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..