"Community Based Information Networks and Health Education"

Catherine Holland
Horse Horse Lion Lion, A Consulting Cooperative
140 Kentucky Ave. SE
Apt. A
Washington, DC 20003

ABSTRACT

This presentation looks at the impact of the emergence of community-based information networks (C-BINs) on the work of health educators, on their organizations, and on their communities. It discusses ideas for incorporating C-BINs into health education efforts, as well as the implications that such applications have for the relationship health educators and communities. Finally, it examines the effects of incorporating computer information services on the health organizations themselves.

PAPER

The Role of Community Networks in Health and Sexuality Education

Some of you may well wonder what role computer networks can have in health and sexuality education, in a field that thrives on human interaction and personal connection. I hope to give you some ideas for that today. I want to talk about community networks because they're becoming more and more central to communicating with people, to serving people, to helping people make important decisions about their lives. Further, the reason I want to discuss our work in terms of emerging technologies is that the tools we use and don't use to do our jobs, define our jobs. They set the limits and the possibilities of what we can do, of what we can even imagine doing.

Think about the telephone, for example, something we all take for granted, that we've probably taken for granted since we were old enough to focus that far in front of us. Now imagine what your job would be like without a phone. Imagine trying to get hold of the information you use everyday without one, or setting up meetings, or making appointments. Would we come to conferences if we couldn't call back to the office during breaks, or call home in the evenings? When our clinic windows get smashed, how would we get them replaced without being able to call the window repair guy or the insurance company? When we need advice, or input, or consolation and we need it fast, how would we get it? All these things we take for granted, all these large and small relationships are made possible as we know them by the telephone. The phone for us today is a very important window onto the world, a very important facilitator of our social relationships.

What I'm getting at is that a technology is not just a machine, or even a machine at all. A technology is a whole system of values and practices that support some activity of ours. So the important thing about the technology of telephones is not the buttons you press or the thing you hold against your face or the wires in the phone. The important thing is the way it lets you do things, to call whomever you want and say whatever you want, and that other people understand how to do that too and have pretty much the same set of expectations about what we can use phones for. A technology doesn't have to be a machine at all. A conference is a technology, a technology for getting out information and strengthening professional relationships. We have other technologies for that kind of thing too, like newsletters, or joint projects, or even schools. Safer sex and abstinence are both technologies of protection, but the fact that we see them as so different from one another points up how technologies are defined by the human, social values we embed in them, by our assumptions about the world and our place in it. Religion is a technology for the accumulation of understanding and sense-making, for connecting ourselves with one another as well as with something larger than us. So is science, in a different way, but maybe not quite as different as some people would have you believe.

I say all this because I want to underscore the tremendous relevance, even urgency, that this subject has to our roles as educators, trainers, and citizens. A lot of people in the social services imagine for some reason that technology is irrelevant to their work or worse, that somehow the values of technology are actually hostile to their concerns and their mission. Partly I think that perception comes from the fact that often in our culture we as citizens don't have very much say in which machines get developed or how they're put to use. And so because we're not involved, the machines end up being used to support things we don't believe in, or whose use has consequences we find unacceptable.
We need to remember, though, that the issue is not the machines themselves but how they're used, which values they support and which values they undermine. Computers, for example, can pose real threats to our privacy, but they also offer the opportunity to protect us and all our information with an ironclad anonymity that gets its strength not from the laws of government but from the laws of physics. I also want us to keep in mind this quote from Sir William Preece, who was chief engineer of the British Post Office in 1876. He said, "The Americans have need of the telephone, but we do not. We have plenty of messenger boys."

Last year there were over 2000 articles published in newspapers and magazines on the Internet, also known as the information infrastructure or the "data superhighway." In the previous year there were fewer than 20. This is a hot topic, and unlike virtual reality, artificial intelligence, or robots in the home it's actually here now as a presence in the lives of 16-20 million people around the world.

