AIDS, breast cancer, Ebola virus, plague; we read of these
epidemics daily. Yet since 1900, for developed and developing
countries, there has been a 25 year increase in life expectancy, the
most rapid improvement in global health in history. Despite dire
predictions, the world is in the best health ever. How has this been
accomplished and how can we maintain this remarkable progress in the
next millennium? Many think the improved health is due to better drugs,
surgery, and diagnosis. This is not so. Almost all the improvement has
been the result of public health: surveillance, sanitation, nutrition,
changing lifestyles, etc.( 1) We in public health
should be proud of what we have accomplished.
Public health is the transfer and exchange of information: we collect
data, do surveillance, transmit the information, and communicate with
people. Information is the infrastructure on which public health is
built, but it is a rickety, old, and expensive infrastructure as the
technology in use, telephone and postal systems, is ancient. The new
telecommunications technologies, however, are a million times faster
with an enormous carrying capacity and are inexpensive, as illustrated
by Boussard et alwith the
Internet.( 2) This initiative is one step
towards an Internet based telecommunications infrastructure to support
disease monitoring. This approach should be expanded so that the
disease monitoring systems for all diseases can be used such that we
can monitor diseases in much the same way as we monitor the
weather.( 3)
A discipline of telepreventive medicine needs to be
established.( 4) Telepreventive medicine is
characterised by low band width information transfer reaching large
numbers of healthy people for prevention. This is in contrast to
telemedicine, where high band width information is collected-such as
for pathology slides or magnetic resonance images-on a small number of
people for cure. Telemedicine is a footpath, but telepreventive
medicine is the autobahn to improved health. We need cyberdoctors,
people trained in both public health and telecommunications, as well as
people trained in telemedicine. These teleprevention information
specialists could be the backbone of global health in the 21st century.
In the 20th century there have been two preventive eras leading to
improved health-sanitation and immunisation. In the 21st century the
third era will begin, that of teleprevention.
Global Health Network
(http://www.pitt.edu/HOME/GHNet/GHNet.html)
Correspondence
to: Dr R E LaPorte,
Department of Epidemiology,
University of
Pittsburgh,
Pittsburgh,
PA 15213,
USA
(email
rlaporte@vms.cis.pitt.edu).
REFERENCES
1 World development report 1993; investing in health.
Oxford: Oxford University Press, 1993.
2 Boussard E, Flahault A, Vibert J-F, Valleron A-J.
Sentiweb: French communicable disease surveillance on the worldwide
web. BMJ 1996;313:1381-3.
3 LaPorte RE. How to improve monitoring and forecasting
of disease patterns. BMJ 1993;307:1573-4.
4 Aaron DJ, Sekikawa A, Libman IM, Iochida L,
Barinas-Mitchell, LaPorte RE. Telepreventive medicine. MD
Computing 1996; 13:335-8.
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