Information in practice

Commentary: Telepreventive medicine--the autobahn to health

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{at}vms.cis.pitt.edu).

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 al with 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.

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. [Free Full Text]
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.