The Internet is a network of networks that can be used to exchange mail, data, and video. It enables you to carry on screen-based conversations with dozens of people around the world simultaneously, or to use university supercomputers, or to download data from NASA, all from your home, office, or classroom. No one "runs" the Internet. There is no headquarters, no policy-making board, except to set the technical standards that allow all these machines to hook up with one another. You get access to the net by signing up with a local provider whose own system is connected to it. You follow the rules and policies of your provider, which vary tremendously from place to place.

Access to the net can be had for free, for the cost of a phone call, or for anywhere from $5 to $50 per month, depending on how you get it. Large companies, universities, and government agencies have provided their people with access to the net for years because it makes it easy and cheap for them to collaborate with others in their field. The net is distance-insensitive, which means you can get files from a computer in Australia as quickly and as easily as from a computer across town. Once you're logged on there are no long-distance charges, so that Australian file doesn't cost any more either. Most people who pay for their connections pay a flat fee every month for unlimited use of e-mail, conferences, file transfer and everything else. Now that everyone wants it, the phone companies, the cable TV companies, and the on-line services like America On-line and Compuserve are getting into the business of Internet access. Starting this year in parts of Massachusetts you'll be able to get on the net through your cable box.

The Internet is growing at the rate of 10-15% every month. In 1981 there were around 200 computers connected to it. By 1985 there were 2000, and by 1989 160,000. Today, less than five years later, there are more than 1.8 million computers connected to the Internet. Usenet news, which is the collection of news and discussion groups on the net, receives about 425,000 articles every two weeks. For those of us who never seem to have enough space on our hard drives, imagine filling about 60 megabytes every day, or more than 800 megabytes every two weeks. For those without computers, that's the equivalent of about 200 full-length novels, every day. And that number doesn't include e-mail, or file exchanges, or chatting, or any of the myriad other activities that the net supports.

But why does this matter to us as citizens, as educators? Why is trying to drink from this fire hose of information any different from 500 channels of cable TV with nothing on worth watching? In terms of stuff we're already familiar with, the Internet is a lot more like the telephone than the television. TV follows the broadcast model of one-to-many. Lots of people listen to what one organization has to say. We can't really use the technology of TV to talk to our friends or to talk back to the TV station. The information flows one way. Even public access cable, which lets anyone get on TV, is still one-to-many. Since access to TV air-time is controlled by just a few big companies, is very profitable, and is regulated by the government, you don't see very much diversity of content or opinion. Because millions of people are watching the same stuff, these companies shoot for the lowest common denominator. That's what makes TV, TV.

The telephone follows a different model. Instead of one-to-many, it's many-to-many. Anybody can call anybody else. We can say whatever we want. We can sing, we can do business, we can talk to our moms, or we can have phone sex. With modems and computers we can connect to other machines and exchange stuff. Each time we pick up the phone we can use it for any of these things, or all of them. The phone is a tool to help you do all kinds of different stuff. TV is not. It always forces you into the same passive relationship. The net is like the telephone in that it can facilitate many different activities and relationships, from the very passive to the very active.

My aim here is not really to talk about the Internet. Instead I want to talk about one particular kind of technology that the net makes possible, what I call the Community-Based Information Network, or C-BIN. If the Internet is an information superhighway, then C-BINs are like the small towns along the road. Some people refer to them as "electronic greenbelts" or "virtual villages." Whatever you call them, they're designed to be places in which you spend time teaching, learning, and interacting with other members of your community.

The idea behind C-BINs is to provide resources and means of communication that support the civic life of a community. They provide electronic mail, library resources, discussion groups, and a means to communicate directly with city government and elected officials. A C-BIN might have a homework helpline, a community events calendar, a listing of local merchants. They can be run directly by city or state governments, by non-profit volunteer groups, or, occasionally, by commercial services.

With the exception of those run by commercial services, access to C-BINs is either free or very low-cost. Their operating expenses are supported by donations, grants, and government money, and special efforts are usually made to place terminals in public places like libraries, schools, and social service agencies so that people who don't own computers can participate as well. In many cities the community networks are connected to the Internet, giving their users access to other community networks around the world, as well as to all the other Internet resources. Today there are community networks operating in twenty or so cities around North America in places like Dillon, Montana; Youngstown, Ohio; and Victoria, British Columbia; and C-BINs are in the works for Seattle and Snohomish County in Washington.

