Access to Health Information in China

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Access to Health Information in China

Hao Jiying

Medical Library of the Chinese People’s Liberation Army

No. 5 Feng Tai Road, 39th Post Office

Hai Dian District, Beijing, 100039

Zhan Youxiang

Medical Library of the Chinese People’s Liberation Army

No. 5 Feng Tai Road, 39th Post Office

Hai Dian District, Beijing, 100039


  1. Recent Progress

In the recent years, the condition of accessing to the health information in China has been improved greatly.

    1. Sustentative programs funded by Government have greatly improved the development of health information resources in China.

In recent years, great attention has been paid to access to health information by China government. In order to meet the need for the scientific and technical health information of the health systems, of the teaching and research institutions and of the health professionals, some programs such as NSTL and CALIS funded by China government are put into practice to increase access to health information in China.

    • National Science and Technology Library (NSTL) is a national virtual scientific information service institute established by the support of Science and Technology Department of China government. In 2000, the Library of the Chinese Academy of Medical Sciences (CAMS) became the Medical Center Library of NSTL. Under the financial support of Government, the library of CAMS takes charge with collecting, organizing and developing the key health information resource, and has provided medical information service for the clinician and medical researchers such as literature retrieval, original articles transfer, Online Public Access Catalogue service, journal contents browsing, Internet information resource guide, digital reference and Preprint service.

    • China Academic Library & Information System (CALIS) is another successful program funded by Education Department of China government. It has successively got approximately 27 millions US$ fund to organize more than 700 academic libraries to establish an information development system in National Education System and has greatly improved the level of access to academic information. In 2001, The Peking University Health Science Library (PUHSL), as National Medical Information Center of CALIS, began to organiz health libraries to subscribe many valuable literature databases by the way of alliance and apply the Interlibrary Loan Service System and provide original article transfer.

With the implement of the NSTL and CALIS, the collection capability and the level of information service of health libraries in the academy of science system and educational system have been greatly improved. In 2004, Library of CAMS subscribed about 2400+ print foreign key medical journals, 1000+ Chinese Medial journals and some full text electronic journal databases and abstract databases. According to CALIS’s investigation statistics, the total fund of 37 health libraries had increased from 4,840,000US$ in 2000 to 11,980,000US$ in 2003, and the average fund of university medical library is about 323,710US$. In 2003, among the investigated 46 health libraries, 80.4% subscribed more than 500 Chinese medical journals and 47.8% subscribed more than 100 foreign medical journals, 48.89% medical libraries subscribed more than 10-30 databases.

The successes of NSTL and CALIS have proved that the sustainable financial supports from government are the most effective way to ease the shortage of fund of health libraries and information institute and ensure the health workers and the public easy and quick access to health information, especially foreign medical literature, which definitely improve their research and clinical care. And also the effect that NSTL and CALIS bring to the development of scientific & technical information resources and the academic libraries in China is far-reaching.

    1. Interlibrary collaborations among health sciences libraries have promoted the whole level of access to health information.

For the historical and managerial reasons, health libraries in China are mainly affiliated with health institutions of academy of science system, educational system, hospital system and army system. Since 1980, in order to satisfy the information needs of clinicians, researchers and the general public, some organizations and cooperative networks of medical information resource have been established under the direction of national departments concerned, and health sciences libraries in different systems have developed strategies to utilize resources from other libraries through cooperation.

  • In 1985, China Association of Medical University Libraries responsible for the coordinating acquisition of foreign biomedical journals was established.

  • In 1990, the project of National Network of Medical Literature Resource Sharing was initiated, which constitutes national network of medical literature resource composed of three level medical libraries: National Center Library, Local Area Center Libraries and Provincial Resource Libraries. Then Union Catalogue Database of Foreign Biomedical Journals in China and Union Catalogue of Foreign Biomedical Journals in Medical University in China were compiled.

  • In 1992, the Coordinating Group of Medical Journal Resource Sharing came into existence responsible for the joint development of foreign journals among the medical university libraries.

