February 11, 2011, after 30 years in power, Hosni Mubarak resigns as President. Thirty-two years ago, in 1979, Ayatollah Khomeini became the Supreme Leader of Islamic Republic of Iran. Stephen Prothero sheds a light on these two events: revolution 2.0 is more secular than Islamic. Iranian Revolution expected a powerful domino effect to involve other countries of the region into the momentum of the movement; but this has not happened.
[Egyptian] rebellion has been fueled not by the tape-recorded sermons of clerics but by the tweets and Facebook messages of people such activist Wael Ghonim.
Arab world turmoil succeed in breaking out conventions: left to simmer for too long in the intimacy, people frustration erupted into violence in Tahrir Square and all the streets in Arab world. In few weeks, revolutionary fervor spread beyond Middle East very quickly owing to social networks, serving as useful communication tools to coordinate and gather protestors in the street, in several cities simultaneously. Facebook, Twitter, YouTube, etc. played a crucial role in transmitting information and in coordinating the contestation: “revolution 2.0″ proves social media’s worth. But will these media tools lead to democracy, asks Mael?
Internet and social networking played a key role as media and coordination tools in the social unrests.
- from revolution 2.0 to democracy 2.0: are these social networks a useful communication tool? Are they able to build a relevant and durable content?
- international media and public opinion discovered these communication tools. But will the needs of the population lead to health 2.0?
Revolution 2.0?
Owing to Internet growth beyond Arab countries, social networking allows an instantaneous diffusion of an ubiquitous information. Despite strong Net censorship, social networks were able to exhort people to come out on the streets to protest. In Tunisia, last December in Sidi Bouzid, then in Egypt, from January 25, riots led to the fall of both presidents, Ben Ali on January 14th and Mubarak on February 11th. Protests spread throughout the Arab world, from Libya to Yemen. These useful communication tools (blogging, social networking, smartphones), overwhelmingly used in the MENA, must not obscure the death toll of women and men.
Nevertheless, the socio-demographic situation was a favorable background for ICT upswing. With 80 million inhabitants, whereby half the population is under 35 years old, Egypt has 24 million people connected to the Internet.
Sources : ”FaceBook” Queries by Google Trends Insights
In Egypt, the information is widely relayed by 5.45 million Facebook accounts, 300,000 Twitter accounts and 250,000 blogs.
| Country | Penetration | FB users | FB non users | Total Population (million) |
|---|---|---|---|---|
| Syria | 0 | 0 | 21906000 | 21.9 |
| Palestine | 2% | 84240 | 3677406 | 3.8 |
| Libya | 2% | 156240 | 6263760 | 6.4 |
| Oman | 6% | 157440 | 2687560 | 2.8 |
| Iraq | 1% | 225600 | 30521400 | 30.7 |
| Bahrain | 29% | 226480 | 564520 | 0.8 |
| Qatar | 28% | 396860 | 1012140 | 1,4 |
| Kuwait | 17% | 518540 | 2466460 | 3.0 |
| Jordan | 15% | 923400 | 5392600 | 6.3 |
| Algeria | 3% | 928100 | 33966900 | 34.9 |
| Lebanon | 23% | 962440 | 3261560 | 4.2 |
| Tunisia | 15% | 1594700 | 8837800 | 10.4 |
| Morocco | 6% | 1849740 | 29937260 | 31.8 |
| Egypt | 5% | 3581460 | 74576540 | 78.2 |
| Israel | 40% | 3006460 | 4525440 | 7.5 |
In MENA there was a total of 93 million Internet users in 2009, almost 5 percent of World population. In KSA, nevertheless, the Twitter calls for revolution last Friday went unheeded. And King Abdullah stonewalling speech, the same day, underlined the crucial role of the Kingdom in the regional strategies, understanding the events only in their religious sense. As said Philippe Mischkowsky, “the situation inside the country is alarming. (…) Peaceful democratic protests in the Gulf region should not be polluted by religious fervor. To be the major ally suits KSA, Iran or Bahrain but in the short term; and the issue is far from certain.”
In spite of Net growth in the Arab world, revolution 2.0 is rooted on a favourable environment. How long did it take to prepare such a background?
Who masterminded the Revolution 2.0?
If Egyptian or Tunisian backgrounds were favourable, Sami Ben Gharbia, an exiled Tunisian blogger, censured since 2002, wonders, in a long but very interesting post, how spontaneous were the social unrests held by Arab digital activism. According to him, strong ties have strengthened between Google, US (and EU) government and digital activism; and it will affect freedom of speech on the Net. For him, large scale popular unrests may be first masterminded by a media planning campaign.
“During her “Remarks on Internet Freedom” speech in January 21, 2010, U.S Secretary of State Hillary Clinton elevated Internet freedom to be a major foreign policy of the new Obama administration. Two months before that speech, in November 2009, Secretary Clinton announced the Civil Society 2.0 initiative which will help grassroots organizations around the world use digital technology, “allocating $5 million in grant funds for pilot programs in the Middle East and North Africa that will bolster the new media and networking capabilities of civil society organizations“. (…) Furthermore, big American web companies such as Google, Yahoo!, and Twitter are becoming convinced of the value of Internet freedom and their interests is sometimes tending to coincide with those of the U.S administration. (…) Between 20 and 22 September, 2010, Google will be holding a conference entitled Internet Liberty 2010 in Budapest, inviting activists, bloggers, NGOs, researchers, governments and corporations representatives. (…) The occasion will be used to launch the “Middle East and North Africa Bloggers Network”, an initiative of the Washington based National Democratic Institute for International Affairs (NDI), which is loosely associated with the U.S Democratic Party. The inauguration, on September 23rd, of a “Middle East and North Africa Bloggers Network” by a Washington based NGO, via its Aswat initiative during an event organized by Google and will be attended by U.S and Western governments and corporations representatives is exactly the kind of interference that we need to avoid.
