Introduction 1 2 5 6 7 8 9 10 8 10 8 9 9 In spite of the significant challenges created by linguistic differences in effectively communicating health information to the world’s peoples online, we could find little quantitative data on this issue. Do the world’s online users, presumably wealthier and more educated than the general population, primarily search online for health information in their local language, or do they employ Web-prevalent languages such as English? Are current online translation efforts by the world’s health and food agencies beneficial, and should these agencies be spending more resources on these efforts? In a world of human migration, which language(s) should domestic governments and international agencies use in order to communicate online health information to target populations? To transmit information to front-line health professionals in developing nations, a group that can include international aid workers from wealthy nations, which language(s) should be employed to target a particular nation? Do indigenous peoples search for online health-related information using search terms belonging to their own language or the colonial language? Real-time, accurate communication of health information might be especially critical during a pandemic infectious disease outbreak or famine. To begin to answer these questions, we have used a case-study approach that examines linguistic preferences in Internet search engine queries. 11 12 13 14 15 16 17 17 18 19 20 19 19 In this paper, we quantitatively demonstrate the need for health and food website translation that not only targets the world’s major languages, but also linguistic minorities within nations, including immigrants, foreign aid workers, and indigenous groups. Methods Measuring the Extent to Which Health and Food Agencies Translate Websites Multimedia Appendix 1 21 Measurements of Online Search Rates and Language Choice Multimedia Appendix 2 M T T A M T A Multimedia Appendix 2 M 10 11 12 Multimedia Appendix 1 Health and Food Security Indicators 12 13 15 17 19 Results Measuring the Extent to Which Institutions Currently Translate Online Information Table 1 Table 1 12 Table 1 15 22 9 23 Multimedia Appendix 2 Table 1 Overlap in the institutional domain names retrieved by Google to measure the extent to which institutions translate websites across languages         English  Search  Term Comparison  Language English Language Search Comparative Language Search URLs Unique  Hosts Host Overlap with  Comparison Languages URLs Unique  Hosts Host Overlap with  English         Avian flu French 906 539 7.1% 801 375 10.1% Avian flu Indonesian 906 539 2.4% 472 190 6.8% Tuberculosis   834 473 8.5% 790 426 9.4% Tuberculosis   834 473 0.0% 809 443 0.0% Tuberculosis Bahasa Indonesia 834 473 0.8% 462 273 1.5% Schizophrenia  813 444 10.8% 764 518 9.3% Schizophrenia  813 444 17.1% 748 463 16.4% Maize Spanish 828 421 7.8% 830 543 6.1% Language-Specific Searching of Infectious Disease Information Though we did not retrieve many WHO- and CDC-affiliated Web pages when we searched across different languages, one possibility is that Internet users, many of whom are well-educated, are supplementing their Google searches for online health information by searching in English. If true, then there would be less of a need for the WHO and other global agencies to translate online information into diverse languages. Table 2 Multimedia Appendix 2 15 12 Table 2 Multimedia Appendix 2 Language of Online Mental Health Information Searches 17 Table 2 24 24 Multimedia Appendix 2 Table 2 Table 2 Google search rates for selected health terms in local languages relative to English*      Search Term Country Public Health Comparison Metric Local Language English Searches (% of Local Language Searches) Avian flu  † ‡    United States 0 (0) English 100.0  France 0 (1) French 1.6  Germany 0 (1) German 0.8  Turkey 12 (176) Turkish 0.9  Democratic Republic of Congo 0 (0) French 1.1  Cote d’Ivoire 0 (3) French 1.4  Burkina Faso 0 (4) French 100.0  Mozambique 0 (0) Portuguese 143.8  Mexico 0 (0) Spanish 3.3  Brazil 0 (0) Portuguese 1.0  Indonesia 56 (211) Bahasa Indonesia 6.5 Tuberculosis  TB Cases §    United States 10510 English 100.0  France 5901 French 9.8  Germany 5243 German 14.3  Turkey 32371 Turkish 29.1  Democratic Republic of Congo 307554 French 23.6  Cote d’Ivoire  116349 French 8.6  Burkina