Let me show you a couple of examples. These are snapshots of opening screens of a few community-based information networks that were collected by Steve Cisler of the Apple Libraries of Tomorrow project for a terrific paper he wrote on community networking. (See appendix)

The first one is from the Cleveland Free-Net.

As you can see, the metaphor used is that of a small town, with distinct places to go for schools, libraries, news, social services, and access to government. The Cleveland Free-Net was the first real community network, and has served as a kind of a template for the other Free-Nets that use its software. Although it may not look very pretty, the advantage of its all-text interface is that it can be accessed from any type of computer using the most basic communications software.

Next up is a selection from Wellington, New Zealand. If you've used a Mac or Windows, you'll recognize the metaphor of folders and the documents they contain. The front window here contains City Council information like by-laws, policy statements, and election results. In the background you can see the icons for information on Wellington's churches, hotels, and kids' activities. Because this interface depends on graphics you need a particular kind of software to get the full benefit.

Next we've got a screen from the Cupertino CityNet down in Silicon Valley. Notice the icons at the bottom for mail, news, conferences, and help. In the middle of the screen you can see the places to go for general information about the city's history, demographics, meetings, and events. In the background are places to go for discussions and public chats with other users.

Lastly, I've got a shot from a kind of hybrid commercial-community network that's accessible from America On-Line, which is a dial-up bulletin board service like Compuserve or Genie and charges by the hour. Right now it's not connected to the Internet, but you can use it to send electronic mail over the net to millions of people who are not America On-Line subscribers. This area in America On-Line is sponsored by the San Jose Mercury Newspaper and is basically an expanded electronic version of the paper. In the center you see the headlines, and off to the left the different areas or sections like entertainment, sports, and classified ads. There's a news library you can browse for research, and you can search the current issue by keyword to find all stories that contain references, say, to both peanut butter and Venezuela. Below that is a communities section where you can go for more detailed information on your particular neighborhood. You can tell that this one has less of a "civic" feel than the others, not because it's more slick, but because its metaphor is the privately perused newspaper rather than the shared community.

Okay. So now we've covered a little bit about the Internet, and a little bit about community networks. What's the point? Why talk about them at a conference on health care? Well, for several reasons, some having to do with where we are today and some having to do with where the world is going and the positions we'd like to occupy in the midst of these changes. First, information is vital to us because it's a big part of our business. We gather, generate, and distribute information; people come to us in great measure because we have the information they want or we know how and where to get it. To those who seek us out we are an information technology. If we want to remain in this business we need to be aware of and skilled with all the ways in which information is delivered. We need to understand their implications for our profession and for the groups and communities we serve. The roles of face-to-face counselling, lectures and brochures change when they're not the only or most accessible game in town.

I want to consider our relationships to information because that's where our practice intersects with the heart of C-BINs. We, as educators and counselors and information providers, are involved with information. It begins with gathering resources and culminates in developing effective ways to serve our clients. On this path we read newspapers and journals, seek out lectures and conferences, wrestle with what we've read and heard. I may have heard in passing that some people are using Glad Wrap instead of dental dams to protect women and their partners during oral sex. I may or may not pursue this tidbit, but if I did, I'd want to know, first of all, is this true or just a rumor. I'd probably call a few colleagues to find out if they've heard anything, know of any references, have positions on it. I'd track down any available research, and try to talk to people who've made the switch, although I don't know how successful I'd be on this step. After mulling this all over, discussing it with friends and co-workers, I'd make a decision about whether to incorporate this new information into my teaching, counselling, or patient education.

Some of these steps involve relatively more initiative and agency on my part, and some of them will hit dead ends because the people with the information don't happen to be in my circle. With a C-BIN I'm likely to get my information more directly, more completely, and more reliably because I can post my questions to a newsgroup dedicated to safer sex for women. Because the network of people coming together here is so vast and yet so focused, there's little doubt I'd get some responses, and more likely I'd be inundated with information and references.

