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THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION

Theme articles

Getting the message across 3 Hiroshi Nakajima A new strategy to empower

people in Africa 4 An Internet forum for the management of disasters? 6 Patricio Bittner 8. Claude de Ville de Goyet

Using electronic links for monitoring diseases 8

Joan Dzenowogis A library without walls 10 Yvonne Grandbois 8. Barbaro Aronson Health and the media: uneasy partners? 12

Philippe Stroot Helping scientists to improve their

communication skills 14 Jitendro Khanna Kick polio out of Africa! 15 Peace through health in Bosnia

and Herzegovina 16 Gregory Hess Breaking down the barriers to

health information 18 Neil Pokenhom-Wolsh 8. Carol Priestley

STOP AIDS 20 Markus Allemonn The influence of Al DS Today radio 22

Jomes Deane Soul City 24 Sue Armstrong Sport sponsorship 26

Addy Carroll Media advocacy for public health 28

Simon Chapmon

Features

News from the Regions Reaching out by radio 30 Polio will soon be history in the Western Pacific 30 WHO publications 31

World Health • 50th Year, No. 6 November-December 1997

IX ISSN 0043-8502 Correspondence should be addressed to the Editor, World Health Magazine, World Health Organization, CH-1211 Geneva 27, Switzerland, or direcrly to outho~, whose addresses ore given at the end of eoch article.

for subscriptions see order form on page 31.

HEALTH

Photo WHO/H Anenden

World Health is the official illustrated magazine of the World Health Organization. It appears six times a yeor in English, French and Spanish, ond four times o year in Arabic and Fo~i. The Arabic edition is available from WHO's Regional Office for the Eastern Mediterranean, P.O. Box 1517,

Alexandria 21511, Egypt. The Fo~i edition is obtainable from the Public Health Committee, Iron Univmity Press, 85 Pork Avenue, Teheron 15875-47 48, Islamic Republic of Iron.

page 12

© World Health Organization 1997 All rights reserved. Articles and photographs that ore not subject to separate copyright may be reproduced for non-commercial purposes, provided that WHO' s copyright is duly acknowledged. Signed articles do not necessarily reflect WHO's views. The designations employed and the presentation of material published in World Health do not imply the expression of ony opinion whatsoever on the port of the Organization concerning the legol status of any country, territory, city or oreo or of its authorities, or concerning the delimitation of its frontiers or boundaries.

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World Health • SOth Year, No. 6, November-December 1997 3

Editorial

Getting the message across

I

nformation and communication are at the very heart of the work of WHO. The Organization was established in 1948 with a mandate

"to act as the world's directing and coordinating authority" on questions of human health. For this, good communication is indispensable.

As our Constitution points out,

"informed opinion and active coop- eration on the part of the public are of the utmost importance in the improvement of health".

WHO's natural partners in dialogue have always been the scientific community and ministries of health.

Set up in the wake of a devastating war, the immediate need was to assess the health situation in countries and suggest ways of dealing with the most pressing health problems. Using the conventional tools of epidemiology, the Organization began building what has become, over the years, one of the world's most comprehensive and authorita- tive data banks on health and disease.

It did this by establishing links with individuals and institutions in the scientific community to gather and synthesize information from the field and define the many kinds of action required to meet global health needs.

The fact that it is people themselves who must be at the centre of health policy was fully recognized by our Constitution, and it has gained worldwide acceptance over the years.

It implies the need to communicate more fully and clearly with the public. This public today is extremely diverse, making it especially important to remember that scientific data - no matter how sound - are not a universal currency. To be accessible and meaningful, information must be couched in terms that take into ac-

Dr Hiroshi Nakajima, Director-General of WHO Photo WHO/H. Anenden

count the culture and priorities of the target audience. Effective communication starts with listening to others, and this must be the guiding princi- ple behind all our work.

In the field of research, for example, agendas must be set not by scientific curiosity alone, but by public health needs established through widely inclusive dialogue.

Furthermore, we should remember that data become information only when they have been validated and organized, and information becomes knowledge only when it has been analysed and interpreted. A great deal of unnecessary confusion results when any of these steps are left out.

Regarding epidemiology, I have frequently stressed the need for a new approach: in addition to the routine gathering of data on disease, epidemiologists today should be prepared to analyse trends and provide advice for policy-making.

Our most direct communication with the general public is through advocacy, and here we are constantly responding to changing needs. WHO produces a wealth of information

materials aimed at different audiences, and in 1995 these were aug- mented by the first edition of our annual World Health Report offering an up-to-date picture of the global situation and trends, and highlighting the most urgently needed action.

Profound changes are occurring as a result of the revolution in information technology, which brings new opportunities as well as new pressures and responsibilities. The increasing speed and volume of communication open up entirely new possibilities for health care. They have also helped to make the public more demanding, discerning and assertive while enabling us to engage in more active dialogue with all our partners.

With the continuous increase in the dissemination of information, WHO today has a special responsibility to ~ake sure its messages are not only scientifically and ethically sound, but as clear as possible. As an intergovernmental authority on health, the Organj.zation's duty is to provide health messages that are both reliable and universally relevant. We depend on our partners at every level of society to make them locally meaningful, and in these pages you will get some insight into the many imaginative ways in which they are fulfilling that task. •

Hiroshi Nakajima, M.D., Ph.D.

