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Indian Journal of Community Medicine

Continuing Medical Education: Cyber Public Health

Author(s): V.S. Prasad, A.K. Aggarwal, R. Kumar

Vol. 25, No. 4 (2000-10 - 2000-12)

Deptt. of Community Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh


Technology can vastly improve the accumulation and dissemination of all kinds of information. In public health arena, we have warehouses of unused information while critical problems are left unsolved. INTERNET can help in timely transmission and utilisation of the information throughout the world. The concept of global village breaking the barriers and closing all the distances can be realized with internet. This new technology can vastly improve accumulation and dissemination of information on public Health1.


Networking started in 1969, when the US defence department financed a network for doing civilian research called Arpanet. This led to linking different networks of computers so that libraries of information could stay safe from fear of nuclear explosion wiping out data stored at a particular fixed site. Telecommunication on networks began with correspondence among scientists2. In early 1980's networks began forming among academic institutions, one of the first was a system called BITNET. The Bitnet was handicapped because government agencies and industry were not represented. During 1980's internet evolved. Internet represents meta network - a network of networks3. It provided a means of joining many diverse networks including those of governments and very recently industry.

Internet: What is it?

This is a global network of computers connecting government, military, educational, commercial institutions and private resources of information. These are linked often by regular phone lines and also by microwave and satellite links. The internet which is often called the information super highway comprises of two basic types of computers or servers, those that store information and those that regulate flow of information. These are interconnected via cables or satellite and may be "logged on" for retrieval of information. In India major internet service provider (ISP) is VSNL (Videsh Sanchar Nigam Limited). Private ISPs such as Satyam, Mantra, Glide are also operational. The essential requirements to logon4 are:

  1. A computer with a modem, an instrument to dial-up and connect to your local server.
  2. Telephone line access.
  3. A GIAS (Gateway Internet Access) account with one internet service provider which is connected via national or international telephone lines. VSNL gives three types of membership for any user:
    1. Shell account: Text only access.
    2. TCP/IP: Text and graphics access.
    3. Web site: For a company or a person to give 24 hours access and a continuous online presence to international clients and colleagues.
  4. Software to be able to surf the web

How to connect:

With the computer dial to ISP, type the user name and password (to protect the account). Once online, one may use search engines or type out the universal resource locators (URL) to perform search. It would be convenient and more interesting to begin with search engines or web directories.

Applications for public health specialist:

E mail: This is the most widely used tool in the internet. It is easy, fast and cheap. The sender and the receiver do not have to be available at the same time as for a phone call. E-mail is useful to keep in touch with your colleagues across the world to find out solutions to problems. Subscribe to e-mail, (,, etc.) which are web based and allow you access to your mail from any computer and your message will be secure on the web. This works independently and it is lifetime e-mail address that works independent of Internet Service Provider. It is safe and secure, protected by password so nobody else can access your e-mail.

Internet and the worldwide web:

This is a part of internet with thousands of homepages maintained by various agencies, universities, publishers, researchers, firms, government agencies and individuals. The addresses are recorded as uniform resource locators (URLs), transmitted by hypertext transfer protocol (HTTP) *and written in hypertext mark up language (HTML)5. Every home page has to have this format so that browsers can read and interpret the information on the page.

The web can be accessed by typing the organisation name, for example: This takes you to WHO website from which you can access a wealth of constantly updated statistical, technical and practical information, including weekly alerts to disease outbreaks, the daily count of cases of specific diseases, country and global statistics, advice on the risks to health and environment posed by hundreds of industrial chemicals and vaccinations. To facilitate the search for appropriate health information, WHO also offers access to 60,000 items in its library database. The audience reached is vast: the WHO home pages attract an average 2.5 million "hits" each month6. The other important website address is http:\\ Under this reports of various governmental organisations can be accessed. Under ministry of health and family welfare information regarding who is who in the ministry, information on department of health and its activities, various national health programmes, financial aspects, National AIDS Control Organisation, Department of Family Welfare and Department of Indian Systems of Medicine and Homeopathy can be obtained.

