Surveillance networks are regional and global, and focus on endemic, epidemic and emerging diseases. Probably the most significant example is ProMed Mail. Operating since 1995, health professionals send in news of outbreaks and medical specialists review it and produce edited versions (Zacher 1999b). In addition to these surveillance initiatives, networks of health professionals are increasingly linked internationally through formal and informal contacts (Zacher 1999b). These networks are organized both by geography and by specific disease interest.
ICT is certainly no panacea; the expanded reach of technology is disparate and it follows and exacerbates the global divisions of wealth. Physical access, cost, cultural differences, language and familiarity with technology remain challenges. In the political sphere, the openness that digital communication facilitates in theory often creates diplomatic sensitivities in reality. Most often, this conflict arises around issues related to reporting disease outbreaks. Reports of plague in India in 1996 generated an estimated loss of $1.
7 billion in exports, tourism and transportation services (Lee and Dodgson 2000) and internal panic as people fled the city of Surat. Nonetheless, given advances in the availability and power of ICT in recent years, along with a marked reduction in its cost, such networks will likely remain important components of global health. At the intergovernmental level, barriers to collaboration via ICT are becoming less significant over time, given a focus on standardization and deregulation and the high level of training of those working on intergovernmental relations in health or other sectors.
On the one hand, one may view these initiatives as “band-aid” initiatives that have relatively little value given the complexities of international health problems. One can argue that they reflect a rational model of policymaking, which assumes that a lack of information is a key factor in the globalization of infectious disease (Lee and Dodgson 2000). Under these circumstances, technology-focused international health initiatives favor immediately available, quantifiable knowledge. Information that helps analyze more structural, long-term determinants of health may be omitted.
Nevertheless, the widened availability of digital communication undoubtedly facilitates more communication across borders. For example, a WHO officer can easily communicate with a government official, scientist and field officer no matter where they are in the world. Additionally, transnational communication may have significant social repercussions over time, by transmitting and expanding the paradigm shift from “international” to “global. ” To illustrate, common reporting standards represent a first step towards international cooperation around surveillance.
Through programs such as WHO’s Global Reporting Initiative, national systems of collecting and reporting data, as well as technology acquisition priorities, could be significantly altered. Increased information sharing also nurtures the development of training networks, so professionals can capitalize upon available information and collaborative opportunities. One example is the Training Programs in Epidemiology and Public Health Interventions Network. Through such programs, professionals learn new goals, values and modes of operation.
At a certain point, even “straight-forward” technical cooperation engages the international health community directly with affairs of state. Information sharing may protect against emerging diseases, but only if national governments can be assured economic stability if they report an outbreak. However, while information can be problematic to states, programs such as ProMed constrict governments’ ability to hide outbreaks. Grappling with these challenges may provide new examples of international diplomacy.
For example, Zacher (1999b) points out, “despite many limitations, the [WHO Outbreak] page is a revolution in thinking, since any earlier attempt by the WHO to disseminate information without states’ permission would not have been permitted” (p. 277). At the same time, increasing use of national surveillance systems, particularly the CDC, as prominent agents of global surveillance could raise other interstate issues. References Dodgson, R. , K. Lee, and N. Drager. 2002. Global health governance: A conceptual review. London: Centre on Global Change and Health, London School of Hygiene and Tropical Medicine.
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