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4 World Health • SOth Year, No. 6, November-December 1997

A new strategy to empower people in Africa

T

he African Region is caught in a downward spiral in which the poor health of the population is undermining economic performance, and the resulting poverty means there is less and less being spent on health care. The health infrastructure in many countries is in a dire state:

hospitals, clinics, health centres and dispensaries have become dilapi- dated and often lack the most basic equipment and drugs. Many facilities are also short of staff. New diseases such as HIV I AIDS are emerging, and old ones like malaria, tuberculosis and diarrhoea are putting a greater burden on the health care system.

Reversing this trend calls for imagination and the careful use of scarce resources. Information, education and communication have a crucial role to play in this regard and are among the most cost-effective interventions for health. Their importance is recognized in the

Constitution of the World Health Organization and has been under- lined many times over the years by resolutions of the World Health Assembly. Yet despite a number of initiatives, they are still very far from being used to their full potential.

A great deal of information exists in research and medical institutions and organizations such as WHO and ministries of health which, if it were made available to people in a form they could understand, would enable them to take better care of their health, prevent diseases, and cope effectively with many problems without recourse to the health services. But at present only a small proportion of the population has access to such information. Analysis of the current situation offers some explanations.

The greatest need for health information is in the rural areas where the majority of people live.

Immunizing a child in Malawi. Target population groups would benefit more from health services if they were better informed about health. Photo Environmental lmages/5. Morgan©

Yet the mass media on which much responsibility lies for disseminating such information are largely urban- based and cater predominantly for an urban audience whose needs they understand. Reaching rural audiences is a challenge. Distribution of printed material, including newspapers, in rural areas is often difficult because of poor roads and transport systems and lack of adequate provi- sion in the budget of information programmes. Moreover, rural people tend to have limited access to television and radio.

Language, too, may be a barrier to effective communication. With the exception of a few countries, official languages in Africa differ from the languages most people use

in their everyday lives. In spite of this, health information material is produced mostly in English, French or Portuguese, which may be appropriate for the people running the programmes but not for the target audiences: they need information in their mother tongue if they are to understand it and take heed.

Another major weakness of existing health information programmes is the lack of involvement of the target audience in the process of communication for health. An effective information campaign should start with the assumption that people know best what their problems are and what they need in order to cope with them. They should be involved in setting the agenda, and in

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World Health • SOth Year, No. 6, November-December 1997

creating and delivering the information messages. Much effort is currently wasted on information and education programmes that do not address communities' priority needs, are inappropriate and lacking in credibility and are therefore rejected.

The attitude of professionals may also create barriers to the dissemination of health information. Health professionals tend not to see why technical and scientific information should be made available to people who might not understand it. And media professionals do little to challenge this prejudice because they tend to lack confidence in handling scientific subjects. This means that health workers at grass-roots level are often inadequately equipped with information, materials and communication skills to take advantage of the opportunities offered by regular contact with communities.

Systematic monitoring and evalu- ation of programmes would enable countries to identify weaknesses such as these, and allow timely adjustments to be made. They are crucial elements in successful information programmes and should always be an integral part of their design rather than an afterthought.

In many countries the telecommunications infrastructure is still poor. In 1994, the average number of telephones per 100 inhabitants in Africa was 1.6 compared with 45 in

Europe. As of 1996, only 15 African countries had full access to the Internet. It is now recognized that, used effectively, modern information technology offers Africa and other developing regions of the world the opportunity to leap-frog some of the stages of development by taking advantage of low cost access to the

"information super-highway". The urgent need for new approaches and new policies to ensure that all the people of Africa have access to relevant and timely health information is now well recognized, and the WHO Regional Committee for Africa, at its meeting in September 1997, approved a strategy detailing measures to be taken to make this possible. The new strategy has as its goal full coverage of the population with information, education and communication activities by the year 2010, and the hope is that this greatly improved access to information will bring about changes in behaviour that will result in signif- icant improvements in health by the year 2025.

The principal beneficiaries will be the populations of rural communities and urban shanty towns who are currently neglected. The strategy proposes that all channels of communication be used to reach people.

Thus, besides taking better advantage of modern technology, countries will be encouraged to use traditional forms of mass communication such as music, drama, puppet shows and story-telling. Seminars and work-

s

shops for media professionals are also proposed, to raise their aware- ness of the value of health information and enhance their capacity to interpret and report on such matters.

Institutions that train media staff will be encouraged to include health reporting in their mainstream curric- ula, and media organizations will be helped to set up or strengthen their health desks. The development and prestesting of health information materials in local languages will be promoted. The strategy also proposes that countries be given support to improve the capacity of the information, education and communication units within their ministries of health.

Moreover, the WHO Regional Office for Africa has committed itself to producing information packages on a variety of health topics for use by the media and the general public in member countries. The first of these packages was launched in Harare, Zimbabwe, in July 1997.

