Abstract
A debate on Internet governance for health, or “eHealth governance”, is emerging with the impending award of a new dot-health (.health) generic top-level domain name (gTLD) along with a host of other health-related domains. This development is critical as it will shape the future of the health Internet, allowing largely unrestricted use of .health second-level domain names by future registrants, raising concerns about the potential for privacy, use and marketing of health-related information, credibility of online health content, and potential for Internet fraud and abuse. Yet, prospective .health gTLD applicants do not provide adequate safeguards for use of .health or related domains and have few or no ties to the global health community. If approved, one of these for-profit corporate applicants would effectively control the future of the .health address on the Internet with arguably no active oversight from important international public health stakeholders. This would represent a lost opportunity for the public health, medical, and broader health community in establishing a trusted, transparent and reliable source for health on the Internet. Countries, medical associations, civil society, and consumer advocates have objected to these applications on grounds that they do not meet the public interest. We argue that there is an immediate need for action to postpone awarding of the .health gTLD and other health-related gTLDs to address these concerns and ensure the appropriate development of sound eHealth governance rules, principles, and use. This would support the crucial need of ensuring access to quality and evidence-based sources of health information online, as well as establishing a safe and reliable space on the Internet for health. We believe, if properly governed, .health and other domains could represent such a promise in the future.
Highlights
The Internet, which began as a government-funded initiative, has spread throughout the world at a remarkable rate during the 1990s and 2000s
The literature search included a limited search of references retrieved from included articles but did not extend to searching Internet web sites, grey literature, conference abstracts, or contacting authors for unpublished data
It must be noted the research contained in this review primarily focuses on North America and Europe; conclusions drawn from these data, must be limited to describing the situation in these areas
Summary
The Internet, which began as a government-funded initiative, has spread throughout the world at a remarkable rate during the 1990s and 2000s. This transition of the Internet from a curiosity among a few academics to permeating most facets of personal and professional life has been described as revolutionary by technology experts and media alike [1]. While just 3 million people had access to the Internet in 1990 (73% of which lived in the United States of America and 15% in western Europe; 2), there are nearly 2 billion people connected to the Internet worldwide (Table 1; 3). Worldwide e-commerce sales are predicted to reach US$ 963 billion by 2013, averaging growth of 19.4% a year [4]
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