Table I: Useful websites.

Organisation name Address or URL*
World Health Organisation (WHO)
United Nations Childrens' Fund (UNICEF)
United Nations Population Fund
Planned Parenthood
Tuberculosis Research Centre, Chennai
National Polio Surveillance Project
Centre for Disease Control, Atlanta
Care International
Medical Society for Study of Venereal Diseases
Ministry of Health and Family Welfare www/
International Union against Cancer
Cochrane Collaboration www.hiru/

*It should be noted that information and web sites are subject to change without previous notification.

Search engines can be used alternatively to yield topics from indexable web which is estimated at 320 million pages.

Table II: Useful search engines.

Alta vista
Meta crawler
Eric marler M.D. favourite web sites

Literature search:

Searching for remote computing sites, in the context of medicine primarily refers to literature search. National Library of Medicine (NLM) in USA maintains a database of literature with ten million citations from 1966 with abstracts from more than 4 thousand bio-medical journals from 70 countries with world wide coverage. This can be logged on at This is popularly known as Medline. Other NLM data bases provide specialized information of particular interest to public health authorities, for example POPLINE, AIDS LINE, BIOETHICS LINE, DIRLINE etc. We now have some such sites serving the purpose in India, Medlars etc. Internet Grateful Medicine is another effective remote computing site7.

Real time discussions:

Users with good connectivity are able to access the system's server, which is usually a graphical user-friendly home based where users can browse through documents, look at maps/graphs, view pictures of each other and examine *messages posted by others. This server is a virtual work place. Users with only e-mail connectivity are able to participate in e-mail discussion by means of a mailing list, whereby messages sent to the group are automatically distributed to all subscribers of the list and simultaneously posted to the central bulletin board. Information can be distributed to such users via e-mail. Forums for discussion available are epi world (list server for epidemiologists), ProCAARE (programme for collaboration against AIDS and related epidemics) etc. One such forum is malaria network. It is a global network with focussed clientele of malaria control programme managers, ministry of Health and Family Welfare officials involved in malaria control. It is a forum for discussion among them and with World Health Organisation.

Distance education:

Computer based distant education is rapidly improving. For example, University of London as a part of external programme offers six postgraduate qualifications under the academic guidance of London School of Hygiene and Tropical Medicine (LSHTM) to meet the needs of health practitioners and scientists where demands on their time prevent them from studying in London. Likewise a Masters in Public Health degree can be pursued from Johns Hopkins University ( It can be pursued without sitting in the classrooms through internet. Reading materials, video pictures, sound can be transmitted across transatlantic and interaction is also possible. Online examinations can be held at the end of the course. Distance education super lectures on epidemiology, biostatistics, Internet and Global Public Health can be learnt from Global Health Net University that can be accessed at

Online journals:

The internet offers public health students and professionals direct access to the main journals in the field via the worldwide web. Most epidemiology and public health journals have constructed sites on the worldwide web that reproduce their paper editions. These websites offer information of varied value for users; from lists of contents (of current and past issues) to free access to full text articles.

Table III: Selected online public health journals.

Journals Medline abbreviation URL
American Journal of Public Health Am J Public Health
Epidemiology Epidemiology
American Journal of Preventive Medicine Am J Prev Med
Public Health Public Health
Annual Review of Public Health Annu Rev Public Health http://www.annual
International Journal of Epidemiology Int J Epidemiol

All the websites accessed were found to be user friendly. General information, table of contents of the current issue are offered in all the journals8. Abstracts of selected articles are given in some journals and full text of the current issue is accessible in few journals, i.e. Ann Review Public Health and American Journal of Preventive Medicine.*

Cyber studies:

Internet has allowed for conducting epidemiological and public health research projects. University of Minnesota, School of Public Health recently initiated the epidemiologic cyber space study to examine the feasibility of usage of internet for conducting the prospective epidemiological studies. The site invites people to join the study, complete an online questionnaire related to diet and cancer. Follow-up questionnaires are planned six monthly. Subjects will enter their physical activity into their individual calendars and data will be immediately entered into a database that is available to the research staff to monitor the progress.

