Canadian Health Network going under

Just when I thought that the Canadian Health Network website was getting better and I was actually starting to use it for consumer health questions, I now hear that the Conservative government is shutting it down in a few months. The program will no longer be funded at the end of March 2008. The surprising news came in an Ontario Health Promotion E-Bulletin, published 8 November 2007.

For those not familiar with the CHN, here are some basics from that depressing piece of news:

The Canadian Health Network is a national, bilingual web-portal that aims to help Canadians find the information they're looking for on how to stay healthy and prevent disease. The CHN does this through a unique and extensive collaboration between the Public Health Agency of Canada, 26 major health organizations, universities, hospitals, and libraries. CHN offers links to more than 20,000 English and French Canadian web-based, quality-assessed resources; in-depth information on 25 key health topics and population groups; and a fortnightly e-newsletter. It is used currently by approximately 381,000 people per month. Usage has grown steadily since it was created in 1999, and especially rapidly in 2007, increasing by 70 per cent over 2006. Approximately 40 per cent of CHN visitors are health professionals who use CHN resources both personally and with clients; Francophones visit CHN in higher proportions than comparable sites; and 94 per cent of users recommend the site to others. Eighty per cent of the 15 million Canadians on-line use the Internet to seek health information. Add to this, the fact that CHN costs are decreasing, making the portal more cost efficient over-time. Why then would government choose to cut this program exactly when the Federal Government is experiencing a surplus?

My initial angry reaction involved some expletive-laced complaint about Prime Minister Harper's needing another tank or two for Afghanistan. But for a government in possession of a budget surplus this can't be the answer, despite the massive corporate tax cut (accompanied by a more chastely administered reduction of personal taxes) announced recently by the Minister of Finance. As the E-Bulletin asks, why are they doing this?

It is difficult to avoid interpreting the planned closure of CHN as yet another assault on the health commons by a government ideologically committed to dismantling the Canadian health care system by privatizing off bits and pieces here and there until there is nothing left but the ring of the cash register. Corporations stand to reap billions in profits from a two-tier system, and part of their "vision" is to replace publicly funded resources like the untrendy CHN with lucrative, advertisement-driven, Health 2.0-style consumer and social networking sites with queasily semi-religious names like Daily Strength, Healia, WeGoHealth, and Inspire. I have posted on my misgivings about Health 2.0 already, and that particular meme's appropriation by the new seigneurs, the foxes who have such a sincere interest in prolonging the lives of the poultry.

I'm finding it hard to imagine how the government will justify shutting down a major program like the CHN. The need for such a service was clearly expressed in the Blueprint and Tactical Plan for a Pan-Canadian Health Infostructure, published on the Health Canada website in December 2000. This report stressed the importance of public sector involvement in providing health information to the public on the web. Among the gaps identified in the developing "Infostructure" [sic] was the limited presence of the public sector in this effort. The CHN is identified as "the most notable effort in Canada" along these lines.

The Gaps
Health Information for the Public - The public sector has a limited presence in providing health information to the public in an electronic form — he most notable effort in Canada is the Canadian Health Network. The private sector on the other hand, especially US firms, have entered this market with highly capitalized ventures providing dynamic, graphic information content. The criticism leveled at these private sector initiatives is whether their health information can be trusted, especially if it is "sponsored" content. Neither the public or private sectors have integrated their electronic health information provided to citizens with other health services. In addition there is still a significant lack of information available on certain subjects or topics, for population group (e.g. Aboriginal populations) and in French.

Information for Health Service Providers - The public sector has a limited presence in providing electronic information to health providers like physicians, nurses and pharmacists. In addition, many health providers have limited ability to use computers and information technology, and thus are not strong proponents of their use in their practice. While information technology offers new opportunities to providers for improving their practices and service delivery through increased standardization, for example, the necessary support for change-management is often lacking. As a result, information technology use is not well integrated with practice. For health providers electronic information is not as extensive as paper — there is still missing information, by subject, by population group and for specific uses. There are no trusted health information standards for providers — either for content or by source.

For both the public and for health professionals, the official stance of the Canadian government has been that the public sector has an important role to play. Even back in 2000, at the time of the dot-com bust, it was clear that big business was poised to make huge profits in web-based health information:

The major players in this market are highly capitalized and are rapidly extending the provision of health information to include sophisticated health business transactions using the Internet and web-based technologies. Sophisticated health "portals" that provide fully integrated "one-stop" encounters for health professionals as well as the public are garnering a lot of attention. Consequently, it will be vital to engage the private sector in the development of the Infostructure.

The public sector was urged to provide leadership in responding to health information and technology needs. According to the Blueprint, government's part should be "to ensure that the information and the technology is accessible, relevant, user-friendly, supports selfcare/telecare, can be trusted and is supported by appropriate standards." The CHN's role in this was seen as fundamental to the Blueprint's authors, and they even made provisions for the participation of private sector vendors:

Canadian Health Network - the objective would be to significantly enhance the Canadian Health Network to become the trusted health information portal for the Canadian public, in both official languages. The Canadian Health Network today is primarily a directory service. It needs to evolve to a portal with a comprehensive set of services. New subject areas would be created, including dynamic news and information feeds, real-time discussion groups, live chats and expert presentations — most likely in partnership with an existing private sector vendor using a "private labeling approach." There would be an emphasis on information of relevance to Canada's Aboriginal peoples. An innovative approach could be for the CHN to co-brand with other health organizations across Canada, thereby including information on local services and how they can be accessed. Finally, the portal would link to provincial selfcare/telecare services and the physician portal.

The CHN has consistently ranked among the top five of Canadian consumer health sites. A recent article by Valeria Gallo Stampino in the JCHLA observes that the CHN has been a valuable means of finding consumer health resources in both English and French, as well as in foreign languages — although it could have done a better job. Canadian health librarians still do not have a central repository for multilingual health information resources for the public, and the impending demise of the CHN will not do anything to shorten the wait.

A 2005 Government On-Line Public Report from a pre-Conservative Health Canada describes the CHN as "a key tool for horizontal integration, collaboration and presentation of information." It mentions the results of an online survey, conducted in the spring of 2004, which revealed that "approximately 95% of users were either satisfied or very satisfied with the quality of information provided by the CHN." But that was two years ago. Apparently the government now has access to more useful information for its purposes.

The Conservatives will appeal to the concerns of some unspecified sectors that funding spent on a consumer health web resource may be better spent on "other initiatives" that would more directly influence health care quality. There will be the usual vague and patronizing assurances that the best interests of Canadians are being served by the redirection of funds to as yet unspecified areas. At the moment there is no official announcement of the demise of the Canadian Health Network on the Government of Canada website. It's unspecified as yet.