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Global Vision, Local Insight Report for the World Summit on the Information Society Acknowledgements Connecting for Health Global Vision, Local Insight Report for the World Summit on the Information Society Acknowledgements This report builds on the excellent work of many others in addressing issues in health, development, and information and communication technologies (ICT). Thanks are due to the European Commission Information Society and Media Directorate General, and the World Health Organization cluster on Evidence and Information for Policy, for their support in preparing this report. Thanks are also due to Professor Jean-Claude Healy (WHO), an acknowledged leader in eHealth, for sharing his insight and experience. The United Nations ICT Task Force provided a valuable forum for discussion, and the multistakeholder Partnership on Measuring ICT for Development, led by UNCTAD, deserves special recognition for its outstanding efforts in mapping the ICT terrain. With special thanks to Kai Lashley for technical editing and to the Department of Knowledge Management and Sharing and the eHealth Unit, for their support. Cover image Base image: Hand-drawn street map of Kikwit, Democratic Republic of the Congo, used for recording cases and contacts to respond to an outbreak of Ebola haemorrhagic fever, 1996. Source: Department of Emerging and Other Communicable Diseases Annual Report, 1996. WHO, Geneva, 1996. WHO Library Cataloguing-in-Publication Data Dzenowagis, Joan. Connecting for health : global vision, local insight. Author: Joan Dzenowagis, in collaboration with Gael Kernen 1. Public health. 2. Communication. 3. Informatics. 4. Information management. 5. Knowledge. I. Kernen, Gael. II. World Health Organization. III. Title. ISBN 92 4 159390 3 (LC/NLM classification: Z699.5.M39) © World Health Organization 2005 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Design: Langfeldesigns Printed in Switzerland. Foreword Connecting for Health Global Vision, Local Insight Report for the World Summit on the Information Society he use of information and communication technologies (ICT) for health, or ‘eHealth’, today represents one of the key instruments for health care delivery and public health. Efficient and robust eHealth solutions have already demonstrated Ttheir value, particularly in facing new global health challenges such as emerging epidemics or the health consequences of natural disasters. Towards achievement of the Millennium Development Goals, it is the health community’s common responsibility to increase the implementation of eHealth, particularly in developing countries. The barrier to this is no longer only technical or financial. Rather, it is also the ability to plan and implement eHealth on a large scale, while adapting it to local health problems, that presents the greatest challenge. This is also the goal of the initiative i2010: European Information Society 2010. It is an enormous task, and one that cannot be achieved alone – active collaboration is crucial. The World Health Assembly eHealth Resolution (WHA58/28) approved earlier this year underscores the World Health Organization’s commitment to advancing eHealth. The Organization is pleased to present this report for the World Summit on the Information Society, developed with the support of the European Commission. Connecting for Health: Global Vision, Local Insight represents a starting point and an instrument for action, bringing together statistics in health, development and ICT to show the opportunities for eHealth in countries. Additionally, it highlights the need for a global, long-term and collaborative approach so that all the citizens of the world may benefit from the best eHealth solution possible. LEE Jong-wook Viviane Reding Director-General European Commissioner World Health Organization Information Society and Media I. Improving health: a common purpose 2 ◆ The changing picture of global health he world has seen significant gains in health in the past 50 years, due not only to advances in science, technology and medicine, but also to expanded infrastruc- tures, rising incomes and better nutrition, sanitation, literacy and opportunities Tfor women. The average life expectancy at birth has increased globally by almost 20 years, from 46.5 years in 1955 to over 65 years in 2002. But while health has improved world- wide, progress is slowing and gaps are widening. The global health pattern today is one of extreme diversity and inequity, with many countries facing a double burden of infectious diseases and increasing rates of noncommunicable diseases as people live longer. In many countries the fundamental conditions for health have not been achieved: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. Long-standing gaps between the health status of the wealthy and that of the poorest segments of the population are increasing. Urban-rural gaps remain wide, and in some countries HIV/AIDS is drastically reversing hard-won gains to health. ◆ The Millennium Development Goals As countries came together to establish the United Nations Millennium Develop- ment Goals (MDGs) in the year 2000, they were facing daunting challenges in health and development. They were also facing the impact of the growth of technological capabili- ties, rapid urbanization and environmental changes, and major shifts towards decentral- ization and community-based initiatives. These changes occurred in a world of revised expectations about the role of government: that the public sector has neither the finan- cial nor the institutional resources to meet their challenges, and that a mix of public and private resources is required. This was accompanied by a shift to a more people-centred approach to development. Where physical and financial capital were once seen as critical constraints, social capital became the factor seen as limiting holistic, integrated devel- opment. ◆ Health and ICT are closely linked The Millennium Development Goals place health at the heart of development. At the time, countries were unprepared for the acceleration of the HIV/AIDS epidemic, the emer- gence and resurgence of infectious diseases, and the rising threat of terrorism. What has also changed in the years since the MDGs were ratified is the awareness of the impor- tance of information and communication technologies (ICT) in meeting health targets. And while ICT diffusion was one target to be achieved in the MDGs, it was not linked to health in any substantive way. Today, health is increasingly seen as a driver for – as well as a beneficiary of – ICT development in countries. 3 ◆ A common purpose Effective action to improve the health of populations is possible in every country. But beyond the global vision of the MDGs, it takes local knowledge and joint action to turn that possibility into a reality. This report, prepared for the second phase of the World Sum- mit on the Information Society, outlines the opportunities for ICT in health and actions needed to realize this. Ministries of Health play a pivotal role, not only in meeting people’s needs for care and protecting public health, but in preserving health systems through turbulent and uncer- tain times. Ministries of Information Technology and Telecommunications are key to de- velopment in all spheres, and can make a vital contribution to the health sector. Common goals and a predictable ICT environment enable coordinated action: building consensus on policy, and facilitating better use of resources, involvement of the private sector, and sound investment in ICT skills and infrastructure to benefit health. Life expectancy at birth, 2003 <50 years 50 to 70 years >70 years Source: The world health report 2005. Geneva, WHO, 2005. II. Towards new health paradigms: eHealth 4 ◆ ICT is changing health care delivery... dvances in ICT have yielded substantial dividends to individual and public health. From the local level to the national level, ICT is changing how health care is de- livered and how health systems are run. Today,
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