A Realistic Goal? Health Information for All by 2015
SCOTT C. RATZAN
When the Journal of Health Communication: International
Perspectives was in gestation a decade ago, a meeting was held at
the British Medical Association where the Health Information Forum was
conceived to address the health information gap in the developing world.
Recently, Fiona Godlee and colleagues published an article in the Lancet
challenging, ‘‘Can we achieve health information for all by
2015’’ (http://image.thelancet.com/extras/04art6112web.pdf).
Equitable and universal access to health care information
is recognized in the latest draft of the World Health Organization’s
(WHO’s) World Report on Knowledge for Better Health as an important
strategic element to reduce global disparities in health and to achieve
the health-related millennium development goals. So it should not be
contentious
to suggest timely and accurate access to quality information as a fundamental
pillar for evidence-based decision making and the creation of knowledge
used to design and implement programs, drive health policies, and improve
health outcomes.
In The Lancet article, Godlee and coauthors point
out a number of challenges that have experienced limited progress over
the past decade. They claim, ‘‘There is little if any evidence
that the majority of health professionals, especially those working
in primary health care, are any better informed than they were 10 years
ago.’’ They suggest physical access—absent, slow, or
unreliable Internet connectivity; expensive paper; and high subscription
costs of products—as being the major barrier to knowledge-based
health care in developing countries. Further, the ‘‘knowledge
system’’ is not working because it is poorly understood, unmanaged,
and under-resourced. Is it a truism that a number of interim measures
that have been instigated in the data rich north and have been made
available in the south or developing world are of little assistance?
Consider the following examples: (Health InterNetwork
Access to Research Initiative HINARI; www.healthinternetwork.org),
a partnership initiative led by the WHO, currently provides developing
countries with access to nearly 2,300 on-line journals. Healthlink Worldwide
(www.healthlink.org.uk)
enables developing country producers and distributors (publishers, ministries
of health, library services, local and regional nongovernmental organizations)
to publish and distribute their own health learning materials. Developmental
agencies fund a variety of projects: The U.K. Department for International
Development supports e-TALC (electronic teaching aids at low cost),
a project with CD-ROMS with a simple search engine, containing copyright-free
information with up-to-date and appropriate health and development information
and training materials for health workers. USAID also supported CD-ROMs
containing up-to-date information on the latest developments, information,
practices, and research in the population and reproductive health field
that have been used by more than 500 organizations in 95 countries.
And of course there are myriad other programs with a variety of information
sources, such as journals, newsletters, other publications, kiosks,
as well as a websites, portals, electronic media, and newer technologies
to provide scientific and technical reviews and access to best practices
and knowledge.
All of these projects, while magnanimous in intent, principally
are aimed at the literate health intermediary or professional. Despite
the great ‘‘divide,’’ there has been limited measurement
of what people in the developing world want (or believe they need).
One such fact cited in The Lancet article is that ‘‘journals
are one of the least useful information sources for health professionals
in practice,’’ yet these frequently are the ‘‘treatment’’
offered to address the information chasm.
The actual ‘‘end user’’—the patient,
carer, or ‘‘consumer’’ who uses such information
to stay healthy, detect and treat disease, or live with the disease
or disability often is forgotten. In many cases, the end user is illiterate,
is not motivated to seek health information in certain formats or from
certain sources for a variety of reasons (e.g., socioeconomic, culture,
environment, lack of hope, etc.), or cannot process the level or type
of information. Hence, the ‘‘user’’-centered or
tailored approach—which ought to be the sine qua non of effective
communication of health information in general, but is of
even greater importance in developing countries—is tantamount to
efficacy of interventions on health outcomes.
As we look to 2015, we will need multiple strategies for
achieving ‘‘universal access to essential health-care information.’’
There continues to be hope with the diffusion of new technologies that
can facilitate two-way horizontal exchange of information and dialogue
through the creation of portals and development gateways. These gateways
create platforms for users with the same interests to talk to one another
and use information creating ‘‘knowledge communities’’
where health professional as well as program planners, researchers,
policymakers, communicators, and others can acquire information,
resources, and tools; contribute their knowledge and experience on specific
topics; and share materials, dialogue, and solve problems with those
working in the same areas.
The result of such an approach is that information and
the process of disseminating such information improves communication,
learning, and the building of networks and communities of practice around
significant development challenges.
This issue of the Journal features a theme of direct-to-consumer
(DTC) advertising for prescription medicines. Currently, such an approach
is allowed onlyin the United States and New Zealand. While the 55-year-old
WHO preamble reminds us of the need for ‘‘informed opinion
and active cooperation on the part of the public are of utmost importance
in promoting health,’’ many countries restrict this competence
of informed opinion to the governmental purveyor of information de facto,
limiting the opportunity for health information for all. Today, the
evidence supports that quality, reliable, salient, trustworthy, easily
understood information presented in multiple formats from a variety
of sources encourages patients (the medical end-users) to ask their
doctors, nurses, and pharmacists (and other health intermediaries) questions
that could improve health. The ideal for health information will require
a multidisciplinary system developing ‘‘quality, reliable,
salient, trustworthy, useable and valuable information.’’
This will require cooperation amongst sectors—government, private,
public, academic, along with a wide range of professionals, including
health care providers, policymakers, researchers, marketers, publishers,
information technology professionals, and others. Perhaps it is time
for a multi sector-driven ‘‘framework convention’’
on health information provision to advance the knowledge base and practice
to enhance health of the public.
Of course, with adequate resources and appropriate goals,
health information for all can be achieved by 2015. But it is not an
end in itself, but rather a foundation to build a health competent society
that is composed of active individuals who are health literate, a community
that supports and encourages healthy activities, a supportive environment
for healthy public policy (sound civil society), and a system with adequate
capacity (human and economic) to deliver preventive and curative health
services.
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Scott C. Ratzan MD, MPA is Editor-in-Chief of the Journal of Health
Communication: International Perspectives.
