Empowering People and Organizations through Information

It gives me pleasure to contribute the foreword to this special issue of the Journal of Health Communication, “Meeting the Information Needs of Health Care Providers, Program Managers, and Policy Makers in Low- and Middle-Income Countries.” The Journal has a long history of documenting the evidence on the role of information and communication in achieving health goals. This special issue contributes to this knowledge base and to the mission of the Journal by documenting evidence from field research that health information for all is a prerequisite for achieving universal access to health for all, and of course, the Millennium Development Goals.

Individuals and organizations are enabled and empowered to make better health care decisions through better access to and use of health knowledge. As Sir Muir Gray stated, “Good health is essential to human welfare and to sustained economic and social development. Knowledge is the enemy of disease, the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade” (Gray, 2007).

The Constitution of the World Health Organization (WHO), adopted by the International Health Conference held in New York in 1946, stipulated the following:

The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health and that informed opinion and active cooperation on the parts of the public are of the at most importance in the improvement of the health of the people (WHO, 1946).

This still remains valid and is at the heart of the mission of WHO and its member states.

The World Report on Knowledge for Better Health reported that knowledge is needed to strengthen health systems, which will be necessary to meet Millennium Development Goals to guarantee equity and quality (WHO, 2004). The report focused on health systems strengthening through research, and it equally emphasized the need to make health information available, accessible, and relevant to people's health needs. In 2005, the 58th session of the World Health Assembly issued a resolution urging member states “to establish or strengthen mechanisms to transfer knowledge in support of evidence-based public health and health care delivery systems and evidence-based health-related policies” and asked the WHO director-general “to assist in the development of more effective mechanisms to bridge the divide between ways in which knowledge is generated and ways in which it is used, including the transformation of health-research findings into policy and practice” (WHO, 2005).

Health is an information-driven and knowledge-based sector. Without evidence-based, timely, up-to-date, relevant, easy-to-use, and affordable information, the health care provider will not be effective in delivering health care to those who need it. The six building blocks of health systems (i.e., health service delivery, health workforce, health information systems, access to essential medicines, health systems financing, and leadership and governance) are all knowledge based. Knowledge gaps in any of these building blocks will result in low-quality health services, unqualified and inadequate numbers of health care professionals, weak data collection and utilization systems, underfinancing of and overspending on health, leadership based merely on opinion and intuition, and misinformed governance that lacks accountability and transparency. Lack of knowledge leads to mistrust and wrong decisions by individual citizens and organizations.

The attempt to identify health information needs on the basis of research is one that is applauded and worth supporting and repeating in more countries and in different regions. The changing nature of health information according to the role played by the health care provider requires more dynamism in handling that information as part of a global knowledge system and makes the research process a strategic endeavor.

Information can be categorized in different ways depending on aspects such as user needs, sources, format, urgency, and applicability. One way to categorize information is as follows:

1.	Technical and scientific medical information in resources such as books, journals, reports, patents, theses, and websites
2.	Clinical information in medical records and laboratory reports
3.	Management, financial, and human resources information in management information systems
4.	Statistics and surveillance data in health surveys and health statistics databases
5.	Public information for health promotion, health education in media, press, and consumers websites
6.	Personal information in health records and other demographic information systems

By taking HIV/AIDS information as an example and applying the aforementioned categorization, it is possible to see clearly that different health care providers need different types of HIV/AIDS information. Those who offer training on HIV/AIDS to other health care providers need different information than do those who treat HIV patients. Those who manage the disease need statistics on its epidemiology, while those who are in charge of financing and management of program resources need to know the cost of drugs and how to deliver them. The general public needs to understand the health risks, economic burden, and behavioral issues attached to HIV/AIDS.

Learning organizations depend on information and knowledge to deliver their services and products and to continue improving their performance. When it comes to individuals, there has been enough evidence to confidently declare that access to and use of health knowledge influences the health of the individuals. Elo and Preston (1996) concluded, “Evidence shows that education is protective of health: An additional year of education reduces mortality rate by about 8% in rich countries.” They added that “since a year of education also increases earnings by 8% on average and since income reduces mortality independently of education, education reduces mortality twice over, once directly and once through additional earnings.” This issue touches on the social determinants of health, with one major contributor being education and access to information.

A study by Shariff and colleagues (2008) concluded, “The provision of necessary nutrition knowledge and skills to children in promoting healthy dietary behaviors is integral to long-term health and nutrition of children as dietary behaviors established during childhood may well extend into adolescence and adulthood.” A preliminary study providing a crude analysis of the relationship between gender status and human development and maternal mortality suggested a strong relationship between female literacy and education levels and maternal and infant mortality (McAlister & Baskett, 2006). Programs aimed at providing medical care to reduce maternal and infant mortality may have limited success unless carried out in parallel with improved availability of education for women. Goldman and Smith (2011) concluded that the value of education in achieving better health has increased over the past 25 years, both in protecting against onset of disease and promoting better health outcomes among those with a disease.

The Internet has been recognized as a major and strategic source of health information. A report to the United Nations Human Rights Council on trends and challenges to the right of individuals to receive and express information through the Internet concluded, “The Internet is one of the most powerful instruments of the 21st century for increasing transparency in the conduct of the powerful, access to information, and for facilitating active citizen participation in building democratic societies” (United Nations, 2011). The report concluded:

Given that the Internet has become an indispensable tool for realizing a range of human rights, combating inequality, and accelerating development and human progress, ensuring universal access to the Internet should be a priority for all States. Each State should thus develop a concrete and effective policy, in consultation with individuals from all sections of society, including the private sector and relevant Government ministries, to make the Internet widely available, accessible and affordable to all segments of population (United Nations, 2011).

This has led the United Nations to discuss access to the Internet as a human right.

Three challenges need to be considered when using the Internet as a source of health information: quality of health information on the Internet, information and communication technology infrastructure, and ability to translate information to policy and action. While many reliable and well-referenced websites attempt to provide high-quality information services and content, the end user may encounter certain risks that result in less than optimum utilization of health information. This can happen for a number of reasons, as described by Berland and colleagues (2001):

	language and complexity barriers
	inappropriate audience or context
	unavailability of certain services or products in certain parts of the world
	difficulty in interpreting scientific data
	accuracy and currency of information
	potential for source bias, source distortion, and self-serving information.

The studies in this special issue provide valuable insight on the health information needs in three countries and an overview of the global knowledge system. To make that system effective and responsive to the health information needs of different health care providers, a few suggestions are put forward for countries and the donor community to consider.

1.	Develop national health information policy and strategies.
2.	Enhance and build knowledge networks.
3.	Build capacity for knowledge management.
4.	Build capacity for knowledge translation, specifically to translate evidence to policy and practices and to contextualize content to fit different needs.
5.	Recognize and strengthen the role of intermediaries including health science librarians, information brokers, editors, web masters, and clinical librarians.
6.	Consider multiple formats when sharing and disseminating information, including print and electronic (Internet, web, mobile phone).
7.	Develop guidance for developing quality health information on the Internet and criteria to assess quality.