Much of the discussion around terminologies, classifications and ontologies takes place in research circles in developed countries. Significant progress has been made in recent years in identifying the user needs, and working out contributions to possible solutions. A key driver is the compelling demand for automated solutions and interoperability of systems. This has been supported by new techniques such as the semantic web and, more recently, the emerging semantic grid architecture Proposed solutions are expected to facilitate the speedy, yet reliable exchange of information within and between countries.

The World Health Organization, for its part, is urged by its community of192 Member States to ensure that such developments will equitably benefit those populations that are faced with the “digital divide”, and to speed up mechanisms that will make modern information technologies available in resource-limited settings. A pragmatic approach at this point suggests that a mix of humans and machines be networked to relay essential information to those who need it most. Conceptualization and gradual adoption of new technologies of recognized efficiency, cost-effectiveness and adequacy will strengthen the countries’ resolve to provide the best possible service to their entire populations. Consequently, efforts should be made to reduce the “know-do gap”: knowledge gained around the world should be swiftly turned into operational solutions that will make a difference in the service of better health for all.

WHO is the custodian of the members of the Family of International Classifications, namely the International Classification of Diseases, the International Classification of Functioning, Disability and Health, and possibly a future International Classification of Interventions. Those long-standing international public goods are being revisited in the light of modern information needs, with the support of a network of Collaborating Centres at the national level. The perception of the world that has been captured informally by the collective knowledge of the authors of the statistical classifications over some 150 years needs to be now formally described, taking into account the multidimensionality of the underlying concepts. This move is also necessary in order to keep abreast with the rapid changes in reference clinical terminologies.

At the other end of the complexity spectrum, on the other hand, countries with the highest mortality rates and the heaviest burden of disease, which are also those with the most limited resources, observe that the 100 most frequent causes of mortality explain more than 90% of the deaths in their populations. Preventive and other public health interventions, which do not usually appear in classifications used in industrialized countries, go a long way to save lives, provided implementation is properly recorded and reported to permit elicitation of trends and planning of future action. It is therefore crucial that the scalability of the existing health information instruments be constantly kept in mind during the development of high technology tools. We submit that adequate design and embedded concept representation should both preserve the integrity of the overall classifications as used in well-to-do countries but be adaptable for use in poorer environments with no loss in quality. It also calls for added flexibility to address culture-specific perceptions: a true localization of existing tools would be highly desirable for added efficiency. Increasing consideration should therefore be given to the multilingual applicability of the proposed knowledge representation systems.

WHO welcome offers from the scientific and research community to develop collaborative activities in the service of the above objectives.