The community plays a central role in new public health concepts. However, local health policy has not achieved a central role in cities and counties. Therefore it seems to be both reasonable and necessary for social sciences to analyse the health options in local politics and to identify aspects for improvement. The implementation of health priorities and their realisation at the local level, the latter with regard to supporting (positive) and hampering (negative) factors, and the development of strategies to implement health programmes are suggested as main research topics. Starting from the assumption that complex organisational processes in communities need organisational support, the role of the public health service as coordinating and initialising factor for the alteration of community health programmes should be investigated more thoroughly. The public health service as a part of the administration in municipalities is also involved in the endeavour to modernize administration. A main area for research will be how far the knowledge about participation of citizens and new management theories support health as a task of local politics.
A key element in the demographic transition process is the increase in the number of very old people (80+) leading to a rising need for long-term care. For the municipalities the efficient organisation of the local support for senior citizens is an important task for legal, political and financial reasons. The local planning process must be based on systematic reporting about long-term care in the community. This report must contain fundamental facts about the demographic situation, the health care system, including the quality of care in nursing homes, by ambulatory services and families as well as the resulting costs in the local welfare budget. Comparing the problem to the methods in local health promotion it is favourable to establish an office to manage the planning process and a committee for matters of care. Committee members should be all relevant stakeholders of the local health, the care and the social sector. The first priority is to achieve the participation of patients, their relatives and the local politicians to agree on targets and measures in the planning process. Key targets are the prevention of risks for long-term care, to secure the quality of care and the preference for ambulatory services, optimisation of local cooperation and minimising the costs for the community. The whole process should be guided by these targets for the provision of care.
The results of two polls were important for the planning of the work in the local health conference. Remarkable are the discrepancies between the two groups. While the citizens focussed on concrete health problems, the experts, concentrated on structural aspects of the health system. The complex of 'Old Age and nursing' and 'Aspects of/deficits in primary health care' were important for both groups. The local health coordination is to develop a concrete agenda to integrate these results. The theoretical basis of community health policy is discussed.
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