Undoubtedly the proposed strategy has ambitious goals. But given political will and the true commitment of countries across the Region, there is no reason why these goals should not be reached, and the deteri- orating health situation in Africa reversed. •

This article is based on documents prepared for technical discussions at the 47th meeting of the WHO Regional Committee for Africa, which took place in Sun City, South Africa, in September

1997

A village in Burkina Faso, a shanty town in Kenya: the main beneficiaries of the new communication strategy will be rural communities and urban shanty towns, which are currently neglected. Photos Still Pictures/M. Edwards ©

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An Internet forum for the management of disasters?

Patricia Bittner & Claude de Ville de Goyet

A city in Nicaragua was destroyed by a hurricane in 1988. Latin America is particularly prone ta disasters; discussions an preparedness will help prev.ent extensive damage.

Photo Panas Pictures/5 Sprague ©

S

ince the early 1980s, the Pan American Health Organization (PAHO) has sponsored yearly meetings of health sector disaster managers in the Americas in an effort to encourage the formation of links. These meetings offer people the chance to share experience and advice and often result in disaster managers pledging solidarity and support to one another's programmes (solidarity after a disaster has never been lacking!). Often, however, the meetings end, time passes and promises fall victim to the reality of heavy workloads, the high cost of telecommunications, and other constraints. Despite the best intentions, communicating is hard work.

But in the 1990s shouldn't we be able to harness the power of the Internet to make communication easier? Isn't electronic mail the tool that disaster managers in Latin America and the Caribbean have been waiting for to overcome barriers to sustained dialogue? WHO's

Regional Office for the Americas, PAHO, thought it might be, and in 1995 launched a project to create an electronic disaster management network in Central America. The objective of the project, which has now expanded into South America, was to improve communication among disaster managers, both within and between countries and to provide access to global sources of information. The idea was not to develop more sophisticated services for the few Internet users but rather to expand the user base by providing access to and training in the

Internet's basic services.

This article is about one of the services set up by the project - an electronic "disaster discussion group". The initial assumption was that simply creating the discussion group would be enough to trigger a flow of communication. But the assumption was wrong. Some major lessons were learned about how to create a successful Internet forum.

What's in it for me?

Some people face a big enough challenge just keeping up with their regular e-mail, and the multitude of specialized discussion groups on the Internet often contributes to information overload. Despite the fact that no Spanish-language discussion group for disaster managers existed in Latin America, creating the framework was not enough on its own to get one going. To attract members, a discussion group must demonstrate a clear purpose and convince people it is worthwhile for them to invest their time.

Corner the market on one topic

Few people have the time to chat idly. Each discussion group should have a clear focus and become a source of specialized and authorita- tive information. Just as successful meetings focus on specific topics and discussions are guided by back- ground documents and knowledge- able moderators, electronic discussion groups must be run the same way. Latin America and the Caribbean are highly vulnerable to natural and manmade disasters; the region therefore has many experts in the field of disaster management - from physicians to structural engi- neers to supply logisticians. This kind of expertise is exactly what is needed to stimulate debate in a discussion group and give weight and credibility to the topic. As a discussion group's membership grows, interests tend to diversify, and administrators can create spin- off groups if necessary.

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Pick a strong leader

Every group needs a strong leader - one who is sensitive to the varying needs and interests of members, is able to provoke discussion and debate, to give encouragement where necessary, and to keep the group on track. The leader, or moderator, should be an expert on the topic under discussion and should set a schedule of subjects that meets the group's needs. Contributions from members, however, are what keeps the group alive!

Users have told us that it takes time to explore the World Wide Web and master the use of the software packages. But time is often short, and people stumble around these software packages becoming frustrated and ultimately not using the tools to the best effect. Time is also money, and in many developing countries it is hard to justify the extremely high telephone charges for on-line time if one is merely "honing" skills. Problems such as this are serious;

they need to be aired and solutions found if discussion groups are to work effectively.

Those who have participated in Internet discussion groups agree they have the potential to transform the way we do business. However, there are a few points to remember.

• We need to consider the human dimension to be as important as the technological dimension. One can start an Internet discussion group in virtually any corner of the world; it doesn't matter where it's maintained or where its members live. The difficult part is providing constant support and motivation to the users so that this tool is used to best effect.

• We need to provide and then follow up training. After the basic training, there must be constant follow-up in the form of formal training, user support and just plain hand-holding. A focal point should be identified in the countries represented by the members to aid in these tasks.

• We need to encourage members of specialized discussion groups

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In the Amazon region of Ecuador, heavy deforestation is the cause of repeated flooding of villages. Forward thinking and good communication could limit such events.

Photo Still Pictures/H Bloch ©

to use the Internet to publish technical information that they have produced. This applies particularly to non-English language material which is in short supply on the World Wide Web and other Internet services.

• We need to communicate periodi- cally with the decision-makers of the organizations represented in a discussion group to reinforce the group's purpose and progress.

This will encourage users and will help to secure the institu- tional backing that is necessary for a discussion group to prosper.

• We need to highlight the initiatives of members, either by fea- turing their concerns as topics of discussion, using the membership for peer review of technical documents, or circulating success

stories and solutions to problems that are common in the region.

