Toward a Latin America Health Information Infrastructure
Spanish
version
Developed by Drs. Ingrid Libman and Benjamin Acosta for
the Global Health
Network
Changes in the pattern of diseases are being seen throughout Latin
America: with fertility declining and the population growing older,
non-communicable diseases have become the main causes of ill health. Remarkable advances in health have been made in a
very short period of time. It is likely that there can be continued
improvements in health with the application of modern information
technology (IT). A problem has been that the current approaches to the
application of IT to health in the Americas have been haphazard with
multiple, small, specific telemedicine projects. However, this misses the
broader picture of overall improved health in the Americas. We have argued
that a global information infrastructure needs to be created for the
Americas. To accomplish this, connectivity should be the first step,
not only within health, but
also with sectors such as agriculture and commerce. Once the low
bandwidth network is in place, which connects all medical schools, medical
school libraries, public health institutions, Ministries of health and
hospitals, then the Latin American Health Information Infrastructure can
begin to save lives.
In the first World Telecommunication Development Conference in
Buenos Aires, Argentina in 1994, a
Global
Information Infrastructure
was proposed for Latin America and the world. Here and now, in 1997, it is
time to consider a Global Health Information Infrastructure for the Americas.
A major goal of any country is to improve the health of its
population. Countries, however, often face numerous difficulties in
achieving this goal primarily due to scarce resources. Advances in
curative medicine, with the use of medical technology, have and will
continue to alleviate some human diseases; but often at a high cost.
Public health is an alternative in that potentially many cases of disease
could be prevented. However, this does not help those who already have a
disease. Most of clinical medicine and public health is information
transfer. Clinicians obtain information from journals, scientists collect
data/information, public health workers promote improved health on a
population basis through the dissemination of information. Information
concerning health in the Americas is transmitted and disseminated by
word-of-mouth in less developed regions and by the use of technologies
such as the media (radio, television, printed material), telephone and fax
in more developed areas. However, these information technologies are still
much the same that were in used in 1960. Since 1900, especially
since 1945, Latin
America has experienced dramatic changes, politically and economically. In the area of health, life expectancy has markedly increased in all the countries and mortality rates have fallen for all ages. Changes in the pattern of disease are being seen throu
ghout the region: with fertility declining and the population growing older, non-communicable diseases have become the main cause of ill health (3). However, the region still faces the burden of infectious diseases, as evidenced by recent epidemics of ch
olera (4). Unfortunately, the statistics concerning these emerging diseases are both inaccurate and not timely.
Modern information technologies (IT), such as the Internet, can bring a solution and countries in Latin America have the chance of "leapfrogging" improvements in health. The Internet, which was based on the National Science Foundation Net (NSFNET), o
riginated in the U.S. during the mid 1980s. It represents a meta network: a network integrating local networks using a common protocol in order to be able to communicate with each other. The development of the Internet has been explosive with over a 12%
growth rate each month (5).
Computer networking in Latin America has also had an impressive growth in the last years. According to the NSFNET statistics, Brazil and Argentina had 8 and 1 nets respectively in 1991, while in 1995, these numbers have jumped to 114 and 20 (5). Moreover
, the personal computer market grew 24% last year to two million units, better than the growth recorded in the U.S. In Chile, sales of PCs and workstations have soared to about $175 million in 1994 from $55 million in 1991. The government in Chile is inve
sting $ 3 million over three years to put computers into schools. The Ministry of Transport is installing a server to monitor traffic flows and the Ministry of Foreign Affairs has linked trade statistics, customs, company catalogs and price lists to PC
s around the world (6).