This brings me to the other relationship to information that I believe is fundamental to the work we do. Once we've taken in some of the tremendous wealth of information available, worked it over, and developed ourselves and our teaching with it, we take our ever-expanding folder of resources and devise programs to educate other people. We order or design curricula, collect articles, compose charts, create activities, and then take all these tools into classrooms, community centers and homes. The manner in which we present our information ranges from straight lecture to highly interactive projects, but rarely do we subvert our position as leader or our students' positions as followers. People approach us with questions, and we answer them outright or get them resources in which the answers are contained. We try to be responsive and forthcoming, but we do occupy the place of gatekeeper; we determine which information will best answer those questions. In essence what we practice is information distribution; we've gathered the information and now we're going to share it with those who ask.

So, why does that matter? In the current scheme of things information gets passed along in relatively straight lines; someone with a question poses it to someone with an answer and hopefully receives the desired information. In this relationship, one person has the information while the other tries to get her to share it. This simple dialectic turns out to have far-reaching consequences because the person who controls the information makes choices, consciously or unconsciously, about the content, delivery, and tone of her answer. She defines the terms, crafts the lens, through which that information will be understood.

For example, if I begin a program on sexuality with all of the dangers associated with sex-like sexually transmitted infections, pregnancy, sexual violence-rather than starting with a discussion of sex as healthy, natural, and complex I've cast the topic in negative terms from the outset. I may in fact want my students to believe that sex is dangerous, and so this serves my purpose. But for the students, reliance on me as their principal source of information leaves them with my rather singular view of things. This is the model we generally see operating in classrooms and, consequently, the mode most of our clients carry with them to other walks of life. They're taught to accept what they're told, not to question it, and certainly not to look further. As educators, we're unique indeed if we incorporate into our programs space for students to make discoveries of their own, especially if that process calls into question our own messages and goals. We haven't been adept at teaching our clients how to get information from multiple sources, how to look at it critically, or how to use it in their day-to-day lives. In short, we aren't shaping sophisticated consumers of information. By controlling people's access to information either at the source or through the skills we do or don't impart, educators ultimately have a profound impact on general levels of cultural and civic participation. Traditional educational settings encourage passivity. This, in turn, contributes to the lack of involvement in community affairs we witness on the part of so many members of our society.

There are lots of things we can do with C-BINs that would provide alternatives to the passive learning that occurs in many of our institutions. For instance, we could coordinate an on-line adolescent development program for parents of teenagers or puberty-age kids. We could post weekly segments on the changes young people undergo at these periods, the joys and difficulties parents encounter with their children through their teen years, how to be effective educators for their children, and so on. Parents would be invited to post questions, observations, and comments. We and the other participants would respond to them, with the discussion circulating among everyone involved.

Another project, one that illustrates how a new community can develop through electronic exchanges, is the facilitation of a discussion group for boys ages 12 to 18 on issues of male responsibility in teen pregnancy. The moderator could put out a notice on the network describing the forum, and invite participants from all over the country. Provocative questions, statements, or scenarios would be offered, and teen boys would respond with their opinions, thoughts, or queries. This type of format encourages openness because kids can ask and say things electronically that they'd be reluctant to voice in person. As long as the facilitator supports people exploring these issues, even if their thoughts aren't always "correct," you'll have a place where boys can really start to tease out the complexities of this subject. Because of the age range and geographical diversity of the participants there would be great differences of experience and opinion which can serve to broaden and enrich the values of those involved. Such a group can grow readily into its own community, one founded on common interest but strengthened by wide diversity.