On-site meetings are not likely to disappear soon. They offer incentives such as social interaction or international travel that are not found in cyberspace. E-mail discussion groups should be thought of as "ex- tensions" of traditional meetings since, by harnessing the power of the Internet, we can continue to share ideas and pursue common objectives during the off season when face-to- face gatherings are not possible. •

Patricia Bittner and Dr Claude de Ville de Goyet are with the Emergency Preparedness and Disaster Relief Coordination Programme, World Health Organization Regional Office for the Americas/Pan American Sanitary Bureau, 525 23rd Street NW, Washington, DC 20037, USA

Disaster resources in cyberspace

desastres-ca@ops.org.ni: a predominantly Spanish-speaking group on a variety of issues related to disaster management in Latin America

ec_desastresur@mia.lac.net: a predominantly Spanish-speaking discussion group comprised of the South American disaster community. Eventually these two discussion groups will be merged

http://www.paho.org/english/disaster.htm: ^PAHO/WHO^Information on Disasters in the Americas.

http://www.netsalud.sa.cr/crid: the Regional Disaster Information Center, providing an on-line search service through a database of more than ,] 0 OOO

documents.

http://www.netsalud.sa.cr/suma: the Web site of SUMA, a computerized relief and humanitarian supply management project.

http://www.ops.org.ni/desass-ni/db-ped.htm: the first Spanish-language Web site created under the Central American Internet communication project; it contains a database of disaster management specialists in Latin America, and lists of recent disasters and other disaster sites.

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Using electronic links for monitoring diseases

Joan Dzenowagis

O

nly two decades ago there was widespread optimism that infectious diseases would soqn be eliminated. Discoveries in science and medicine brought us antibiotics and vaccines which, along with advances in public health, pest control and sanitation, led to the prevention or control of many infectious diseases.

Today we are seeing a dramatic increase in new diseases, as well as the recurrence and spread of familiar diseases once thought to be under control. There has been a rise in the spread of strains of bacteria resistant to antibiotics, and fresh concerns

have arisen about new infectious agents of animal origin that could infect humans, as in the case of bovine spongiform encephalopathy.

These problems are most severe in developing countries, but the risk is increasing in all countries. It is particularly high where people live in poverty and in the most difficult conditions: crowding and depriva- tion, undernutrition, chronic expo- sure to disease, and inadequate access to health care.

The spread of communicable disease concerns every country.

Internationally, we must build up our ability to track all communicable

India. Women destroy garbage to prevent the spread of plague. Accurate and timely information can avert outbreaks of infectious diseases. Photo Keystone/ AFP ©

diseases of public health importance and respond to them. It is only by consistently following our common and known diseases that we will be able to detect the unusual and respond in time to avoid the devastating consequences of epidemic, or population-wide, disease.

Emerging infectious diseases are diseases that hove either appeared in a population for the first time, or hove occurred previously but are increasing in incidence or in areas where they hod not previously been reported.

Changing environmental conditions, for example, might bring more humans into contact with disease-carrying animals or insects, thus creating on opportunity for disease to infect a new population. Re-emerging infectious diseases are known communicable diseases that were once declining in a population but ore now increasing again.

WHO's Division of Emerging and other Communicable Diseases Surveillance and Control (EMC) coordinates international efforts to respond to communicable diseases.

We are working with many organizations and countries in this effort.

Global information systems are an important part of our work.

Global information

Relevant, accurate and timely information can avert a local or national outbreak and, at the same time, prevent an international crisis.

Global information systems utilize up-to-date communications technology to make sure that information collected through global monitoring

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World Health • SOth Year, No. 6, November December 1997

is rapidly and widely shared.

Developments in electronic communications in recent years mean that we can now use communication networks to collect and analyse data rapidly in order to guide international policies, collaboration, travel and trade. We are working to ensure worldwide sharing of information - through the Weekly epi- demiological record, WHO publications, the Internet's World Wide Web, and other means.

Electronic communications make that information available at any time in almost any place.

Published in electronic and print formats in a bilingual English/French edition, the Weekly epidemiological record is a weekly bulletin covering diseases and health risks around the world, from major communicable and noncommunicable diseases to ill-health linked to working conditions, contaminated food or lifestyle.

The WER is found on the World Wide Web at http://www.who.ch/

wer.

Internet and the World Wide Web(WWW)

We also post Disease outbreak news, a summary of disease epidemics and outbreaks reported to WHO, on the World Wide Web. Our WWW site includes fact sheets with information on diseases of public health importance in the news. ^Itis updated every time new information comes in. The simple, no-frills EMC home page is found at http://www.who.ch/

prograrnmes/emc.

Disease outbreak news ^is available by subscription through electronic mail. This is an automated list enabling subscribers to receive the newsletter weekly. To subscribe to Disease outbreak news, ^send an e-mail message to:

majordomo@who.ch. Leave the subject blank. In the body of the message, type subscribe wer-reh as the only item in the text part of the message.

Tracing disease outbreaks

Rumours of disease outbreaks - whether from health workers, the media, travellers or other sources - spread quickly and can cause_ pu~lic concern or even panic, resulting m severely disrupted travel and trade.

The WHO working group on surveillance has set up a mechanism to investigate rumours of outbreaks and to make this information available as quickly as possible on our Disease outbreak news page. Our procedure is based on sharing information through electronic communications (e-mail and the Internet) linking a network of public health professionals within WHO headquarters, WHO's Regional Offices, country representatives and other groups involved in disease surveillance.