Potential benefits for the future:

Networking and Global Disease Monitoring:

Networking public health workers, including those in local health departments, academics, governments, industry and private agencies will bring great benefits. Information regarding what works (and what doesn't) can be transmitted almost instantaneously especially in outbreak investigations9. Accurate estimates of incidences of important communicable and non-communicable diseases can be obtained. Data on registered cases can be sent rightly from the disease reporting centres to national centres. Extraordinary potential exists for very accurate disease monitoring and forecasting in much the same way as we monitor and forecast the weather10. Online vital statistics could be entered electronically and be usable almost instantaneously. In France, sentinel system of general practitioners use personal computers to transmit the data to a front server and the incidence of the disease is calculated weekly.

Environmental monitoring:

Data systems for environmental monitoring have not been organised with user friendly databases that integrate environmental information with morbidity data as morbidity data for non-communicable diseases are poor11. Linking the global disease tele monitoring with environmental data would considerably improve in knowing the environmental factors of the disease.

Internet publishing:

The inherent difficulties of publishing a work, the costs involved have served as automatic quality controls. The internet is much easier to handle, much more cost-effective and with potential to reach far greater audience. This relieves the backlog of publication. The disadvantage could be unauthorized usage and maligning the existing material.


Information technology has changed the way a lot of people interacted earlier. It provides a timely information source with global reach and the opportunity to join in lively discussions in the various news groups. Our experience has been largely trouble free and extremely enriching. We had few problems connecting to internet through a major internet service provider. We found the software to be friendly and connecting to and surfing the worldwide web intuitive. We would encourage everyone to explore this new technology providing a timely information source with global reach. The limitations in using the internet are that one needs new skills, access, limited understanding of its use in public health. It is true that until now this new medium has been dominated by computer technopiles but with the simple and effective worldwide web browsers that are currently available, it is now affordable and easy to join and participate. The first step is to connect everyone in public health. Once these local and global public health centres have been connected it is possible to reach all the public health workers in the world. It is time for public health professionals to enter the electronic information superhighway and to lay to rest the myth that internet is only for computer wizards.


  1. LaPorte RE, Grower IF, Rewers M, Tuomilehto J et al: Telecommunication and international health research. Am J Epidemiol 1988; 128: 439-42.
  2. Fuchs I. BITNET: because it's time. Perspectives in Computing 1983; 3: 16-27.
  3. Jennings DM, Landweber LH, Fuchs IH, Farber DJ et al: Computer networking scientists. Science 1986; 231: 943-50.
  4. Dhawan N, Agarwal AK: ENT on the Internet. Indian Journal of Oto Laryngology and Head and Neck Surgery 1999; 51: 96-9.
  5. Prasad S, Nagpal M, Nagpal PN: Ophthalmology on the Information Superhighway: An Introduction to the Internet. Indian Journal of Ophthalmology 1997; 45: 181-7.
  6. Anonymous: WHO on the internet. World Health Forum 1997; 18: 377-8.
  7. Betsy L, Humphrey S, Angela BR, Cahn MA et al: Powerful connections for Public Health: The National Library of Medicine and the National Network of Libraries of Medicine. Am J Public Health 1999; 89: 1633-6.
  8. Fernandez E, Sobreques J, Schiaffino A: Epidemiology and public health journals on the internet. J Epidemiol Community Health 1999; 53: 510-2.
  9. WHO Directors of Non-Communicable Disease Collaborating Centers and Key Officials. Needed universal monitoring of all serious diseases of global importance. Am J Public Health 1993; 83: 941-3.
  10. LaPorte RE, Gooch WA, Gamboa C, Tajima N: International disease counting (IDC) from. Lancet 1993; 342: 930-1.
  11. LaPorte RE: Global public health and the information super highway. BMJ 1994; 308: 1651-2.
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