BMJ  2004;329 (17 July), doi:10.1136/bmj.329.7458.0-h

Editor's choice

Health information for all by 2015?

In my increasingly desperate search for originality in editor's choice I've come up with something devilishly simple: choose something from the Lancet. I urge you to read "Can we achieve health information for all by 2015?" by Fiona Godlee and others, which was posted on the Lancet website on 9 July (http://image.thelancet.com/extras/04art6112web.pdf). This move isn't quite as crazy as it seems as the article is free, hugely important, written in part by a BMJ employee, and coincides with a meeting held this week in BMA House.

The meeting marked the tenth anniversary of our first meeting to bring together and learn from groups who were trying to improve the flow of health information to the developing world. The meeting spawned the Health Information Forum, which played a central part in producing the Lancet paper. It was commissioned by the World Health Organization in preparation for the Mexico Summit on Health Research in November.

Ten years ago the supply of health information to the developing world was appalling. Many medical schools had no current journals. Textbooks were out of date, stolen, or destroyed. Internet access was almost non-existent. Worse, major international bodies like WHO didn't see information supply as essential. It was more a "nice to have."

Today—despite the explosion of the internet and the commitment of WHO and others to fix the problem—things are not much improved. "Overall," says the Lancet article, "there is little if any evidence that the majority of health professionals, especially those working in primary health care, are any better informed than they were 10 years ago." The 10/90 gap, whereby less than 10% of health research is concerned with the conditions that account for 90% of global disease, may well be a 1/99 gap when it comes to health information. Doctors in the rich world are drowning in information; health workers in rural Africa have no more than 10 years ago. Journals may be more part of the problem than the solution.

The article discusses ways to close the "know-do gap," the huge gap between what evidence shows is best practice and what practitioners actually do. If you haven't heard this phrase, you can rest assured that you will do so repeatedly, not least because the developed world also has a substantial "know-do gap." (Indeed, I have one personally, as, I'm sure, do most of you.)

Closing the gap requires not exhortations for everybody to try harder and spend more money but some "systems' thinking." The article describes an information cycle that identifies 13 steps that have to do with identifying health information needs (a commonly missed step), adding to the body of knowledge, synthesising the knowledge, and then localising it. The model is helpful, and with WHO's lead and help from the broader community the goal of health information for all by 2015 is "realistically achievable."