A joint initiative of the World Bank, the United Nations Joint Programme on AIDS (UN AIDS) and EMC will enable us to connect our system of collaborating centres, laboratories and institutions electronically by means of local telephone services, radio-to-telephone, or radio-to-satellite. Once centres are connected, we shall establish mailing lists for priority diseases, such as yellow fever or meningitis, to share restricted information with the collaborating centres. Improved communication and access to information worldwide helps us to be better prepared for disease outbreaks and better able to respond to them.

WHO's influenza surveillance network

Influenza viruses are the focus of the WHO influenza surveillance network which aims to detect new variants early, evaluate their potential to cause epidemics, and estimate how well existing vaccine or antibodies in the population might protect against a new variant. WHO vaccine recom- mendations are published annually and are followed by vaccine manu- facturers worldwide.

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The WHO influenza surveillance network is a specialized network of laboratories that carry out routine disease surveillance. These laboratories can detect influenza viruses that could trigger a pandemic. Linking these laboratories electronically is an essential part of the preparedness plan for the next influenza pandemic.

The laboratories exchange virus strains, diagnostic reagents and information to complete the understanding of influenza during the season. Every week during the influenza season, laboratories provide information which contributes to a global picture of influenz~ epi~e~- ology: geographical location, timmg and extent of activity, age groups affected and laboratory results. This information is analysed and published by WHO in the Weekly epi- demiological record, by fax service during the influenza season, and on the Internet (http://www.who.ch/

prograrnmes/emc/flu).

We have developed FluNet, a prototype Internet WWW site for the electronic submission of influenza data from participating national laboratories. Submissions are possible only by designated users, but the results - graphics, maps and tables of influenza activity on a global scale - are available to the general public.

On submission and verification of data, the maps and summary tables are immediately updated, giving users a summary of the influenza situation. This information is accessible by following links from our home page on the World Wide Web. •

Dr Joan Dzenowagis is a Technical Officer working on lnformotion and Comm_unication Strategy with the Division of Emerging and other Communicable Diseases Surveillance and Control, World Health Organization, I 2 I 1 Geneva 27, Switzerland.

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10 World Health • SOth Yem, No. 6, November-December 1997

A library without walls

Yvonne Grandbois

&

Barbara Aronson

The reference room of the WHO Library in Geneva. Behind this traditional image, information is being received and disseminated at the speed of light

Photo WHO

T

he popular image of a library is of hushed rooms lined floor to ceiling with books through which people leaf in search of information. But this image is out of date.

Today's libraries are at the forefront of the information revolution, busily transmitting knowledge to colleagues and clients around the world using the latest technology. WHO's library is no exception. Our librarians based in Geneva and six regional offices are involved in a wealth of communication activities with a wide variety of clients, from ministries of health, hospitals and international organizations to individual scientists, researchers, students and general enquirers. Our services include sending ready-packaged mini-libraries of vital health information to clients worldwide, running a free exchange service of books and medical journals for other libraries, and training librarians around the world in the latest health science library technologies.

Every week we receive masses of queries and requests for information.

Here is a typical selection of questions and the answers we give:

Our library budget is very limited, and we can't convert it to foreign hard currencies. How can we sub- scribe to international journals for our researchers and purchase the latest textbooks for our medical students?

You can order your books and medical journals through WHO Library's health literature purchasing service, and pay through WHO's Revolving Fund with your local currency. WHO Library will ensure that you get the best value for your money. You may even be able to find some of the items you are looking for free of charge through our International Health Literature Exchange.

Our documentation centre has just been connected to e-mail, and our country should have full Internet capacity by next year. What services can we already have access to, and what can we look forward to when we can enter the World Wide Web?

Through e-mail you can already use our services, including WHOLIS

(for bibliographic records), WHODOC (for information about new WHO publications and documents), and entire issues of our Library newsletters (for professional updates on new technologies and trends). These same services are also available through the World Wide Web (http://www.who.ch), where they are even easier to find.

Of special interest to our colleagues in Africa are AHILANET (African health sciences librarians discussion group on e-mail), our full text WHO Library Digest for Africa, and the African Index Medicus bibliographic database, both on the Web and gopher.

We receive WHO publications at the Ministry of Health. How can we know which one to look in to find the answer to a particular question?

Consult the WHOLIS database and its WHODOC updates available on diskette, paper, or the Internet (gopher and the Web). Write, telephone or e-mail the WHO Library closest to your country for guidance.

Our health dispensary is in a rural area several days' journey from any library. How can our personnel get the information they need to provide the best possible medical services?

Our Blue Trunk Libraries/

Bibliotheques bleues and WHO Documentation Modules can meet your need. They contain basic manu- als and are designed as "instant libraries", ready for use on arrival.

The WHO Library can help you get started.

We know that the health conditions and problems in our area are similar to those in other districts and in neighbouring countries. Is there any way we can share knowledge re- sources locally and regionally?

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How do we communicate?