There are always a number of different ways any given set of goals or information can be put into an instructional program. We know now that sometimes a lecture makes sense, sometimes a role-play, sometimes a brochure, sometimes a counselling session. The same holds true for electronically-mediated information. On community networks, for example, I could choose to use a database, a real-time chat group, moderated discussion groups, unmoderated e-mail, and so on. Each of these has different characteristics, and brings out different values and skills in the people who use them. The flexibility of the system and the variety of available modes are useful for us as educators because we can get our students to practice certain qualities, like reflection or spontaneity, simply by choosing one tool over another. For example, if I were running a program designed to teach teenage boys to be less aggressive and more reflective, I might run it over e-mail because that medium encourages deliberation while keeping the discussion fresh. If I were working with adolescent girls to help them be more assertive verbally I might run it in a live chat forum, which encourages spontaneity and provides a safe space in which to practice controlling conversations. Rather than just preaching these values at my students, trying to work them in from the outside, I can embed them in the technologies of communication they use, so that every act of their self-expression becomes an exercise in practicing those values, trying them on, getting comfortable with them.

Let's look at another example, a person who's interested in finding out the rates of HIV infection among women within her community and how they compare to the national figures. With a C-BIN at her disposal she could do this with ease from terminals at her home, local library, or school. She wouldn't need to rely on a teacher to give her that information; she has direct access to it herself through a number of electronic pathways, like the local health department, the Centers for Disease Control, the Women's Health Network, etc.

I want to develop this person a bit so we can look at why C-BINs would be appealing to all of us now, and where they can take us in the future. Let's say this person is a young African-American woman, about 17 years old, and she's noodling around on-line one day, perhaps sending her friend an e-mail about an upcoming party, and she stumbles across a pointer to AIDS resources. She's mildly curious so she looks in further and finds that list splitting off into an assortment of more specific areas, like epidemiology, pediatrics, gay-lesbian-bi youth, and so on. She settles on the women and AIDS topic and starts poking around in there. There are statistics, articles, projects devoted to a wide array of topics, including the impact of HIV disease on African-American women nationally and locally. Now this young woman isn't surprised to learn that HIV is affecting women of different races in disparate ways. Her curiosity, joined with the ease of access to data that the network provides, encourages her to explore the reasons why these differences exist.

Now, this young woman, let's call her Sarah, is not an anomaly. She's displaying qualities and using skills that are increasingly common among young people today. She's at ease on a computer, in an electronic world, and she's learned to use an important means of communication broadly by adapting it for both her social and cognitive use. Most young people haven't yet learned to rigidly compartmentalize their lives, so things learned in one context often spill over into others. The beauty of working with them is the incredible array of uses they create for tools we've designated as singularly appropriate for work or school or social settings. Sarah is doing another thing young people do all the time; she's looking into things she's curious about, things that affect her world. But this HIV stuff is not a burning passion of hers, so if more effort had been necessary to explore it, she might have left it at the "I wonder..." level. But exploring on a C-BIN is so easy, just a few keystrokes and a little reading, and her "I wonder" stretches out to become a chain of "Oh reallys". The ease of access to information and people inherent in computer networks should not be underestimated; Sarah's world broadens and deepens because so many other worlds are right there, open to her.

Sarah is a tremendous resource, not only for her own communities, but also for us as educators. On the simplest level she's learning more and more, and can educate her peers formally or informally. On the next level, she's learning how to get information herself, and what those skills open up for her. For us as educators, Sarah is a person who can guide and shape our involvement in her community because she's developed her own sense of the needs. She can act as an engaged participant in both her own world and ours.

C-BINs offer communities the opportunity to more actively and directly define their educational needs by providing an information infrastructure that is accessible on a truly local level. Such a system, by its very nature makes its users function as both information recipients and producers. For example, with direct and ready access to the infant mortality rate among babies born to teenage Cambodian girls in Philadelphia, anyone within that community could use their network to raise awareness of the issue, to communicate with other like communities, to discover what's being done elsewhere to confront the problem, and to initiate interventions. All of this can be done from within a community rather than being done for them by outsiders, however benevolent these individuals may be. The immediate availability of information resources, coupled with the interactive nature of community networks, encourages inclusion and civic involvement by grounding action within the community.

