
Uncertainties about the use and impact of
information on different groups
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Information quality: potential for harm?
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Role of regulations and standards
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Need for public education and engagement
World Health Organization
July 2002
Internet traffic flows
World Health Organization
July 2002
Source: Stephen G. Eick, Bell Laboratories; Cybergeography
Opportunities
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Strengthen policy structures to enhance health
information quality, e.g. dot.health
Build partnerships and mobilize resources to
facilitate equitable access to ICT for health, e.g.
Health InterNetwork Initiative
Develop and share knowledge and best
practices.
World Health Organization
July 2002
Opportunities: Health information quality
Stakeholders
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World Health Organization
July 2002
International agencies
Governments & public institutions
Nongovernmental organizations
Health practitioners and associations
Private sector, e.g pharma companies
Citizens and consumer associations
Academia
Response: Codes of conduct
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Numerous organizations trying to address quality
of health information
All of these codes have their primary goal of
citizen protection
Secondary goal of protecting the company’s good
name: competition based on quality
Derive from different philosophies and apply
different approaches and processes
Driven by market forces and demand
World Health Organization
July 2002
WHO’s position
Health information quality is too important to be
left to market forces alone.
WHO’s response:
Prevention of harm is laudable and viable through
the creation of a new top-level domain, .health
World Health Organization
July 2002
Internet top-level domains
Domain name system
Introduced in 1980s to handle growing Internet
Administered by ICANN, private sector non-profit
corporation in USA
Organizes Internet by name (previously by number)
Uses hierarchical structure: names separated by dots
Top-level domain follows last dot: .com, .edu, .int
Each top-level domain managed by single
organization
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World Health Organization
July 2002
.health: A new top-level domain
Aims:
Establish an easily-recognized label for
trustworthy health information
Coordinate and harmonize efforts to improve
health information on the Internet
International quality and ethical standards
NOT an attempt at regulation
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Addresses key shortcoming of self-regulation in that
it is enforceable: domain name can be suspended
or cancelled for non-compliance.
World Health Organization
July 2002
Opportunities: Build partnerships and
mobilize resources
The Health InterNetwork Initiative
United Nations Millennium Action Plan
September 2000, HIN one of four United
Nations development initiatives
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Two themes
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Use ICT in the service of public health
Encourage building of partnerships (public
and private sector)
World Health Organization
July 2002
UN Mandate
“..As a concrete demonstration of how we can build bridges over
digital divides, I am pleased to announce the Health InterNetwork.
...This network will establish sites in hospitals, clinics and public
health facilities throughout the developing world to provide
tailored access to relevant up-to-date health and medical
information...
...Internet access will be provided in cooperation with foundation
and corporate partners....Training and capacity-building is an
integral part of the project.
...The World Health Organization is leading the United Nations in
developing this initiative with external partners.”
UN Secretary-General Kofi Annan
Millennium Report of the UN Secretary-General
September 2000
World Health Organization
July 2002
The World Health Organization
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Specialized United Nations agency with a charter
for international health
Worldwide representation: 191 member states, 130
of these are developing nations
50 years’ experience in public health
Ability to draw on a well-established, international
process for bringing together countries and actors
at every level.
World Health Organization
July 2002
Aim
Support existing public health programmes and
priorities through:
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Content: relevant, high quality, affordable
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Connectivity: improving internet access
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Capacity: training to use health
information effectively
World Health Organization
July 2002
Public health focus
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World Health Organization
July 2002
Health service providers
Researchers and scientists
Policy makers
Partners
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World Health Organization
July 2002
UN agencies
Governments
Nongovernmental organizations
Foundations
Private sector
Collaborating institutions, universities
and health centres
Principles
Consistent with UN framework
Inclusiveness: local, national and
international partners; public and private
Partner orientation non-profit, noncommercial
High standards for quality and ethics
Equity and affordability
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World Health Organization
July 2002
Phases
Three phases over 7+ years
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World Health Organization
July 2002
planning and development
demonstration projects and evaluation
expansion to broader scale
Working structure
Steering committee
Advisory
groups
WHO
task force
Implementation
partners
World Health Organization
July 2002
Project teams
Milestones
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HIN concept developed; portal launched
Demonstration projects: India, Eastern Caribbean,
Bolivia, Research Network…
WHO role in ICT for health: UN ICT Task Force,
G-8, World Summit on Information Society…
Global content and technology consultations
Major breakthrough on access to research: HIN
Access to Research Initiative (HINARI)
World Health Organization
July 2002
HINARI: An example of equitable access
Content
Over 2000 journals from 22 publishers
Journals in full text, directly from publishers’
websites
Subject scope: biomedical and related social
sciences
No restrictions: current issues and back years
included
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World Health Organization
July 2002
HINARI: Training and support
Training
English language training modules
First training-for-trainers workshop: focus on
malaria research in Africa - June 2002
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ICT support
No resources currently available; potential for ICT
support volunteers
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World Health Organization
July 2002
Who is eligible?