Besides answering queries the conventional ways - by post, telephone and fax - WHO Library communicates with clients:

* by e-mail:library@who.ch

* through its home page on the WHO Website (http://www.who.ch);

* through its electronic database, WHOLIS, which enables clients to find out what WHO's view is on any health- related topic;

* through its newsletter, Liaison, distributed to health science librarians in developing countries;

* through its WHO Library Digest for Africa, transmitted by satellite to ground stations in Africa;

* through the AHllANET e-mail discussion group for health science librarians in Africa

WHO's Regional Office libraries

organize health information and literature services programmes including training, expert counsel and advice. They also publish indexes - topics, authors and titles each arranged in alphabetical order-to the health and medical literature published in countries of the region. Some indexes are already on the Internet, others are on CD-ROM, or on paper. Regional libraries also run networks for sharing resources.

Contact your Regional Office library to find out more about its activities.

Our institute does research on public health topics. How can we know what WHO has written on these subjects?

Consult WHOLIS on the Internet, CD-ROM, diskette, or paper. This international database indexes all WHO-produced knowledge and information (books, unpublished technical documents, official records, journal articles, CD-ROMs, videos, press releases) from all WHO offices and projects worldwide. •

Ms Yvonne Grandbois is Chief, ond Ms Barbara Aronson is Librarian, Office of Library and Health Literature Services, World Health Organization, 12 11 Geneva 27, Switzerland.

The Library of the University of Dor es So/am. Libraries in the world ore not closed in behind their wolfs: they ore links in o vast network of information, an important port of which spreads precious knowledge about health. Photo Panos Pictures/H. Netocny ©

Libraries at WHO Headquarters and Regional Offices

WHO Headquarters

Office of Library and Health Literature Services 20 Avenue Appia

l 21 l Geneva 27, Switzerland African Region

Regional Office for Africa Library P.O. Box No. 6

Brazzaville, Congo (T emriorary address):

PB. BE773 Belvedere Harare, Zimbabwe

Region of the Americas Regional Office for the Americas/

Pan American Sanitary Bureau Library 525 23rd Street, N.W.

Washington, D.C. 20037, USA Eastern Mediterranean Region Regional Office for the Eastern Mediterraneon Library PO Box 1517

Alexandria -2151 l , Egypt European Region

Regional Office for Europe Library 8, Scherfigsvej

DK-2100 Copenhagen South-East Asia Region

Regional Office for South-East Asia Library World Health House

lndraprastha Estate Mahatma Gandhi Road New Delhi l l 0002, India Western Pacific Region

Regional Office for the Western Pacific Library

PO Box 2932

l 099 Manila, Philippines

Tel (41-22) 791 20 62 Fax: (41-22) 791 41 50 e-mail : library@who.ch

Tel (00242) 83.90.3 l /32/33 Fax: 100242) 83.94.30 e-mail: afrobibl@htsd mail corn Tel: 100263) 4 707 493 Fax (00263) 4 705 619 Tel: (001) 202.974.3000 Fax (00 l) 202. 97 4. 3663 e-mail: library@paho.org

Tel (00203) 48.202.23 Fax (00203)48 38 916 e-mail: postmaster@who.sci.eg

Tel: (0045) 39. l 7. l 7. l 7 Fax (0045) 39.17.18.52 e-mail: msb@who.dk Tel (0091) l l .33 l .7804 Fax (0091) l l.331.8607 e-mail: postmaster@who.ernet.in

Tel (00632) 528.80.0l Fax (00632) 52 l l 036 e-mail: postmaster@who.org.ph

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Health and the media: uneasy partners?

Philippe Stroot

Goodwill and mutual understanding are

indispensable for a new and much-needed partnership between the health sector and the press. But if iournalists are to be effective

intermediaries, they must be given the freedom to do it in their own way.

M

ost of the information that the public receive on health problems comes through the media. This is very obvious as re- gards AIDS, Ebola fever or "mad cow" disease, and it is equally true of "diseases of civilization" linked to such unhealthy lifestyles as smoking, alcohol abuse or lack of physi- cal exercise. But if they serve as vehicles of information, the media also help to propagate harmful ways of life. Especially vulnerable in this respect are those people in developing countries or countries in transi- tion who indiscriminately yearn to adopt "Western" lifestyles.

For evidence of this we need look no further than the ubiquitous advertisements for cigarettes in eastern Europe, both in the newspapers and on giant hoardings. After helping to create new smokers among young people impelled by one-upmanship or unthinking admi- ration for imported novelties, the media in those countries will certainly convey information about the harmful effects of smoking and

Ebola crisis in Zaire. General information about health reaches the public mostly through the press.

publicize the draconian measures taken by other countries to fight against this scourge ...

So the impact of the press, radio and television on public health is a complex affair, but its importance is steadily growing. Every opinion poll that examines what the public wants puts health high among the priorities for readers, listeners and viewers. Yet regular sections or programmes devoted to health problems are far from common in the media, though nobody could possibly imagine them failing to have a section on sport, the weather or celebrity gossip.

It is something of a paradox that information about health should be considered of secondary importance by editors and programme directors when public interest is clearly so strong. One possible explanation is that "medical" news is often judged to be too "specialized" and that journalists themselves may suspect they don't have sufficient knowhow to discuss such topics without the risk of making mistakes. What cannot be denied is that many scien-

tists, particularly in the health field, complain that their statements have occasionally been distorted by journalists.