The other worrying issue is the “invisible revolving door between Silicon Valley and Washington“, if I may borrow the expression from Evgeny Morozov, as many State Department officials are working for Big Web industry, with four Google employees having gone to work in the Obama administration. The most recent example is Jared Cohen, the technopragmatist and specialist on the use of technology to advance U.S interests, counter-terrorism and counter-radicalization, who served as member of the Secretary of State’s Policy Planning Staff under both the Bush and Obama administrations, and who has just left the U.S State Department to lead a new division at Google called Google Ideas. Jared Cohen was the same person whointervened in June of 2009 to keep Twitter online and delay its scheduled maintenance work in order to keep Iranians tweeting the post-election protests. The same Twitter is also looking to hire a government liaison in Washington D.C. whose job it will be to helping Twitter understand what to do “to better serve candidates and policymakers across party and geographical lines“. On July 9th, 2010, Katie Stanton, who worked for Google in 2003 and for the Obama administration as “Director of Citizen Participation,” in 2009, has joined Twitter where she will be working on international and business strategies.”Health is a new political stake
Planned or not, these social unrests are an expression of the Arab people’s malaise toward an outdated system: strong power, corruption, censorship and no freedom, etc. And health is a key factor.
The major health reforms initiated in Morocco, in Egypt or in Jordan, supported by the World Bank or the USAID, contributed to extend the social & health coverage to all segments of population. But governments assigned healthcare to private providers in exchange for US aid. These reforms opened health to the private sector: far from reduce bribery, this increases the cost of care for patient.
[In Egypt] households directly pay 70 per cent of total national expenditures1
This two tier health enhances on the one hand strong private health services, but on the other hand, many poor people are excluded and (re)discover an useful and cheap traditional medicine for health primary care.
Furthermore, MENA emerging countries bet on liberalism, with a strong power and without any social policy: the poor conditions of living of low-wage workers2 are a striking example. We can notice now a U-turn on this topic: Jordan launched a 169-million-dollar plan for education and health, KSA planned primary health care and private investments, etc.
Arab revolutions are rooted on specific context and shed a light on two main ideas:
- health is a crux of social problem Arab contested regimes,
- Internet, ICT and social networking, taking part of the contagion of protests among MENA countries, reveal a very efficient information and media network.
Health 2.0 in the Arab World
Jordan last October announced the launch of the “Jordan Health Initiative“ to promote and bring together ICT initiatives, Gulf countries, connected, announced the launch of several projects on smartphones or on medical files sharing Websites. Ministry of Health of United Arab Emirates launched a free iPhone application where people can geotag services and health care providers. Moreover, on Internet, the new Website Doctor-I allows to select quickly your doctor (from a 700 professionals database), to locate and make an appointment with him. A confirmation by SMS is then sent to the patient. In the same idea, in Dubai on 17 October, the Dubai Health Authority presented its new site at the Conference on Technology, the GITEX 2010.This platform enables to identify the different health professionals but also to share medical information about patients.
Even if a control should be settled to know when a smartphone become a “medical” device, as says EileenOBrien. Thanks to smartphone, a system of alerts via SMS/email called Weqaya has been deployed at large scale and can reach a large population of diabetics in Abu Dhabi. A contract between QTel and mHealth has been firmed in order to provide health services in the MENA countries, including monitoring of chronic diseases like diabetes and obesity.
Mobile Power, Susannah Fox, September 2010.
Some public statistics show us that Emirates have equal or higher internet connections than US. And all countries in the Middle East are growing 3 times more quickly in adopting cell phones than the internet, as Victoria Stodden noticed in 2008, and are soaring since 2005.
eHealth Virtuous Circle by Scott Shreeve (health20.org)
Health 2.0 or Doctor 2.0 ?
Ted Eytan defines himself as “a family physician with an interest in patient empowerment and patient-centered health information technology“. He realized a poll on Sermo, the community Website for physicians. A recent survey from JAMA, as noticed an article from Huffington, analyzed the Twitter habits of 260 self-identified physicians (more than 500 followers), revealing that half of the tweets were related to health or medicine and around 3 percent were flagged as “unprofessional,” and urged them to use more often social media in order to reach out to their patients who want quality medical information.
“I know that only a minority of physicians are visible on social networks like Twitter.com, after all, a minority of them are even exchanging e-mail with patients, so there could be no doubt that this topic would be a controversial one with a community of 110,000 physicians, most of whom do not practice in integrated care systems. (…) There were also stories of the challenged, pressurized world of the physician today, wrapped around quality requirements, patient satisfaction scores, business arrangements – a whole host of things that society insist that they get “right,” in addition to the right diagnosis and treatment. For a physician who is on their own or in a small group (where 90% of Americans get their health care), it may be difficult just to understand the “why?” of these things, much less be able to master them and lead the health care system with them.”
If Doctor 2.0 has difficulty to launch, the very revolution is patient’s one. As says Susannah Fox, one in five internet users with chronic disease have gone online to find others like them. By contrast, 15% of internet users who report no chronic conditions have sought such help online.
The internet provides access not only to information, but also to each other.
Revolutions among Arab countries reveal efficient media and communication tools. If it is not obvious that revolution 2.0 could turn into democracy 2.0, MENA countries have sufficient technology to take up the future stakes of growing chronic diseases.Will Health 2.0 be the Next Arab Revolution?
- Réformer l’assurance en Égypte pour résorber son déficit ? Enquête sur un alibi, Françoise Clément, in Figures de la Santé en Égypte, n°4, 2007, CEDEJ. [↩]
- In the Gulf, foreigners make up 40 per cent of population. [↩]