  • In 1995, China Medical Information Network (CMINET), which is connected to the Internet started to run and the National Center Medical Library and Local Area Center Medical Libraries began to provide the network retrieval of library collection catalogues and union catalogues.

  • In 2000, NSTL and CALIS were initiated. Through the development of NSTL and CALIS, the development and share of health information resources among member libraries in the academy of sciences system and educational systems has also been strengthened.

  • In 2004, PKHSL as Medical Center of CALIS, the Library of CAMS as Medical Center of NSTL and the medical library of the Chinese PLA as the Medical Information Center in the army and the director of China Hospital Libraries Association agreed on the coordination among them. And then the above three largest libraries in China, as the Service Libraries of CALIS Interlibrary Loan System, began to provide original article transfer in the same software system.

The implement of above projects and interlibrary cooperation efficiently improve the health information share, the librarians can provide more service such as network literature retrieval and original article transfer and their readers especially in hospital libraries are able to better access to health information than before.

    1. The applications of information and communication technologies have improved the level of information management of health sciences libraries.

The quick development of information technologies has made great impact on the way libraries acquire, process, disseminate and share information. In the 1990’s, health sciences libraries in China applied widely the library automotive management system to realize the computerized management of collection, catalogue and circulation of information resources, and also began to develop some databases such as Chinese Biomedical Disc Database, Chinese Medical Current Content and Chinese Medical Citation Index. At the end of 20 century, with the development of Internet, the information technologies are used more widely in the health libraries. In the investigation of 38 health sciences libraries’ network conditions by CALIS in 2003, 82.3% set up the library local networks, the bandwidth of 63.2% are more than 100MB(megabyte), and 82.3% established their library websites and carried out network information service such as OPAC search, databases retrieval, digital reference service and network article transfer. According to the statistic of CALIS, 80% health libraries provide digital reference services including real-time reference desk, Email Service, Message Board and BBS.

    1. Organized health information resources in Chinese have basically met the need of health professionals and the public.

Since 1990’s, medical librarians and information workers has put more efforts into the development of indigenous databases of original medical literature. Until now, about 60 databases of Chinese biomedical literature has been developed and put into operation, such as Chinese Biomedical Disc Database, Chinese Medical Current Content, Chinese Medical Citation Index, Hospital Knowledge Library, which all have covered 90-95% of Chinese biomedical journals.
Medical librarians and information workers also attach attention to the dissemination of health information to the public. Nowadays, MLPLA has developed Database of the Guide of Medications Information, which provides the authoritative information in Chinese about a lot of medication used in the medical treatment. And also the Library is going to develop a database that collect the information about the etiology, symposia, diagnosis, treatments of illnesses from the reliable information sources. These will be made available on the Websites where the health professional and the general public can search the information they need. And also the idea of establishing the Health Information Service System for health promotion has been put forward.
In addition, more and more health sciences libraries assist their users in finding reliable health information online by providing the lists of evaluated sources on the libraries’ Websites. For example, during the epidemic spreading of SARS in 2003 MLPLA and PUHSL created the SARS Subject Website. And Medical Library of Zhong Shan University has developed Family Planning and Prepotency Database, Medical Methodology Database, and Gene Therapy Database and put into use. And many health science libraries have selected, evaluated and organized some Internet information as their linked virtual library collection in their websites used to instructing readers and users to look for the valuable network information they need.
In conclusion, I think that access to medical literature has been greatly improved in China. However, lack of access to health information is still a major barrier for both health professionals and the people, and much work needs to be done.

2 Work needs to be done
2.1 Financial support of health libraries is to be further improved.

In recent years, most health libraries in China find it very difficult to procure required amount of foreign medical journals and books and maintain the information service network due to their high cost. Global price rise in newsprint and fluctuating exchange rates further aggravates the situation. In the investigation of 46 health sciences libraries by CALIS in 2003, the annual budget of most of health sciences libraries is only 13000-37000 US$, some small libraries’ budget is only 1500 US$. The shortage of funds has caused the continual reduction of health literature and has hold back the development of information infrastructure in health libraries. If health libraries lack the new literature and the new information services supported by the new information technologies over a long period of time, there will have a deep effect on both the reader’s enthusiasm of utilizing health libraries and the health’s libraries role in the information society.