A shared responsibility

There are wrongs committed on both sides, however; if the press some- times takes these matters too lightly, the specialists too are often ignorant of the ways in which journalists work and the constraints they face.

They may refuse to make an effort to explain matters precisely to inter- viewers who, generally speaking, have rather limited ideas about the subject of the interview. The specialists therefore have to share the responsibility and take pains to ensure that what they say is very clear. The journalists in tum should not hesitate to say so if they have not fully understood and to ask the person interviewed to explain.

With a little effort on both sides, there can be much better collaboration between those whose precious

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findings are vitally needed by the general public (doctors, research workers, specialist groups or international bodies) and those whose task is to transmit that information. In the Swiss city of Geneva, a group called Cultural Encounters brought together experts in various fields to clarify the role of the media in the general context of "scientific and technical culture for all citizens."

One of the participants, a radio journalist, commented that "if the two worlds of science and the media have long had trouble understanding each other, it's because they really are poles apart! The one concentrates on long-term, in-depth, rigorous examination of observations or statistics, while the other necessarily works at high speed and looks for a colourful, simplified and approxi- mate story." What is true for scientific news in general is equally true for news about health. Another participant quoted the huge media attention given to in vitro fertilization - "test-tube babies" - and stressed that "superficial and partial knowledge entails the risk that the general public will see only the trivial and peripheral aspects of an ethical debate which should concern every member of society". The recent excitement about the cloned sheep called Dolly, and speculation about the implications of cloning technol-

I

ogy for human beings, make these remarks particularly relevant.

In practice, officials working in health and members of the press are being driven to arrive at some mutual understanding, the former because they can only improve public health by keeping the public fully informed, and the latter because the public insists on being better informed about health. Ideally this information will consist of much more than the same old advice about nutrition and diet, and will be delib- erately aimed at developing fundamental health knowledge among the general public. This would not only help people to protect their own health better and to avoid what might be harmful, but also to better appreciate the major health problems of our times and to support the efforts being undertaken to counter- act them.

Priority for health

Who is better placed than the press to help the public understand that the battle for health must have top priority, and that any untimely penny-pinching in this domain may put the future at risk? As witness to this risk, take the re-emergence of such diseases as diphtheria in parts of the world from which they had

n- , 1

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Press Conference al the University Hospital in Zurich, Switzerland. By sharing their findings with the media, scientists can contribute lo a better understanding of fundamental health issues.

practically disappeared, simply because the health protection of the public has fallen victim to political and economic upheavals.

13

At a time when information technology is expanding at an un- precedented rate, there is no short- age of technical means to guide public opinion; what is lacking is the willingness of decision-makers to set the right kind of priorities for the information conveyed. Press managers and editors have to decide whether the eradication of polio and the elimination of leprosy, children's vaccination, disease prevention and the advocacy of healthy lifestyles are minor topics compared with the mass of other news items churned out daily by newspapers, radio stations and television channels.

As for those who hold key information about health matters, they ought to make a greater effort to communicate it to the press, always bearing in mind that a newspaper article is not a scientific publication and that they should not expect a journalist to write in the same way as a research worker addressing his or her peers - even if this means that the in-depth detail and strict science may not be perfectly reflected as a result.

Goodwill and mutual understanding are indispensable in this new and much-needed partnership between the health sector and the press. If journalists are to be effective intermediaries, they must be given the freedom to do it in their own way; this means helping them in their task, and certainly not trying to

"use" them - they have a horror of that! The activities of international or national organizations working in the field of health have everything to gain from this partnership and, at the end of the day, so too does humanity in general. •

Mr Philippe Stroot is Coordinator, Media Relations, Health Communications and Public Relations Unit, World Health Organization,

1 2 1 1 Geneva 27, Switzerland.

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Helping scientists to improve their communication skills

Jitendra Khanna

H

ealth research helps to generate new knowledge to solve health problems. However, maximum benefit from research is achieved only when the new knowledge is transmitted rapidly to all who can use it. The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) believes that a health researcher's job is not over until the research findings have been reviewed by other scientists and published, and have been transmitted in a user-friendly format to health policy-makers and the general public.

Unfortunately, the advanced training that researchers undergo in their fields seldom includes writing scientific research papers or communicating effectively with the general public. The latter in particular re- quires specialized training as it often involves communicating difficult scientific concepts through the mass media to lay audiences. In developing countries, where literacy levels and coverage of the media are low and science journalism is not well established, communicating science poses a considerable challenge.

A mock inteNiew taking place during a recent WHO communication workshop for reproductive health researchers held in New Delhi. Photo WHO/OMehta

Since its establishment in 1972 HRP has been helping developing countries to strengthen their capacity to conduct research in reproductive health. Many developing countries have benefited from this support and have set up institutions that conduct valuable research of national interest.

Unfortunately, a lot of the new knowledge generated by this research never leaves the laboratory because many scientists find it difficult to write and publish papers and to communicate with the media.

Most science journals around the world - even in many developing countries - are in English, and few researchers have the skills to write good papers in English. On top of that, there is stiff competition to publish papers in good science journals and poorly prepared papers have little chance of being accepted even if the science is good.

