No. 4, October 2004
FROM THE EDITOR IN CHIEF
Lynne S. Wilcox, MD, MPH
Suggested citation for this article: Wilcox LS.
Revolution. Prev Chronic Dis [serial online] 2004 Oct [date
cited]. Available from: URL:
After the establishment of written language, the most revolutionary
development in human communication was the invention of the printing press
in the 15th century (1). Before then, books were handwritten,
rare, and expensive. Medieval monasteries supported the transcription of new
manuscripts from existing ones, and errors were common because of spelling,
handwriting, and abbreviation idiosyncrasies. Because opportunities to read
were few, even members of noble families were often illiterate. The
transmission of most information was oral and depended on memory (1).
After the printing press was invented, its use spread rapidly through
Europe. Within 50 years, eight million books were printed for multiple
disciplines, including religion, law, and medicine (1). Some of the most
common publications were “how-to” manuals. These instructional books,
predating the Dummies guides by half a millennium, allowed anyone to
learn new skills on topics such as herbal remedies, money management, letter
writing, and cooking (2). The exchange of technical information no longer
relied primarily on memory, and errors were markedly reduced (1).
But the true revolution was the societal change initiated by books. Books
communicated the breadth of European culture to middle-class households, and
literacy gained value among the populace. National identities developed as
languages became formalized in print (2). The natural sciences advanced
because scholars were able to refer to standardized concepts, definitions,
texts, and images. Empirical observations were published and reviewed by
other scientists and became the gold standard for scientific endeavor (1).
Another communication transformation occurred during the late 20th
century: the Internet. At first, during the 1970s, the Internet offered only
a few military and academic applications. Much like the illiterate masses of
the Middle Ages who had no books and could not read, most people 30 years ago
had no access to Internet information and no skills to achieve that access.
This changed by the 1990s with the convenience of personal computers,
e-mail, and the Web. Today, anyone with basic computer skills can walk
through the doors of a cyber café and transmit data to the other side of the
This issue of Preventing Chronic Disease explores the application
of technology to public health and chronic disease. Wagner et al describe
Internet use for health information by people who have one or more of five
common chronic conditions: hypertension, diabetes, cancer, heart problems,
and depression (3). Block et al outline a worksite nutrition
intervention program based on behavioral change models that is delivered to
individuals entirely by e-mail (4). Bensley et al describe
health education materials provided to special clinic populations and college students via the Web;
these materials also are designed according to behavioral change models
(5). Despite these opportunities,
arise on the “digital divide” created by differences in income, education
and literacy, race and ethnicity, age, gender, geography, and disability. If
we as chronic disease professionals are to use the Internet as a tool, we
must rigorously examine the concept of access. Bush et al provide a
thoughtful discussion on access and offer a framework that defines Internet
and Web access issues for health researchers (6).
As books did, the Internet has revolutionized the way society — including
government institutions — functions. Fountain describes the opportunities
and challenges of digital governance as a two-stage process: first,
government to citizen and second, government to government (G2G)
(7,8). Many public health agencies are now passing through the first stage:
providing information and services to citizens through the Internet. The
more difficult tasks occur in the second stage: electronic communication
among government institutions. However difficult the tasks may be, G2G
exchange has the potential to drive major improvements in how government
organizations interact and shape themselves.
The G2G concept is more than theory. In the early 20th
century, vital statistics became one of the first forms of public health
data in the United States. Rothwell describes how the reengineering of
state vital statistics systems will standardize information, improve
accuracy, and combine data from a multitude of sources through secure
Internet connections (9). A major emphasis of the reengineering is reducing
error, as much a challenge in the 21st century as it was in the
Middle Ages. As death certificates become more accurate and timely, we can
assess chronic disease mortality in more sophisticated ways and achieve more
success in chronic disease prevention and health promotion.
Another example of a G2G relationship is the Public Health Information
Network, which includes state, federal, and private organizations (10). This
program is actually a series of interactive systems that allow rapid
exchange of health information among institutions. Components include Epi-X,
which delivers key health alerts — such as early signs of disease outbreaks
— to appropriate professionals across the country; the National Electronic
Disease Surveillance System, which creates data standards to facilitate
information transfer among clinical and public health entities; and several
other systems that allow secure and standardized data sharing. The use of
the Internet to convey public health information is a revolution — a
profound change in how public health professionals structure their data
systems to make an immediate impact on public health policy.
With this issue, Preventing Chronic Disease completes its first
year of publication. It is especially appropriate that an electronic journal
marks this milestone with a discussion of health and the Internet. The 21st
century is still young. Today, most teenagers surf the Web with far greater
skill than their grandparents, and many outperform their parents. If public
health organizations follow through on their potential to use the Internet
effectively, young people may become as skilled in healthy living as they
are in Web use, and the greatest revolution in chronic disease
prevention may arrive sooner than any of us have dared to dream.
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- Burke J. The day the universe changed.
Boston: Little, Brown and Company; 1985. Chapter 4, Matter of fact; p.
- Wiesner-Hanks M. The world of the Renaissance print shop [Internet].
Milwaukee (WI): University of Wisconsin, Milwaukee [cited 30 Mar 2004]. Available from: URL: http://www.uwm.edu/Library/special/
- Wagner TH, Baker LC, Bundorf MK, Singer S.
Use of the
health information by the chronically ill. Prev Chronic Dis
[serial online] 2004 Oct.
- Block G, Block T, Wakimoto P, Block CH.
Demonstration of an e-mailed
worksite nutrition intervention program. Prev Chronic Dis
[serial online] 2004 Oct.
- Bensley RJ, Brusk JJ, Mercer N, Underhile R, Rivas J, Anderson J, et
The ehealth behavior management model:
a stage-based approach to behavior change and management. Prev
Chronic Dis [serial online] 2004 Oct.
- Bush N, Bowen DJ, Wooldridge J, Ludwig A, Meischke H, Robbins R.
do we mean by Internet access? A framework for health researchers.
Prev Chronic Dis [serial online] 2004 Oct.
- Fountain JE. Electronic government and electronic democracy. In:
Christensen K, Levinson D, editors. Encyclopedia of community. Thousand
Oaks (CA): SAGE Publications; 2003. p. 436-41.
- Fountain JE.
Digital government and public health. Prev Chronic Dis [serial
online] 2004 Oct.
- Rothwell CJ.
Reengineering vital registration and statistics systems
for the United States. Prev Chronic
Dis [serial online] 2004 Oct.
- U.S. Department of Health and Human Services.
Public health information network [homepage on the Internet].
Atlanta (GA): Centers
for Disease Control and Prevention [cited 8 Jun 2004]; 2004.
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