Virtual Hitchhiker's Guide to the Medical Universe
Armchair exploration of foreign health care systems can be almost as enlightening as an actual visit.
Medical tourism, the practice of combining medical treatment with vacationing, is growing at a staggering rate. Of course, like much international travel, medical tourism is for the adventuresome. If you're among the more cautious, there's a safe way to sample the health wisdom of other nations from the comfort of your armchair: the Internet. For our tour, we chose English-language Web sites from 12 countries. All are produced or vetted by the central health agencies of the countries featured.
The variety of experiences is staggering. There are striking commonalities and huge disparities in health topics featured from site to site. Almost every country has a version of the food pyramid and recommended exercise goals, which are, for the most part, interchangeable with those in the United States. But the advice for pursuing such efforts is as varied as the national temperaments. Botswana encourages its citizens to approach risk reduction with creativity and enterprise, while Hong Kong prescribes meticulously designed regimens. Not surprisingly, developing nations emphasize infectious diseases, while developed countries concentrate on degenerative disorders. The richness of a nation's Web site seems to be proportional to its GDP, but even the poorest nations offer nuggets of advice that could serve all of us well. We've posted all the Web sites listed in this article on our Web site at www.health.harvard.edu/healthextra. Bon voyage!
Australia
www.sunsmart.com.au
Americans may vacation Down Under to soak up the sun, but the natives take great pains to avoid it. Australia has the world's highest skin cancer rate and quadruple the melanoma incidence of the United States. It's no surprise the nation has made sun protection a national priority. Travelers to Australia will find plazas shaded by enormous umbrellas; virtual tourists will find SunSmart, the world's most comprehensive Web site on skin cancer prevention. SunSmart is the state of Victoria's ongoing educational campaign, which has reminded a generation of Australians to slip into protective clothing, slop on sunscreen, and slap on a hat. The message is simple, but it's delivered in exquisite detail — the optimal weave of fabric, and how to wear it; instructions for storing sunscreen; the minimum width of a protective hat brim (no baseball caps allowed!).
The site also has sections on shade and shades, with hints for finding the most densely canopied tree to relax under and the most protective pair of sunglasses. Before leaving, it's hard to resist clicking on the Cancer Council Victoria Shop for a look at sun-protection gear manufactured according to rigorous Australian government standards.
Botswana
www.moh.gov.bw
Home to the fictional "No. 1 Ladies' Detective Agency," Botswana has an equally colorful government Web presence. The advice dispensed by the Ministry of Health is not copious, but it's charming in its simplicity, particularly the dietary messages found at the "Health News" link. One section, titled "Healthy eating does not sentence you to boring & unpleasant meals," offers a number of basic but clever pointers for preparing heart-healthy feasts, based not on calorie or fat content but on color, shape, and texture. Warning: the article may warrant a trip to Google, if not to an ethnic produce market, in search of morogo-wa-dinawa, rothwe, and dhelele, among other vegetables.
More sobering is the Masa part of the Web site. Botswana has one of the highest HIV/AIDS rates in the world, and the Masa (it's a Setswana word for "new dawn") section describes the country's ambitious program to provide free anti-retroviral therapy.
Canada
www.hc-sc.gc.ca/index-eng.php
Health Canada, the division of government responsible for public health, produces a Web site of great breadth and depth. A one-stop portal for health matters, it's a repository of information on health care, diseases, and social issues that affect personal and public health. It's as though the Canadian equivalents of the National Institutes of Health, the FDA, the CDC, and Medicare had pooled their resources. The Web site is well organized and easy to navigate.
The "Health Care System" link offers a close examination of the nation's celebrated — and excoriated — delivery scheme. It's well worth a comparative look as the American health care debate heats up.
Fiji
www.health.gov.fj
One glance at the Ministry of Health Web site is enough to let you know that you've left the developed world behind. Unlike the admonitions to Canadians, which highlight a warning on the hazards of garage sales and flea markets, the Fiji site in 2008 alerted its visitors to filariasis, the mosquito-borne parasitic disease that can lead to elephantiasis (a lymphatic blockage that produces edema of gargantuan proportions). The site was worth a visit for a primer on filariasis, including the conditions that foster it, the physical and social havoc it wreaks, and the Fiji government's program to eradicate it by 2010.
Hong Kong
www.gov.hk/en/residents/health/healthedu
www.lcsd.gov.hk/healthy/en/virtual.php (for videos)
Hong Kong is world-renowned for its fine tailoring, and the government is on a mission to ensure that its citizens look good in their bespoke suits. The Department of Health Web site has copious advice on healthful eating, including pages on choosing wisely at a Chinese buffet and keeping one's appetite in check during Lunar New Year festivities, particularly when it comes to the seductive moon cake. The government has also been waging a "Healthy Exercise for All" campaign since 2000. The Web site has an exercise routine for every stage of life — and almost every level of fitness. The workouts range from the familiar drills of sit-ups and push-ups to dancing, rope skipping, and stair climbing. All can be accessed as written and illustrated instructions or as videos. The videos are narrated in Chinese with English subtitles, accompanied by music, and the exercises are meticulously executed. You can't go wrong following any of the routines, but you may attract some wary glances from co-workers if you do the "Workplace Exercises" as performed on the video.