Now, how do community networks change our professional roles and their relationships to each other, and what are the deeper consequences of these changes? C-BINs eliminate the notion and the practice of a single information source. Information becomes widely and cheaply available from multiple origins. This can be achieved by establishing access points for the public at citywide terminals, in schools, or in homes that allow people to link into the services that a municipality has provided on its network. In addition, with broader connections to other networks nationwide the information available through a C-BIN multiplies immeasurably. This increase in the number of information pipelines has the effect of diffusing the authority of any single source. There's more than one place to find out what you want to know, and as a result many more facts and many more interpretations come into circulation. The accessibility of a wide range of opinions, ideas, and data provides people with the support to shape their positions much more critically than is possible if you're relying on a single person or place for your information.

C-BINs redefine the idea of community by basing it on shared interest or affiliation, rather than on common place. Instead of people's bonds growing, if at all, out of the geographical settings they more or less reluctantly share, they emerge from the willing exchange of ideas and opinions that a networked forum relies on. Take the case of a large, urban high school. The people involved with this school come from a vast range of backgrounds and have opinions and values that vary accordingly. Because the school has an interest in serving as many of its different constituencies as it can, or at least in outraging as few of them as possible, it will shape its programs to meet the least controversial common denominator (much like television). A program on prevention of sexually transmitted infections will be so vague or single-minded-like saying abstinence is the only protection we can support-as to be virtually useless. And still the school will miss. There will be those who are scandalized that their child learned anything about sexuality in school, and those who will be disgusted that their child isn't learning anything useful about sexuality in school.

C-BINs address these problems by enabling people to come together around common interests and values, rather than trying to organize them around common zip codes. Thus, parents, educators, and administrators who are interested in a comprehensive program to teach young people about sexual health can participate in a forum devoted to this issue on their community network. No one there is a captive audience, and everyone there is interested in making a contribution. Network pathways offer educators a viable alternative to the schools, thereby undoing the stranglehold that the threat of controversy seems to sustain in many formal educational settings.

C-BINs support young people actively seeking and discovering information that is otherwise limited within their communities. They extend the use of a medium with which kids feel comfortable into many more areas of their lives. They can link up civic, school, home, and business computing resources, so that these artificial boundaries dissolve, if we want them to. They provide youth with a place to search that is within their control, and whose resources are equally available to everyone regardless of age. This can be essential in locations where health care providers are scarce, libraries are inadequate or non-existent, or community values discourage making controversial material available. A young man with questions about his sexual orientation could discover an on-line support group for gay, lesbian and bisexual youth with participants spread all over the country. He can forge ties with a new community, a virtual neighborhood, which can offer him the support and openness lacking in his physical community. Such connections provide people a path out of the isolation they may be experiencing, for whatever reasons, in their own municipalities.

C-BINs offer people accessible sites for exploration of sensitive topics where voluntary anonymity is easily maintained. This is especially useful for young people who are looking at sexual development, identity, and expression, but who don't always have the tools or the support to do this in a face-to-face situation. There is research that supports our observation that many students are more comfortable getting feedback from a machine than from a teacher, because of how kids feel adults judge them. Now, such findings obviously raise some unsettling implications for us as educators and adults, and I'd certainly be the last to say that we shouldn't work on this. But in the meantime, it seems sensible to me to increase the number of venues available to young people where they feel free to ask sensitive questions, and receive complete and accurate answers at their own pace, on their own terms.

In addition to creating new communities of interest, C-BINs also operate to support and strengthen existing geographical communities by providing an easy means of involvement for everyone. This is significant when we consider who, within a given community, is marginalized because of constraints on their mobility: mothers with limited access to child care, individuals confined to their homes because of disability, older people who are no longer ambulatory, young people with transportation difficulties, and so on. These people would be able to participate in community affairs through home, school, or neighborhood terminals that linked them all up to the network. By re-integrating community members whose absence we may have lamented but been unable to overcome, we can use C-BINs to strengthen existing neighborhoods, towns, and cities. Such networks enable participation by many more segments of the population, and deepen our own resources by incorporating the talents, knowledge, and skills of those who have long been omitted or prevented from actively shaping their communities.

