Governance and Capacity Building in German and Austrian Public Health Since the 1950s

Abstract

The German speaking countries (Germany and Austria) have a strong tradition of universal health insurance since the late 19th century. Germany was one of the leading countries in "social hygiene as health science", an interdisciplinary field of academic work, health policy and practice, providing a comprehensive scientific basis both for professional education and training in the new academies for social hygiene, the schools of public health in the 1920s, and also for a rapidly growing network of municipal public health services. Public health in Austria at that time was less advanced. There was a rupture in the field of public health in these countries as the Nazi regime and World War II destroyed almost all of the human resources, the scientific basis and the institutional infrastructure required for advancement. In the postwar period Germany was divided with separate social and health systems in East and West Germany until reunification in 1990. Meanwhile, Austria became a democratic federal republic developing a social welfare policy on the basis of a successful economy. Whereas Germany set up national programmes to support the development of a new public health, Austria established a health promotion fund. As a result, there has been more growth in the public health community in Germany than in Austria. However, in both countries strong efforts to strengthen the educational base will be needed to address the complex issues facing public health in the 21st century. For example, health expenditures in Germany and Austria are among the highest in the European Union, but health systems indicators such as healthy life years show values below the European average. The challenge to renew the highly fragmented systems of health/disease care and improve the social determinants of population health underline the need for strengthening public health structures and national policy in the two German speaking countries. Development of the scientific community is underway but has not yet reached the levels of the outstanding achievements of the late 19th and early 20th centuries.

Challenging Diversity: Steering Effects of Buzzwords in Projectified Health Care

“…Since the implementation of health promotion as a policy field in Austria in the 1990s, the definitions of priorities and goals set for activities are largely tied to project funding (Noack 2011; Hofmarcher and Rack 2006). The women’s health center, similar to other public health actors in the Austrian context, has only limited stable funding that ensures their ability to offer basic health counseling hours.…”

“…Traditionally, the universal Austrian health-care system, which covers virtually the full population living in Austria, was strongly oriented toward a curative approach, and the first legislative initiatives for health promotion were not established until the 1990s (Noack 2011; Hofmarcher and Rack 2006). The most important legislation was the federal Health Promotion Act of 1998 that delegated the implementation of health promotion measures to the publicly funded nonprofit Healthy Austria Fund .…”

“…The fund’s main purpose is to finance health promotion measures through short-term projects; they do not receive funding for long-term programs. From the beginning, Austrian health promotion has thus taken a highly projectified form (Noack 2011).…”

Editorial: Why a Theme Issue on Public Health Ethics?

“…13 German medical complicity with the Holocaust, even with belated apologies, has had long lasting negative effects in the fi eld of public health in the German speaking countries. 14,15 The participation and indeed leadership of the medical profession made clear the vital importance of addressing medical ethics anew, beyond the general humanism and the Hippocratic Oath. The Nuremberg Doctors' Trial in 1946 defi ned the rights of individuals to informed consent, freedom from risk of pain, suffering and harm, voluntary withdrawal from research and the defi nable scientifi c value of the work.…”

Editorial: Education for a Public Health Workforce in Europe and Globally

“…Consequently we have included a series of case reports, on topics such as the development of bachelor's and master's training programs at a new university in the UK 13 and at Maastricht University in The Netherlands 14 ; the global mentoring activities of experienced staff of the Braun School of Public Health in Jerusalem 18 ; and the challenges of adapting to public health education needs in Austria and Germany. 10 We can learn from how Canada reinvigorated its public health training after severe weaknesses were revealed by the SARS epidemic of 2003, with the strengthening of federal public health institutions and the creation of eight academic public health centres since 2006.…”