Telecommunication networks began with electronic computer-to-computer correspondence among scientists(3). In the early 1980s networks began forming among academic institutions; one of the first was a system called BITNET (Because It's Time Network) (4). Although it linked institutions that granted degrees, Bitnet was handicapped because government agencies and industry were not represented. During the 1980s Internet evolved(5). Internet represents a "meta-network"--a network of networks. It provided a way of joining many diverse networks, including those of governments and very recently industry.
The number of its users is growing by 12% a month: 10 million people in 91 countries now have access to the system. Internet was initially used for electronic mail and allows "bulk" mailings, with over 2,500 electronic newsletters and 4000 discussion groups. Bulletin boards supply information of public interest, details of relevant meetings, and the like(6).
In addition to these, Internet supports three tools to help find and retrieve files(5): the gopher, the wide area information server, and the worldwide web. The gopher (from "go for"), allows you to tunnel through "gopher space", to identify various databases. It provides a means to move through various layers of databases. With the gopher you can browse the card catalogue of the Vatican library, access to data on global weather, examine labour statistics, obtain publications from the United States government, and review pictures from art galleries.
While the gopher finds information by going through a series of menus, the wide area information server (WAIS) searches the full text of stored articles for keywords provided by the investigator. The third information server is the worldwide web (WWW), which is a hypertext information retrieval system. Hypertext joins documents through a preselected group of words and thus permits rapid linking of ideas.
In Krol's example (5) you could identify the specific title of a book (for example, J. Last, Public Health and Preventive Medicine; subject: public health, preventive medicine). Hypertext would then allow you to obtain Dr. Last's curriculum vitae (if this was available), his picture, and articles that he had published (through Medline). You could expand on the subject of public health, obtain the definition from a dictionary, identify papers on the topic, and enter databases on the subject in the public domain. Thus you "jump" from topic to topic on the basis of interest and need. All these systems and more can now be accessed using systems such as Mosaic, which allows access to picture, video, and sound.
The first step is to connect everyone in public health: without this a telecommunication systems for global public health will fail. Public health organizations such as ministries of health, the World Health Organization, the Pan-American Health Organization, the United Nations, and public health and medical societies should encourage members to be reachable electronically.
Once local and global public health centres have been connected, how can these links be used? Obviously, computer based telecommunications will vastly improved communication owing to effective transmission of information. There are, however, several further possibilities for its use in public health.
Global Disease Telemonitoring--With new epidemiological techniques such as capture-recapture and a telecommunications backbone, accurate estimates of incidences of important communicable and non-communicable diseases can now be obtained(7,8). Data on registered cases can be sent nightly from the disease reporting centres to national centres. Rates adjusted for missing cases by using capture-recapture can be reported to international centres by Internet, with accurate information concerning the patterns of disease available almost daily. Isses such as confidentiality need to be worked out, but extraordinary potential exists for very accurate disease monitoring and forecasting in much the same manner as we monitor and forecast the weather(9). Currently all countries in the Americas except Haiti are connected through Internet. Connections to Africa are rapidly being established, with integrated systems of telecommunication being developed in, for example, Zambia, and Mozambique. No systematic integration of telecommunication and public health systems across countries has occurred.
On Line Vital Statistics--All vital statistics (but especially births and deaths) could be entered electronically and be usable almost instantaneously. This would facilitate monitoring and forecasting of population growth and the health nees of mothers and children.
Environmental Monitoring--Data systems for environmental monitoring have not been organised with user friendly databases that integrate environmental information with morbidity data as morbidity data for non-communicable diseases are poor (7-9). Linking global disease telemonitoring with environmental data would considerably improve our understanding of the environmental determinants of disease.
E-Mail Searches--Internet is already linked to the National Library of Medicine through BITNIS. Should someone in Bolivia be interested in having the library search for references on a particular topic the request and the results can be transmitted through Internet.
Public Health Gopher--We are establishing a public health gopher, which will allow people to roam through the existing sources of data relevant to public health. Gophers can also be developed for national data with a common set of querying commands to find data, reports, or other materials.
Distance Education--Computer based distance education is rapidly improving. For example, networking of injury epidemiologists would allow electronic courses on injury prevention to be provided across the world. Reading materials, video, pictures, and sound could be transmitted across huge distances for low costs, and interaction would be possible. Students from several countries could work together to establish research programmes in public health. Health education might be targeted at those most in need-- for example, maternal and child health programmes could send targeted messages to mothers and have mothers ask questions through media such as television. The links are being established between cable television and telecommunication systems. Hundreds of schools are already networked together.
On line journals Global public health needs to begin to plan for a public health communication system that can reach all the public health workers in the world. The first step is to network public health workers. It is time for public health to enter the electronic information superhighway.
We thank Tony Villasenor for his comments.
Ronald E. LaPorte
Professor Department of Epidemiology,
University of Pittsburgh,
Pittsburgh, PA 15213
Other authors are:
SHUNICHI AKAZAWA (Data Processing and Communications Information Office, World Health Organization, Geneva 27, Switzerland)
PETER HELLMONDS, EUGENE BOOSTROM (World Bank, Washington, DC 20433)
CARLOS GAMBOA (Pan American Health Organization, World Health Organization, Washington, DC 20037)
TONY GOOCH (Security, Dumfries, VA 22026)
FAROOQ HUSSAIN (Sprint Corporation, Reston, VA 22096)
INGRID LIBMAN (Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213)
ERIC MARLER (National Information Infrastructure, North Tarrytown, NY 15091)
KEN ROKO (US Agency for International Development, Rosslyn, VA 22209)
FRANCOIS SAUER (Digital Corporation, Dearfield, FL 33441)
NAOKO TAJIMA (Jikei University School of Medicine, Tokyo, Japan)
Internet address for authors:
Ronald E. LaPorte---RLAPORTE@VMS.CIS.PITT.EDU Shunichi Akazawa----AKAZAWA@WHO.CU Peter Hellmonds-----PHELLMON@WORLDBANK.ORG Eugene Boostrom-----EBOOSTROM@WORLDBANK.ORG Carlos Gamboa-------GAMBOA@NLM.NIH.GOV Tony Gooch----------TGOOCH@USAID.GOV Farooq Hussain------FAROOQ@ICM1.ICP.NET Ingrid Libman-------IML1@VMS.CIS.PITT.EDU Eric Marler---------GMARLER@RHQVM15.VNET.IBM.COM Ken Roko------------KROKO@USAID.GOV Francois Sauer------SAUER@LACVO1.ENET.DEC.COM Naoko Tajima--------NTAJIMA@JPNSUT01.BITNET Tony Villasenor----VILLASENOR@NASA.GOV