Community networks give us exciting ways of working with existing communities, but also offer possibilities for building and supporting new communities, ones built on common interest instead of common addresses. As educators we'll have an opportunity to weave ourselves into these actual and virtual neighborhoods and, in so doing, to become truly a part of the communities we want to serve. This hasn't always been easy for a number of reasons; our commitment to working within the schools has subjected us to oversight that often ends up watering down the messages and information we'd like to give to students. This, in turn, cuts down the credibility we have with young people because we're not able to tell them anything terribly useful. In addition, when we've chosen to try to work outside of the educational system, it's often been difficult to find a central entry point into a community. When we do, our programs are sometimes not encouraged because they haven't grown out of the needs expressed by the community, but rather out of our outsider's ideas of what the community needs. We may not be far off, but there can be difficulty selling a project if it isn't created collaboratively.

C-BINs can re-define the very notion of community, a concept that has traditionally been bound, to varying degrees, by geography or narrow affiliation. These networks enable the emergence of virtual communities, no longer founded on location, profession, organization. Instead, people who share common interests can come together electronically to exchange information, ideas, projects that effectively create new communities. Individuals interested in discussing and exploring efforts to reduce violence in schools can meet in their own forum. An isolated, rural community with its first known case of AIDS can build ties to other communities affected by HIV to learn about the disease, how to support people who are infected, and how to educate their community. High school students interested in practicing abstinence could begin a support and discussion group with other young people around the country. Each of these points of interest offers the participants new associations, new neighborhoods, based on shared concerns but encompassing a diversity of experience and background that is not usually found in physical communities.

C-BINs also offer us a great deal as professionals. On the simplest level they provide a medium for us to disseminate our numerous brochures, pamphlets, and fact sheets far more cheaply and easily than we can do today. Educators from different agencies across the nation can readily collaborate on a project to jointly educate young adults about sexual health. Counselors from sites in three distant cities could team up to co-moderate an on-line support group for teen parents. We can send and receive electronic mail between offices, from agency to agency, and to and from private practitioners. We can establish mailing lists for colleagues interested in any imaginable topic, like support programs for kids, or public policy on RU486, or health care job openings. We'll have immediate access to statistics, research data and findings, and experts in a variety of areas. Networks offer agency administrators an easy means of distributing position papers and health alerts, or of coordinating statewide lobbying efforts.

Finally, C-BINs can play a crucial role for our organizations as they evolve under health care reform. There's a lot that's unknown about what will shake out, particularly in service delivery. But what's clear is that information, and the ability to create and disseminate it effectively will be more important than ever before. Preventive medical care, which is based on information and education, seems likely to be central to any plan that is adopted, and in fact health education is specifically identified as a key component of the national reform plan. Easy and inexpensive information delivery is going to be highly valued within this developing system. C-BINs offer us the chance to plant ourselves squarely in the middle of this delivery stream, and to ensure a vital position for us as organizations. As health care reform reshapes the entire world of medical practice, agencies that currently provide direct patient care may no longer do so. All of us need to think about what roles we might or might not be playing in the future. We have our own mandate for re-invention: if we don't take it we will likely find ourselves squeezed out of both the service and the information businesses by powerful cooperatives with a strong interest in education and preventive care, and who were able to see the writing on the wall more clearly than we. We need to make ourselves much more relevant to the lives of the communities we serve. There are important questions about organizational survival which C-BINs can address. Community networks are a powerful tool for expanding our educational efforts into communities we hadn't previously been able to reach, as well as into domains that have a newly emerging need for strong information providers.

If we try to hang on to our status as gatekeepers of privileged information, we will lose. There are very few secrets that are worth anything any longer; in fact, there are very few secrets at all. We need to begin to understand and shape our own development in the "information age" so that we can make smart and effective contributions to the changes taking place as a result of the rapidly expanding access to information.

I want to end with a quote from Bruce Sterling, a science and science-fiction writer who spoke not too long ago before the National Academy of Science's Convocation on Education and Technology. He was speaking of the need to get classrooms connected to the net, which some people refer to as cyberspace, but I think his words apply here as well. He said, "I know something important about cyberspace. It doesn't matter who you are today--if you don't show up in that mirror in the next century, you're just not going to matter very much." What we do matters, matters a lot. We have to show up in that mirror. Even if we do have plenty of messenger boys.

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