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Here is the text of what I said at the IMIA meeting.. given I was there as chair of the group, I think it only right I let people know.. Information systems design and health in the world of global knowledge: a contribution to the IMIA debate. John Lindsay Reader in Information Systems Design Kingston University Chair, British Computer Society Developing Countries Specialist Group Information for Development Co-ordinating Committee Many thanks for inviting me to participate today, and I bring greetings from the BCS and the Information for Development Forum, welcoming you to London. What are we to say about health in the time of global knowledge? Boxes and books One of the first things I learned about information and the new information and communications technologies (ICT) is that there is a world knowledge gap between the people whose specialism is information, those we called librarians, and those concerned with the computer. I've referred to this as the divide between the boxes and the books. We are unfortunate in having at least six distinctly different meanings attached to the word information so some how or other, as a community, we have to work out what we mean. When we introduce systems perspectives it becomes more difficulty. Development and health Third world activity is always a tiny minority of the interest of first world professionals, except for those whose specialism is third world development. Information practitioners are also always a small minority within the domain they practice. In Europe my experience is that not many health practitioners with a development angle are active within the development community. There is a Health Informatics Forum but it does not participate in the Information for Development Forum. At the level of the European Association for Development Institutions Information Management working group, there is not an health presence, and I suspect here at IMIA there is not a strong development orientation. Professionals and citizens I'd like to draw a further distinction. When it comes to health, as professionals we are both within our own core discipline, professionals and citizens. What do I need to know about my own health? What obligation do I have to my fellows to maintain my own health, that of the immediate environment around me, and the wider environment? What rights do I in turn have and what right have I to expect from my fellows? All our associations have some sort of charter which put on us obligations which are not those of all members of civil society, and health must be the area where the public and the private most interconnect? Urban And one point further still, that my concerns are with the role of information systems design in the management of cities, but most development interest has been with the rural while most politics and economics is concerned with nation states. What is the nature of health management in large urban spaces, and in particular those large urban spaces of the poor in developing countries? Globalisation and development I make these introductory remarks in the context of the white paper recently published by the Department for International Development in Britain, www.globalisation.gov.uk. That emphasises the role of pro poor policies. That I support. So what would pro poor policies in urban management for information systems design in health in big cities in developing counties look like? And let us remember that now more than half the world's population live in cities. It also calls on all people of moral conscience to join a political fight against cynicism and negativism, (Making globalisation work for the world's poor is the greatest moral challenge facing our generation. This too I support. What is pro poor and how is it measured; and secondly in the establishing of our own practices, how do we do it? By appealing to people of moral conscience, we have to take an interest too, not only as professionals but in our political lives. I must admit I am a little puzzled by this idea of an appeal to people of moral conscience. I can't imagine that there is anyone alive who would claim to not be one? Pinochet presumably is one? So is Mandela? And Thatcher? And Blair. And Short? And Bush. So it encompasses a wide category with lots of capacity for proof. Good rich stuff for information systems designers. But is seems a challenge to which our professional societies must respond. There is an extra challenge for the information community. The Prime Minister in his foreward specifies "get increasing access to modern knowledge and technology". Claire Short in her foreward says she has "set out an agenda for managing the process in a way that could ensure that the new wealth, technology and knowledge being generated bring sustainable benefits to the one in five of humanity who live in extreme poverty. This is our bundle? One section is quite specific: o Promote better health and education for poor people, and harness the new information and communications technologies to share skills and knowledge with developing countries. Research One section of the white paper is about research and enjoining that to be pro poor. As information systems designers we then have two angles to deal with, the first being the pro poor research, the second being the knowledge organisation and information management. But those of us who are information systems designers have also to be interested in what role the actual Information systems design plays and it immediately seems to me that water, waste, shit are what health is about above all else. Electronic health One more thread we will need to add, for now electronic commerce, electronic