2.2 Joint development of health information resource and their sharing is to be further improved.

In China, although great progress in medical information sharing has been made in recent years, the results are not satisfactory. There are three main problems.

  • The first is the irrational allocation of medical information resource. Most foreign medical literature is collected in Beijing and some coastal provinces, especially in three large health libraries. Some small health libraries do not subscribe foreign journals at all.

  • The second is the lack of balanced and restrictive systems for the mutual benefits in member libraries. Member libraries want to share information but lack the sense of joint development.

  • The third is the low efficient interlibrary loan system. Only less than one-third of 130 medical university libraries can provide network retrieval of their library collection. Some interlibrary loan services in health libraries are not satisfactory.

    1. The network condition of accessing to health information is to be further improved.

Now Internet has became an important stage that medical publishers, librarians, researchers, clinicians and the public disseminate, exchange and search health information, and enable health information to be made available to the people the instant it is produced. However, the condition of access to Internet is not satisfied in China due to high cost of Internet services and broad band facility. According to the statistical report issued by China Internet Network Information Center in January 2005, in China, which has a population of 1300 million, 94 million are Internet users, whose percentage is only 7.2% (the percentage in Unite States is 68.8%, the percentage in Denmark is 62.5%). And there is also unbalanced disparity in the different areas in China. For example, the percentage of Internet users in Beijing’s total population is 27.6%, the percentage in Shanghai is 25.8%. Comparatively, the percentage in Qinghai Province, Inner Mongolia, Henan Province is about 4 %. These statistical data can show the access to Internet information in eastern coastal regions is much better than in western and middle regions. In addition, in the same region there is still digital divide between rural areas and urban areas. Few peasants in the rural areas in the western region can have access to the Internet.
2.4 Polices and related laws and regulations for the development and utilization of health information are to be further perfected

The importance of information resources decides that the sharing of information resources is a national activity, and also a problem of policy. What information resources can be shared? Where can these information resources be shared? How can they be shared? All of these questions are decided by national information policies. In China, during the past 50 years some laws and regulations have been issued. However, all these documents have not functioned effectively. In 2001, the enaction of Library law was initiated in China but until now still not completed. Health sciences libraries have abundant health information resources and librarians who have abundant experience of collecting, evaluating and organizing health information. Therefore, it is necessary to underpin a sustained and concerted development effort for health sciences libraries. The criteria of different type of health sciences libraries, such as the library budgets, scope of library holdings, conditions of network, methods of information service and number of librarians etc, should be set up by agencies of government to ensure the sustainable development of health sciences libraries.

  1. Much work on the valuable health information is to be done.

Now there is a lot of health information in Chinese on the Internet, but 13.4% Internet users in China think that medical treatment information hasn’t meet their need. It is common that you can see “copy” and “paste” in the content information of different websites for the reason of the imitation problem among websites in China and there is not enough Chinese websites of characteristic or special health information. The level of organization of health information also needs to be improved. The health information retrieval instruments such as PubMed, MedlinePlus, Medical World Search, HealthWeb and OMNI etc are the golden-standard of organizing health information. In China, due to lack of coordinative planning under united leadership, there are some problems regarding the collecting coverage, indexing depth, searching speed and the function of retrieval software in health information retrieval instruments. In addition, according to the requirements of The Plan for Health Education and Health Promotion in China (2005-2010), some government-sponsored consumer health information websites in Chinese should be established, and the health sciences libraries should provide specific consumer health information service and channel the public to the organized, valuable and reliable health information.
In my opinion, “Health Information for All” is prerequisite for achieving “Health for all”. With the improvement of life quality, access to essential health information has become an important issue that more and more people are concerned about. In recent years, with the development of health libraries, the condition of accessing to health information in China is much better than before. And I also think the future will be much better than now.

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