Elsevier

The Lancet

Volume 355, Issue 9222, 24 June 2000, Pages 2231-2236
The Lancet

Public Health
North and South: bridging the information gap

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Summary

Information exchange is critical for development of health systems. The information needs of less-developed countries are especially challenging, but many factors inhibit free flow of knowledge. There is much talk about how technical fixes-such as the internet-might fill this information gap. Yet few attempts have been made to ask clinical investigators who work in resource-poor regions for their views on these difficulties and the possible solutions. The messages reported here, from a survey of Lancet editorial advisors, suggest that information, research, and publication capacities are intimately linked. Investigators, publishers, editors, and editorial organisations all have important parts to play in solving this global information poverty.

Section snippets

India and South East Asia

Although thought of as resource-poor regions of the world, India and South East Asia have become major sites for investment by western information technology companies. As Ian Pearson and Chris Winter have written, “In spite of having only 1·3 telephones per 100 people, India is rapidly developing the key skills to thrive in the information economy”.11

According to my preliminary survey, the signs from India are optimistic. One investigator commented that editors in the western world have been

Africa

Many parts of Africa have a far worse industrial infrastructure than India and South-East Asia. This severe practical difficulty was reflected in the responses I received from African investigators.

The management of medical schools and national hospitals is commonly in “disarray.” There is almost no science base, and research capacity is weak in most parts of sub-Saharan Africa. School and college education is of variable quality, there are few centres of excellence from which good research

South Africa

In some ways, South Africa acted as my control. Located in a continent facing huge research and information challenges, South Africa is a pocket of relative prosperity that might reveal what can be achieved in the future.

Certainly, the pattern of perceived barriers matched more closely those that Northern journal editors usually hear from scientists—resistance to new scientific ideas, lack of interest in public health compared with clinical medicine, delays in editorial peer review and

What can be done?

The difficulties in research, publication, editorial bias, and information access facing the least-developed parts of the world are profound and seem almost intractable (panel 2). One paediatrician from Africa wrote about the “perversity in the world of research that centralises information in the Northern hemisphere and probably delays a useful local application.” And another African contributor spoke for many when displaying his frustration at the lack of attention paid to these issues by

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