Global health: where are things heading? And what does this mean for health information professionals?

For academics summer is a time for reflection and taking stock. Hence, it seems like an appropriate time for me, the person who developed this column, to do some soul searching and to share my thoughts with our readers. The pessimistic side of me does from time to time wonder whether issues of globalisation, international trends and the wider world of health information management are really of direct interest or use to the jobbing health science librarian preoccupied with budgets, collection management and staff training. Do librarians really want to learn about what is happening in far away corners of the world, let alone spend time reading about a field called health informatics which seems to want to lay claim to much of the domain traditionally occupied by information scientists and health science librarians? As it takes considerable thought and effort to keep a column going, a commissioning editor needs to believe in the importance of the topic and its relevance to the journal. When faced with doubts I console myself with the thought that whilst many busy journal readers may bypass this column or mark it as something to browse when they have some free time, those who do engage with the material may be stimulated to think about their professional practice and priorities. So, how may the themes of globalisation and health informatics help to inform the work and career development of health science librarians? And what do librarians have to contribute to problems associated with globalisation? In this piece I will explore developments in global health using ‘pandemics’ as an illustration of the way in which changes in the world create new challenges and opportunities for those working in the field of health information. Since this column was launched in 2007, the topic of global health has grown in prominence, attracted the attention of the media, politicians, academics and non-governmental organisations (NGOs). The developed world is showing renewed interest in improving the health of populations in the developing world, driven not just by altruism but also self-interest. ‘Tackling the developing world’s diseases has become a key feature of many nations’ foreign policies over the last five years, for a variety of reasons. Some see stopping the spread of HIV, tuberculosis (TB), malaria, avian influenza, and other major killers as a moral duty. Some see it as a form of public diplomacy. And some see it as an investment in self-protection, given that microbes know no borders.’1 (emphasis added) As Garrett’s comments suggest, health policy is no longer strictly a national issue, but has spread into foreign policy. The recent outbreak of swine flu is a case in point. In the late 1970s, leading health officials announced ‘the end of major epidemics’. But the situation has been reversed after 30 years of demographic growth and global development. Not only are old scourges such as tuberculosis and malaria reappearing, but new pathologies are emerging and threatening the world with global pandemics. Although the nature and causes of their development are varied, they have all appeared in the new context of globalisation.2 On 11 June 2009, the World Health Organisation (WHO) declared a pandemic as a result of ongoing community-level outbreaks of swine flu in many parts of the world. The rapid spread of swine flu has highlighted the importance of robust public health systems. With more mobile populations diseases can spread in hours, necessitating a radically different approach to pandemic control. Information networks are essential to provide intelligent information to public health personnel on how they can efficiently respond to emergencies and health crisis across the country. Being able to monitor risk, identify potential carriers and share this information locally, nationally and internationally are at the heart of controlling potential pandemics. In turn, accurate information must be at the heart of this approach. And given the speed at which disease can spread, information has to be as near to real time as possible.3 Governments around the world are commissioning systems to track the spread of swine flu and systems to inform the public about how best to self-manage flu symptoms so as not to overwhelm health services. Politicians are under pressure to provide the public with up-to-date information about the outbreak and how to cope if they contract the flu: ‘It is absolutely vital that the public have access to a reliable source of information on swine flu to provide reassurance and to take the pressure off GPs surgeries.’ (Norman Lamb, the Liberal Democrat health spokesman).4 In the UK official websites have been set up together with telephone call centres. According to the Health Minister, Andy Burnham: ‘The National Pandemic Flu Service will give patients access to information and antivirals as quickly as possible. It will free up GPs so they can focus their efforts on helping those in at risk groups and patients with other illnesses.’5 In the UK the provision of patient-oriented information has been beset by political controversies and technical problems. Soon after it was launched, the national online flu assessment website, designed to give sufferers direct access to anti-viral drugs, collapsed under the weight of demand immediately after being launched. The pandemic flu service site received more than nine million visits an hour—or 2600 a second—after being activated at 15:00 hours.4 Although Western countries struggle to provide information on pandemics to ministers, clinicians, managers and the general public, developing countries experience far more problems. According to one expert,6 it is in countries where health systems and structures are inadequate that new viruses are most likely to spread unchecked and take the greatest toll on lives (Fig. 1). Screen shot of UK Website providing information on swine flu (http://www.direct.gov.uk/en/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_178842.htm) The challenge a pandemic poses for governments and healthcare systems is enormous. What skills and expertise does the LIS community have to offer? To paraphrase the NLM,7 health libraries do not actually treat patients, investigate disease outbreaks, clean up toxic spills or conduct