Tài liệu Safety and security on the Internet Challenges and advances in Member States docx

Based on the findings of the

second global survey on eHealth

Global Observatory for

eHealth series - Volume 4

Safety and security

on the Internet

Challenges and advances

in Member States

ii

WHO Library Cataloguing-in-Publication Data

Safety and security on the Internet: challenges and advances in Member States: based on the findings of

the second global survey on eHealth.(Global Observatory for eHealth Series, v. 4)

1.Internet - utilization. 2.Computer security. 3.Computers. 4.Access to information. 5.Medical

informatics. I.WHO Global Observatory for eHealth.

ISBN 978 92 4 156439 7 (NLM classification: W 26.5)

© World Health Organization 2011

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Printed in Switzerland.

2011

Based on the findings of the

second global survey on eHealth

Global Observatory for

eHealth series - Volume 4

Safety and security

on the Internet

Challenges and advances

in Member States

iv

Acknowledgments

This report would not have been possible without the input of the Observatory’s extensive network of

eHealth experts and the support of numerous colleagues at the World Health Organization headquarters,

regional, and country offices. Sincere thanks are due to over 800 eHealth experts in 114 countries

worldwide who assisted with the design, implementation, and completion of the second global survey.

Special thanks to the authors of this work Kevin Clauson and Karen Vieira, and the international expert

reviewers including: Erin Holmes, Lana Ivanitskaya, Pauline Sweetman, and Michael Veronin. The

publication was internally reviewed by Najeeb Al Shorbaji and Joan Dzenowagis.

We are grateful for the financial support and collaboration of the Rockefeller Foundation.

Our appreciation goes to Jillian Reichenbach Ott for the design and layout, and Kai Lashley for editing.

The global survey and this report were prepared and managed by the WHO Global Observatory for

eHealth: Misha Kay, Jonathan Santos, and Marina Takane.

Photo credits: ©Thinkstock, page 55 - ©WHO

1

Table of contents

Acknowledgments iv

Executive summary . . . . . . . . . . . .5

1. Introduction 9

1.1. Internet pharmacies 10

1.2 Internet security . . . . . . . . . . . .12

Spam 12

Viruses and malware . . . . . . . . . . . . . . . . . . . . 14

Phishing scams . . . . . . . . . . . . . . . . . . . . . . 15

1.3 Online safety of children and adolescents 16

Unsupervised access to children and teens . . . . . . . . . . . . 16

1.4 Digital literacy and online health information quality 16

Accuracy and reliability of online health information . . . . . . . . 17

Online Health Information in developing countries . . . . . . . . . 19

2. Review of the literature 21

2.1 Internet pharmacies 21

Methodology . . . . . . . . . . . . . . . . . . . . . . .21

Safety of medications purchased online: is there cause for concern? . . .22

Availability of prescription-only drugs and lack of clinical oversight . . . 22

Medical questionnaires . . . . . . . . . . . . . . . . . . . 23

Internet pharmacy locations . . . . . . . . . . . . . . . . . 24

Counterfeit and substandard medications . . . . . . . . . . . . 24

Packaging and labelling . . . . . . . . . . . . . . . . . . . 25

Summary . . . . . . . . . . . . . . . . . . . . . . . . 25

2

2.2 Internet security 28

Methodology . . . . . . . . . . . . . . . . . . . . . . .28

Pharmaceutical and health-related spam, spim, and spit . . . . . . . 28

Does spam affect consumer behaviour? . . . . . . . . . . . . . 28

Reliability and validity of health products purchased from spam e-mails . 29

Summary . . . . . . . . . . . . . . . . . . . . . . . . 30

2.3 Online safety of children and adolescents 31

Methodology . . . . . . . . . . . . . . . . . . . . . . .31

Are children and adolescents at risk when online? 31

Children and adolescents online without supervision . . . . . . . . 31

The link between children online and child pornography . . . . . . . 32

Summary . . . . . . . . . . . . . . . . . . . . . . . . 32

2.4 Digital literacy and online health information quality 33

Methodology . . . . . . . . . . . . . . . . . . . . . . .33

Searching for health information online: is quality content easily accessible? . . 34

The role of search engines . . . . . . . . . . . . . . . . . . 34

How do health information seekers search for information? . . . . . .35

Quality of search engine results . . . . . . . . . . . . . . . . 35

Do Internet searches retrieve desired health information? . . . . . . 36

Summary . . . . . . . . . . . . . . . . . . . . . . . . 36

3. Analysis and discussion of survey results 39

3.1. Internet pharmacies 39

Regulation of Internet pharmacy operations . . . . . . . . . . . 40

Regulation of online purchase of pharmaceuticals from abroad 43

Implications . . . . . . . . . . . . . . . . . . . . . . . 47

3

3.2 Internet security 47

Implications . . . . . . . . . . . . . . . . . . . . . . . 49

3.3 Online safety of children and adolescents 50

Information and education about Internet safety 50

Safety and security requirements . . . . . . . . . . . . . . . 53

Implications . . . . . . . . . . . . . . . . . . . . . . . 55

3.4 Digital literacy and online health information quality 56

Implications . . . . . . . . . . . . . . . . . . . . . . . 58

4. Conclusions 61

5. References 67

Appendix 1. Methodology of the second global survey

on eHealth 77

Purpose . . . . . . . . . . . . . . . . . . . . . . . . .77

Survey implementation . . . . . . . . . . . . . . . . . . . 78

Survey instrument . . . . . . . . . . . . . . . . . . . . .78

Survey development . . . . . . . . . . . . . . . . . . . . 80

Data Collector . . . . . . . . . . . . . . . . . . . . . . 80

Preparation to launch the survey 81

Survey . . . . . . . . . . . . . . . . . . . . . . . . . 82

Limitations 82

Data processing . . . . . . . . . . . . . . . . . . . . . .83

Response rate 84

Response rate by WHO region 85

Response rate by World Bank income group 86

References 86

Executive summary

5

The Internet has moved beyond an educational and research tool that served as a social network for a few elite

scientists and has been transformed into a commerce and health care juggernaut accessible to much of the

planet. However, the accessibility of this resource has not been unencumbered by complication and challenge.

Internet pharmacies demonstrated potential early on as a hub within a wider set of eHealth services,

but has since been mired in doubts regarding transparency, fraud, product quality, and even its viability

as an ethical business model. Even now, over a decade after the first Internet pharmacies, questions

of legality and policy plague this venture. It is telling that among the total responding countries to this

survey (114), most Member States (66%) remain uncommitted on this issue, unable to decide whether

Internet pharmacies should be prohibited or allowed. And while those among World Bank categorized

upper-middle and high-income countries are most likely to have addressed this issue, overall there is still

more prohibition (19%) than permission (7%) of Internet pharmacy operations.

Internet security, in the form of spam, is another persistent challenge. Crime follows opportunity and the

first spam actually appeared in 1978, shortly after the Internet itself had been opened to the public. Spam

itself poses a risk for individuals and institutions, but its greater threat may be as a vehicle for fraud, viruses,

malware, and spyware. Spam has also been used to target vulnerable populations suffering from poorly

treated or socially stigmatized medical conditions. Overall, technology filters remain the most common

tool employed to combat spam. E-mail filters are used by Member States at both the local organizational/

business (75%) and Internet service provider (67%) levels. A combination of legislative (33%) and educational

(30%) responses also remain staples in attempting to reduce spam by responding countries, although

these are most likely to occur in high-income countries, at rates of 55% and 52% respectively.

Executive summary