Faso 46815 French 15.9  Mozambique 123360 Portuguese 28.4  Mexico 45710 Spanish same term  Brazil 141115 Portuguese 5.6  Indonesia 605759 Bahasa Indonesia 1779.3 Schizophrenia  ||    United States 13.70 English 100.0  France 22.00 French 6.6  Turkey 1.00 Turkish 10.5  Democratic Republic of Congo 0.04 French 43.0  Cote d’Ivoire  0.20 French 7.1  Burkina Faso 0.05 French 9.5  Mozambique 0.04 Portuguese 24.4  Mexico 2.70 Spanish 4.1  Brazil 4.80 Portuguese 3.6  Indonesia 0.21 Bahasa Indonesia 115.4 * † 12 ‡ 13 § 15 || 17 Multimedia Appendix 2 The Online Search Rates of Immigrant Minorities 15 Table 2 12 Table 3 Table 3 Table 3 25 Table 3 8 26 Table 3 Online search rates of immigrant minorities       Search Term Country Immigrant Language * Immigrant Language Searches per 10000 Major Language Searches † Turkish immigrants in Europe Avian flu Belgium Turkish French 56.1 ‡ Switzerland Turkish German 9.2 N/A United Kingdom Turkish English 31.2 N/A     Austria Turkish German 60.2 § Belgium Turkish French 5.8 ‡ Germany Turkish German 11.8 || Switzerland Turkish German 10.7 N/A United Kingdom Turkish English 2.8 N/A   Belgium Turkish French 15.9 ‡ Switzerland Turkish French 62.2 N/A United Kingdom Turkish English 2.9 N/A Indonesian/Malaysian immigrants in Asia/Pacific     Australia Bahasa Indonesia English 234.7 ¶ Bangladesh Bahasa Indonesia English 10474.0 N/A Hong Kong Bahasa Indonesia English 3424.4 N/A India Bahasa Indonesia English 154.4 N/A Singapore Bahasa Indonesia English 2268.0 N/A  Hong Kong Bahasa Indonesia English 23.3 N/A Singapore Bahasa Indonesia English 17.0 N/A    Australia Bahasa Indonesia English 6.0 ¶ Bangladesh Bahasa Indonesia English 687.4 N/A Hong Kong Bahasa Indonesia English 295.1 N/A India Bahasa Indonesia English 16.0 N/A # Avian flu Unites States Spanish English 102.8 ** Schizophrenia Unites States  English 91.8 ** ‡‡ Unites States  English 37.9 ** * † ‡ § || ¶ # ** ‡‡ Table 4 Search rates in European languages in Sub-Saharan Africa     Country Colonial * Minority Language Minority Language Searches per 10000 Colonial Language Searches Search Term: Avian Flu Angola Portuguese English 6629 Cameroon French German 323 Ghana English French 2024 Ghana English German 1744 Ghana English Dutch 498 Kenya English French 2941 Mozambique Portuguese English 14286 Mozambique Portuguese French 4444 Nigeria English French 4235 Nigeria English German 897 Rwanda French English 1481 Senegal French English 732 Search Term: Tuberculosis Angola Portuguese French  1504 Cameroon French Portuguese English 2405 Democratic Republic of Congo French Portuguese  2364 Ghana English  836 Kenya English  1128 Mozambique Portuguese French  2842 Nigeria English  506 Rwanda French Portuguese  2808 South Africa English Afrikaans 1547 Search Term: Schizophrenia Angola Portuguese Spanish English 1547 Cameroon French English 1922 Democratic Republic of Congo French English 4304 Ghana English French 488 Mozambique Portuguese Spanish English 2441 Rwanda French English 18453 Senegal French English 3287 * Search Rates in European Languages in Sub-Saharan Africa 18 19 Table 4 Table 4 15 8 The Effect of Region-Specific Cultural and Indigenous Terminology Table 5 27 Table 5 19 Table 5 The effect of region-specific cultural and indigenous terminology     Country * Search Term Comparison Search Rate Ratio Canada † corn:maize 36:1 United States 512 corn:maize 28:1 United Kingdom 115 corn:maize 7:1 India 38 corn:maize 2:1 Nigeria 179 corn:maize 1:2 Kenya 775 corn:maize 1:3 Tanzania 646 corn:maize 1:4 Zimbabwe 720 corn:maize 1:4 Spain † maíz:elote:choclo 10:1:4 Venezuela 467 maíz:elote:choclo 16:1:3 Colombia 312 maíz:elote:choclo 20:1:5 Mexico 1081 maíz:elote:choclo 14:16:1 Guatemala 869 maíz:elote:choclo 12:10:1 Peru 145 maíz:elote:choclo 11:1:25 Argentina 132 maíz:elote:choclo 41:1:51 * 19 † Discussion Principal Results In a world where infectious disease pandemics and threats of famine are always present, and in spite of the fact that the World Wide Web offers great hope for rapid and accurate sharing of information between peoples, we have demonstrated that one linguistic group does not or cannot access the health and food security websites of a different linguistic group. Our data suggest at least three reasons for this. Table 1 8 9 Table 2 Table 3 Table 4 Table 5 Recommendations 23 10 Table 2 Table 5 28 Multimedia Appendix 2 Future Studies 29 30 31