clinical trials. Nonetheless, they can produce innovative and robust information systems and services that assist all of these activities. By conducting and supporting research and development projects related to disaster information management, the expertise of librarians will be useful to those involved in disaster planning and management. As information specialists, there are various ways in which librarians can assist in preparing for pandemics—by providing information for clinicians, service managers, researchers and the general public; by creating new resources; by supporting and participating in research; by assisting with education and training. Here are some specific examples of ways information professionals can help deal with such public health crises. (1) Improve the quality of information. The most immediate contribution librarians can provide would be to ensure that the information disseminated both to professionals and the public is reliable and evidence based. In addition, librarians understand issues relating to information literacy and can offer input about the accessibility of materials aimed at the general public. (2) Improve information retrieval methods. Much of the literature relating to global health has tended to be fragmented and dispersed. Librarians can improve information retrieval by helping to design databases and ensuring that users are aware of these services and trained to make effective use of such resources. Two examples are the Global Health database and the Global Health Archive, which provide extensive coverage of all aspects of public health at both the international and community levels. The Global Health database is a specialist bibliographic, abstracting and indexing database dedicated to public health research and practice. It has a controlled vocabulary indexing designed to improve retrieval.8 Aalai et al.’s preliminary comparison of CABI’s Global Health database and medline found that the Global Health database held a high proportion of unique records in comparison with medline. They suggest that the Global Health database is complementary to medline in the subject areas of public health and global health.9 (3) Develop Resources, Build Specialist Collections. The McGill Library in Canada has developed a wiki, the Global Health Resource Guide, which aims to promote collaboration as well as share information and resources within the industry.10 Stanford University in California has set up a Global Health Portal.11 (4) Contribute to education, training and professional development. Health Librarians have a long history of contributing to education and training. Universities around the world are setting up programmes with the words ‘Global Health’ in the title. Librarians should be involved in these academic programmes—helping to design the curriculum and the resources; providing teaching and evaluating the outcomes. My impression is that in the USA librarians have spotted this opportunity and are helping to shape these programmes. I am not so sure that the same is true in the UK and rest of Europe (Table 1). (5) Conduct research. There are opportunities for librarians to get involved in both basic and applied research. One area which is probably worth investigating is the information needs of those who deal with pandemics. What sort of statistical digests do they require? What sorts of policy documents would help them cope? The information needs of the general public also need to be explored. Such research could provide evidence as to the types of specialists services would be valued by front-line workers. Writing at the time of the earlier avian flu in 2005, Klaus Stöhr noted that substantial gaps in knowledge means the ability of science to guide policy is imperfect at a critical time.12 He observes that information is urgently needed, in the short term, in five research areas: case management and hospital infection control; clinical research on the immunogenicity of vaccines for pandemic influenza; early interventions to slow down the spread of emerging pandemic viruses; the role of various animal and bird species in the epidemiology of influenza viruses with pandemic potential; risk assessment. The National Library of Medicine in the USA has created a Disaster Information Management Research Center.13 The aim of this centre is to provide access to quality disaster health information to the nation at all stages of preparation, response, mitigation and recovery. The assumptions behind this initiative are twofold: there is increased need for disaster health information; libraries have the potential to be a major resource during disasters. The Disaster Information Management Research Center is tasked with the effective collection, organisation and dissemination of health information for natural, accidental or deliberate disasters. One point which had not occurred to me when I began to research this article was the need for libraries (especially medical libraries serving a large clinical population) to have a plan as to how the service would cope in the event of a pandemic. How can libraries ensure continuous access to health information and effective use of libraries and librarians when disasters occur? What measures can libraries take to keep resources and core services available to their patrons even if their buildings are closed? The NLM Archive for the ‘Pandemics/Epidemics’,14 offers some very specific suggestions: have an alternate home page ready, to show altered hours, to highlight online resources, and to offer online chat services to patrons who need help; remember to change the voice mail message on your library’s main telephone to reflect changed hours and availability of online resources and services. A number of medical libraries have produced templates and tool kits which can be adopted to meet local needs.15, 16 Organisations which anticipate the future are most likely to survive and prosper in times of change. The same is true for professionals—those who look beyond the pressures and deadlines of today, and try to imagine what the future is likely to bring are those who are more likely to become future leaders. Professionals need to have vision—for health science librarians that vision needs to embrace developments in global health and the tools and methods of health informatics.

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