business, government direct, on line government, open government, different words, but what is encapsulated is the relation between citizen and state and egovernance, or a changed relation between the citizen and the professional. What do we know? So what do we know of all this, and how is our knowledge organisated? That is too long for me to answer here, but in www.communityzero.com/kisup, strengthening the knowledge and information systems of the urban poor we are attempting to bring together what we do know. Community information This means, what do communities know, and what can a community be expected to know? Health must be one of the main components, but there is a relation between work, money, and health. Between education and health, and there is some point where the individual cannot carry complete responsibility, where the community cannot carry complete responsibility. And there is a point where information meets reality, where changing information is not enough. Or rather there are points. One of these I call the Epworth condom. You can have as much information on aids as you like, you can even have the condoms, but if the man wont put it on, what have you achieved? Doctors as specialists I see a special danger with professionals in the context of development: we are privileged. We are inclined to act to defend our privileges. Doctors are particularly privileged. But when it comes to ICT they are citizens like any other, and when we build information systems and they don't understand what it is we are doing, we are creating a spread of difficulty. High technology swatches I am very doubtful of the role of new ICT. I can see what the digital watch has done to timekeeping. I can see even more important the role of the mobile telephone. But neither of these makes the drains clear. It means to me that health is predominantly about the interface between the citizen and the community, and this is a social and organisational thing. There are no organisational swatches. This is where medicine and health are not the same thing. Citizens are not patients. To have a patient focus might be right for medicine, but you cannot have a patient focus for health. To be a patient is an health failure, not a success, so you cannot have health efficiency measured by the treatment of patients. Information systems design (rather than just ICT) is much concerned by what things are. There are no swatches for these concepts. They are not needed, the concepts are so simple already. Regions in third world with first world enclaves There are elements of the first world in third world cities. The professionals in these will have the same interests as others in the first world and will not have a unity of purpose with their fellows. In first world cities there are third world enclaves. First world professionals often have no particular interest in their fellows. But from my view as a system designer, the opportunities presented by the building of the rubbish disposal, voter registration, tax management, money management, retailing logistics distribution, health management, all these exist in some form or other and are capable of being extended at almost no extra cost. The hard work is in the initiation. But this does mean different economic models. Cities and citizens It also means different attitudes to our obligations as professionals who live in cities and practice as professionals. My own interest has become one in walking. Walking as transport, as health, as leisure, as landscape design, in the context of sustainable development, social inclusion. But in a city, I am as unknowing as anyone else. My boyfriend rents a room in a subdivided privately owned house. On Sunday nite he found he had bedbugs and escaped to me. What do I know? What is he to do? These are the simple things which are paralysing. His WAP enabled mobile telephone is not yet of help. Efficient markets effective government The white paper to which I referred earlier enjoins Efficient markets and effective government as its framework. I'm afraid I don't see either of these, or their combination, as having so far produced much in the way of health for the dwellers of the poorest of the poor settlements in the biggest of the big cities of the world. The project I've recently been working on has returned to the role of education, public libraries, community information centres, university settlements, all the lessons of nineteenth century urban development with the appearance that we have learned nothing in the intervening one hundred years. But we now have digitalisation, virtualisation, abstraction, the new ICT and we must work out how to harness it as steam power was harnessed. Ten contributions to a charter In our contribution to the consultation period for the white paper, we suggested ten points: Intellectual property obligations Content and containers Development Information Plan Professional societies Education and training Methods, tools and models IDRC International /information development resource champions Connectivity Open source Governance good practice I'm not going to run over what they mean, if they aren't intuitively obvious, for it is all discussed in the documents on the web site I referred to. I invite you to include these in your action programme and work out whether they are generically useful. I think also we have a need for simple publication which explains information systems in the context of health. Perhaps the draft we have done so far will move us in that direction? Finally I would like to invite you to the EADI meeting in Bordeaux from 12 - 16 September when information professionals will once again be discussing these sorts of things. this is going on globdev..