Academic journal article Public Health Reviews; Rennes

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

Academic journal article Public Health Reviews; Rennes

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

Article excerpt

INTRODUCTION

At the end of the 19th and in the early 20th century, Germany was seen as one of the leading countries in the development of social hygiene, as well as of Bismarckian social health insurance. During this time period, public health led to many scientific breakthroughs such as those of microbiologist Robert Koch, and the epidemiologist and highly influential civil servant Adolf Gottstein, making public health a cross-sectoral field.1 Austrian public health followed a similar course, but was less advanced. These "golden years" of public health in Germany came to a sudden end in 1933 when the Nazi Party seized power. With the forcible incorporation of Austrofascism into the First Austrian Republic in 1934 the conditions for ongoing development of the field deteriorated rapidly in this country as well.

During the Nazi period of 1933 to 1945, the Hitler regime preached many aspects of "public hygiene", but in reality the science base in the biological fields was stricken by the elimination of Jewish contributors through expulsion and murder. Simultaneously, public health was complicit in the corruption of eugenics leading to the mass murder of "inferiors". In response to these atrocities, the Nuremberg Doctors Trials of 1946 helped to set new ethical standards for research behaviour protecting participant's rights.

Since the establishment of federal democratic states in 1949 and 1950 both countries have achieved high levels of economic growth, social security and standards of living. They have established extensive and highly differentiated systems of health/disease care and health expenditures have risen to more than ten percent of Gross Domestic Product (GDP).2 However, both countries lag behind in the development of public health governance as that in comparable European countries, Austria to an even greater extent than Germany. Public health governance has been largely concerned with governance of medical and nursing care while the academic field of capacity building, research, education and training in new public health has existed in Germany only since the late 1980s, and in Austria, to a lesser extent, since 2002.

This review aims to explore the governance structures and activities in both countries. It describes, contrasts and discusses capacity building efforts for a new public health in Germany and Austria, with recommendations to strengthen the public health infrastructure, including education of the public health workforce to meet the challenges of the 21st century.

A THEORETICAL FRAMEWORK

Public Health has been defined as "collective action for sustained population-wide health improvement"3 offering a new vision both of individual and collective health.4 As with other fields, it has entered into an era of rapid global changes that may have an impact on the economic, social and environmental determinants of population-wide health development.

Public health theory as developed by international and national organisations includes three broad conceptual frameworks: Governance of Health and Health Systems, the Public Health Action Cycle, and Capacity Building Activities to implement public health efforts into societal and organisational practice.

Governance of Health and Health Systems is more than just management and constitutes leadership through direction and support of organisational change. Health systems governance refers to activities explicitly organised by society such as the Public Health Action Cycle. The distinction can be a subtle one as the debate on the contribution of medical care to the rise of life expectancy has shown.

The Public Health Action Cycle as defined by the Institute of Medicine of the United States National Academies of Sciences comprises three Core Functions of public health: Assessment, Policy Development, and Assurance. Each core function encompasses more specific public health activities defined as Essential Public Health Services to fulfil the core functions of public health (Table 1). …

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