Countries
Two tiers: according to ability to pay (country
GNP), Berne signatories (waived for poorest
countires)
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Institutions
Schools of medicine, nursing, public health,
pharmacy; universities; research institutes;
government offices; teaching hospitals; medical
libraries
NGOs accepted as “walk-in” users
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World Health Organization
July 2002
World Health Organization
July 2002
“Today we cannot find the words to express
our satisfaction by receiving free access to
1500 biomedical journals online.
The reason is simple. More than 10 years
ago, we do not receive budget to acquire
journals. And a few minutes ago we become
too rich by becoming part of HINARI. What
a Wonderful surprise for the whole
Institution.
Thank you, best wishes and long Life to
HINARI.”
Elisabeth Andong
University of Yaounde I; Cameroon
World Health Organization
July 2002
HINARI Plans
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Integrate locally-produced information
Include other information formats (books,
databases)
Expand training efforts including French and
Spanish modules
ICT support to institutions
Solutions for countries not included in the
publishers’ offer
World Health Organization
July 2002
HIN Demonstration projects:
HIN India
Priority public health programs:
Revised national tuberculosis control program
National tobacco control program
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Public health community:
Primary and community health centers in 2
districts
District, state and central health departments
Medical colleges and collaborating institutions
Relevant research institutions
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World Health Organization
July 2002
Opportunities: Building and sharing
knowledge and best practice
. Goal:
Understand the relevance of different types of
information and the internet to the objectives
and needs of organization as a basis for
planning how to use the internet.
If the Internet is the solution,
what is the problem?
World Health Organization
July 2002
Assessing needs
Needs assessments:
Organization and end-user information and
communication needs (e.g. HIN)
Local content inventory
E-readiness and connectivity - hardware, telecom,
logistics - (e.g Harvard-MIT)
Information environment and workflows research, policy, practice, public engagement
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World Health Organization
July 2002
Internet Action Plan
Action planning tells how you will reach your
goals
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Start with your objectives
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List the basic elements to achieve them
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Determine what it will cost, the timeline, who
will do it…
Recognize that the plan can change if
circumstances change
World Health Organization
July 2002
Evaluation
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Were the strategic objectives of the action plan
met (goals and indicators of progress defined) ?
Were the identified information needs met?
Was there adequate planning, training, and
resource allocation to meet the objectives?
World Health Organization
July 2002
Focus on evaluation
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Build evaluation into action plan, program
development, and workflow
Prioritize and evaluate what is useful for action (try
and avoid ‘so what?’ data collection)
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Use regular evaluation to assess return on
investment and monitor progress
One of the main problems in health and development
work is the lack of standardized assessment that
hinders learning across time and contexts.
World Health Organization
July 2002
Civil Society Organizations:
Participation I
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Set up projects using ICT to support health
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Encourage HINARI sign up
www.healthinternetwork.net
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Equip institutions for internet access
HIN e-readiness assessments; budget
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Offer or organize training workshops
HIN training packages
World Health Organization
July 2002
Civil Society Organizations:
Participation II
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Include a communications/capacity building
aspect in grant applications
Building up the knowledge in the field:
conduct needs assessments, contribute to
“evidence” and knowledge development
Find out about free resources, and make sure
your constituencies know about them and
how to use them
World Health Organization
July 2002
Civil Society Organizations:
Participation III
Promote national ICT strategies and capacity
building:
Awareness raising of decision-makers
Advocate for equitable access
Regional centers of excellence
National internet training centers
Standards for user training
Improved ICT training at schools,
universities, research networks, workplace
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World Health Organization
July 2002
What is your vision?
How would you use the internet
if nothing stood in your way?
World Health Organization
July 2002