A small proportion of the research conducted in developing countries does get published. But this does not guarantee that policy- makers and the general public will hear about it. Much knowledge is doomed to remain locked up in libraries and research institutions.

Many scientists do not see it as their responsibility to inform the public about their work. Moreover, lack of knowledge of the process of communication hampers the efforts they may make.

To help bring the research findings out from the dusty files and computer databases and make them available to health planners, HRP conducts workshops in scientific writing and science communication in research institutions in developing countries. So far 16 scientific paper writing and four science communication workshops have been conducted in 11 countries. In 1995 a survey of the impact of the scientific paper

writing workshops in Latin America showed that, after attending the workshops, researchers published more papers than before and were more confident of their ability to prepare papers for publication in learned national and international journals.

In the science communication workshops the main objectives are to make researchers aware of the prin- ciples of communication and show them how to communicate effectively with the media. The workshops include both researchers and journalists and seek to build trust

and strengthen networking among them. This is very important as many scientists avoid contact with the press because they believe journalists favour sensationalism over accuracy. On the other hand, journalists complain that scientists present their ideas in language that non- scientists cannot understand.

HRP's experience with the science communication workshops has been very positive. Scientists taking part often express amazement that there is so much to learn about communication and that appropriate

"packaging" of information can mean so much to the impact of the message. Many journalists say that after discussing science reporting with the scientists they are able to appreciate better the researchers' concerns about accuracy. Both agree that they have a vital role to play in health promotion and that they need to collaborate in this endeavour. •

Mr Jitendra Khanna is Technical Officer (Com- munication and Information Dissemination), UNDP /UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, l 2 l l Geneva 27, Switzerland.

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World Health • SOth Year, No. 6, November-December 1997 15

Kick polio out of Africa!

P

oliomyelitis is the number one cause of paralysis in sub- Saharan Africa. Today, practically everyone knows of someone crippled by the disease, but such cases will be increasingly rare by the end of the century if the campaign to

"Kick Polio out of Africa" achieves its goal.

Football is being used as the medium for the campaign's message that no one need be a victim of polio:

given mass commitment to immunization, the disease could be eradi- cated from the African continent by the year 2000. Besides underlining the tragedy of polio through the stark contrast between the disability of victims and the super-fitness of sportsmen, "there is no better way than through football of reaching so many people at once," says John Lloyd of WHO's Expanded Programme on Immunization in Geneva. Football matches are played to packed stadiums, and live coverage of games on television and radio regularly attracts audiences of 50 million people across Africa.

The campaign, supported by Rotary International and other partners, was launched at the World Cup qualifying match between Nigeria and Burkina Faso in Ouagadougou on 27 April 1997. At the opening ceremony, 50 children filed on to the pitch and unfurled a huge banner bearing the campaign symbol of a sportsman kicking the virus into oblivion. A ceremonial "Kick Polio"

football, first signed by President Nelson Mandela of South Africa, was signed by the President of Burkina Faso in the presence of the team captains, and journalists covering the match received special polio information packs. There were an- nouncements about the eradication

A moment of leisure for the veteran football reporter Apollinaire Gahungu, himself crif,pled by polio, and the Ghanaian-born footba I star Abedi Ayew Pele. Both are ambassadors for the campaign launched by WHO to "kick polio out of Africa". Photo WHO/V Abramov

campaign over the public address system, and TV and radio spots broadcast regularly during the match reached homes in 31 African countries. The "Kick Polio" football will be signed at every major international match this season by the president of the host country.

Veteran football reporter Apollinaire Gahungu, himself crippled by polio, and Ghanaian-born football star Abedi Ayew Pele have been appointed ambassadors for the campaign by WHO's Regional Office for Africa. Their job is to keep polio in the public mind, and to encourage families to have their children immunized against the disease.

The key to eradication is a series of national immunization days that supplement routine immunization activities and focus effort on reaching all children under five years of age with polio vaccine. National immunization days should be held annually and conducted in two rounds several weeks apart. Some countries have been conducting mass

immunization days against polio since 1995, but the continent-wide effort to eradicate the disease began in August 1996 when WHO's Regional Director, Dr Ebrahim M.

Samba, set up a Polio-Free Africa Committee chaired by President Mandela. Heads of state throughout the continent subsequently pledged support for the campaign at the 1996 Organization of African Unity conference.

So far national immunization days have reached an estimated 73% of children under five in the 41 African countries where polio is endemic, compared with 54% of children routinely vaccinated against polio throughout the region. The goal is to vaccinate 100 million children in the endemic countries, and to declare the continent free of polio by the year 2000. However, the challenges ahead are formidable. Civil war rages in some of the worst polio-affected countries; the cold chain for delivering vaccines is weak in many places because of worn out equipment; surveillance systems for monitoring progress towards eradication urgently need strengthening;

and the campaign is short of money, having been pledged only about half the US$52 million budgeted for this year.

Nevertheless, the continent is winning the battle against polio, and President Mandela has called for a redoubling of effort "until we can safely say we have kicked polio out of Africa for ever". •

This report is adapted from an article in

"Vaccine and Immunization News"

(WHO, No. 4, June 1997)