India
www.indianmedicine.nic.in
www.healthy-india.org
The Indian Ministry of Health provides an opportunity to toggle between two medical worlds. One is the Department of AYUSH, an exploration of five systems of traditional Eastern medicine — ayurveda, yoga and naturopathy, unani, siddha, and homeopathy. The AYUSH Web site shows the results of an effort to standardize the products and procedures employed in the traditional healing modalities. The other, Healthy India, has information on risk modification based on Western medicine's observational studies and clinical trials. The tips for reducing the risk of cancer, diabetes, and heart disease are as applicable to residents of Denver or Des Moines as they are to those of New Delhi.
Iraq
www.emro.who.int/iraq
The Web site established by the Iraqi Ministry of Health is gone, replaced by another operated by the World Health Organization, the ministry's partner in reconstructing the nation's health system. Don't expect to find advice for healthy lifestyles, but you will get an up-to-date cholera surveillance report. Most of the site is devoted to depicting the state of health — and health care — in Iraq. The news isn't good. According to a list of grim "health status indicators," life expectancy is 58 years and the infant mortality rate is 10%. Plans for building a decentralized health care system with a strong network of primary care providers are detailed, as is progress in that direction. For a realistic picture of daily life in Iraq through the lens of health care, download the report on the community-based health initiative. It's a little turgid, but the charts and tables are revelatory.
The Netherlands
www.minvws.nl/en
The Dutch have been intrepid social explorers over the last century, as the Web site of the Ministry of Health, Welfare, and Sport attests. The home page features an item on "magic mushrooms" (they were recently banned), and the link for "Drugs" in the "Themes" section leads to a downloadable report discussing the Netherlands' storied — and arguably successful — policy of casting marijuana and narcotics use as a medical, not legal, issue. The site also contains an evaluation of the practice of euthanasia, which the Dutch legalized in 2002. But perhaps most notable is the exposition of the nation's universally mandated health insurance system, which, like that enacted in Massachusetts, provides insurance through private contractors who are required to accept all comers. The site offers a brochure detailing the particulars of the plan. It's worth a read as the United States considers health care reform.
New Zealand
www.moh.govt.nz
For a country of only four million people, New Zealand is information-rich, and its Ministry of Health has admirably aggregated that wealth. The "Links" tab on the home page is a portal to scores of other New Zealand Health Web sites concerning matters from biosecurity to disease screening. One of the most comprehensive is Agewell, which deals with health issues so numerous that many people might not even be aware of them all — for example, the need to be medically prepared for a hurricane. An extensive section on grandparenting covers the emotional and physical complexities of dealing with one's kids' kids, including a guide for indigenous Maori parents and grandparents on bringing up children within their own tradition.
Singapore
www.hpb.gov.sg
In the World Health Organization's assessment of health systems in 191 member states, Singapore ranked just behind leaders France and Italy. A visit to HPB Online (HPB stands for Health Promotion Board) quickly shows how well the government employs the Web to keep Singaporeans engaged in the dozen national fitness and disease-prevention programs it recommends. The Web site has a set of "fun downloads" that live up to the billing. The National Myopia Prevention Programme offers a pop-up screen that appears every 30 to 40 minutes with a reminder to take a break and focus on a distant object, and the Activity Programme provides software to compute one's daily caloric allowance based on exercise, metabolism, and weight.
South Africa
www.doh.gov.za
There isn't a lot of health advice to be had at South Africa's Department of Health Web site, but what there is seems to be directed at health professionals. Common conditions discussed in dry detail include HIV/AIDS, alcohol abuse, cholera, drug-resistant tuberculosis, parasitic infections, leprosy, and malaria. There's little mention of heart disease, cancer, or diabetes — the big killers in the developed world. There is great wisdom in one of the most comprehensive offerings: a guideline on foot care. As the introduction explains, feet are literally the foundation of good health because they are the primary means of transportation for most South Africans; older people are out of luck if they can't walk miles to the nearest clinic. Most of the pointers for foot hygiene are old news to Americans, but some of the foot exercises recommended are likely to challenge even the most adroit among us.
United Kingdom
www.nhs.uk
The National Health Service (NHS) turns 60 in 2008, and Great Britain is giving its government-run health care system a face-lift. Beginning in 2007, the government has conducted a series of public deliberations involving scores of patients and health professionals. Videos of the meetings, some of them spotlighting the dynamic NHS Minister, Lord Darzi, a surgeon who pioneered the "keyhole" procedure, are available at the "Our NHS, Our Future" link. The experiment in creating policy by plebiscite promises some interesting viewing.
Also worth a look: the Health Tools Library — a collection of risk calculators and assessment programs — and the interactive maps of the male and female bodies.