The initiative "Hemisphere-Wide Inter-University Scientific and Technological Information Network" (RedHUCyT), approved by the Organization of American States (OAS), has contributed to this growth. It's main objective is to connect the member States
of the OAS to the Internet, by integrating an electronic network for the exchange of specialized information among different academic and scientific institutions (7). All countries in the region, but Haiti, have access to Internet. Within the next five ye
ars, Mexico and other Latin American countries are expected to upgrade their telecommunications infrastructure with fiber optics (9). Also, a fiber optic network is being designed in Central America and is expected to operate by the year 1997. Although th
ere is still a long way to go changes are rapidly taking place and much has been accomplished. If clinical medicine and public health can be a part of the IT change this can mean an enormous effect on health.
How might this IT revolution have a positive impact on health in Latin America?
The programs that are already being developed are focused on accessing
medical databases by electronic mail to conduct bibliographical searches and retrieve information (BITNIS Project (10) and the Pan American Information Network on Environmental Health or REPIDISCA (11)) or on the concept of telemedicine, mainly clinical m
edicine (for example in Costa Rica). Although the BITNIS and REPIDISCA Projects are very good resources for finding information, they do not fully utilize the capabilities of the
Internet. The telemedicine programs promote technology demonstrations that transmit high bandwidth images such as MRI scans across great distances, usually from rural clinics to urban centers, and at a relatively high cost. Although telemedicine is import
ant, the role of tele-PREVENTIVE medicine potentially is of equal, if not greater importance for the Americas.
The concept of tele-preventive medicine is simple: improved low cost
access to information about disease monitoring patterns and prevention
through a telecommunication backbone has to make dramatic improvements in
the area of health. This has not fully occurred yet and perhaps one of the
reasons is the lack of a good model. However, recently, a prototype system
called the Global
Health Network (GHNet) has emerged.
It is our belief that in order to develop a tele-medicine and a
tele-preventive medicine program the first and foremost need is
connectivity. One cannot use a telephone unless one has a connection to a
telephone. One cannot use telemedicine and telepreventive medicine unless
one has a connection to a network. Moreover, health networks have to be
intertwined with other sectors such as agriculture, labor, commerce. There
are no "health" telephones or "agriculture" telephones so there should
not be "health" or "agriculture" networks. To know the connectivity of
the region there needs to be a monitoring of current and ongoing health efforts. We have begun to do this by searching the Internet for homepages from Latin America. This is the beginning effort for the construction of a global connectivity table.
The development of a Global Health Information Infrastructure will
serve as the foundation for higher bandwidth as once people are connected
they will begin to demand more and more services.
The following web site is the initial development of a place where the
connectivity of health around the world can be monitored. It is hoped that in a few years all institutions dealing with health can be connected, and have their own web sites.
References
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(2) World Development Report 1993: Investing in Health. Oxford University Press 1993. New York.
(3) Omran AR. The epidemiologic transition--a theory of the epidemiology of population change. Milbank Memorial Fund Quarterly 1971;149: 509-38.
(4) Organizacion Pan Americana de Salud. Las condiciones de salud en las
Americas. Volumen I. Edicion de 1994.
(5) NSFNET Statistics. Merit Network Information Center Services.
(6) Computer sales sizzle as developing nations try to shrink PC gap. The Wall Street Journal, Thursday, June 29, 1995; Vol LXXVI No 180:1.
(7) Hahn S. Networking in Latin America and the Caribbean and the OAS/RedHUCyT Project. Proc. INET'95:867-71.
(8) Casari Adolfo. Internet or Internot. On the Internet. An International Publication of the Internet Society. May/June 1995: 28-31.
(9) Resnick R. OlJ. Latin America's net presence is growing. Internet. The Magazine for Internet Users. April 1995: 86-90.
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Informatics. Volume 23. IOS Press, 1995.
(11) REPIDISCA or Pan American Information Network on Environmental Health. Pan American Center for Sanitary Engineering and Environmental Sciences. Lima. Peru.
(12) LaPorte RE, Akazawa S, Hellmonds P, Boostrom E, Gamboa C, Gooch T, Hussain F, Libman I, Marler E, Roko S, Sauer F, Tajima N. Global Public Health and the Information Superhighway. Brit Med J 1994;308: 1651-52.
