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Calls are increasing for the legalization of cannabis. Some legal experts, various politicians, political parties and associations are demanding a change in drug policy. The legalization debate is lively and receiving wide coverage in the media. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) comments on the most important questions from a medical scientific perspective: can cannabis consumption trigger mental illnesses, what consequences would legalization have for the healthcare system and where is more research needed?

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Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cities can be described by different factors. From a health perspective, density is a factor of great importance. Cities are seen as dynamic places with interaction between built and social environments as well as design by societal stakeholders. This is illustrated through the example of noise and greenspaces as determinants of health and the provision of health services. Different city types and guiding principles of spatial and urban development are explained through the health lens. The potential to influence health determinants through local interventions is illustrated by planning instruments of urban development and environmental protection. Participation of the public and other stakeholders plays a crucial role in local settings. This paper shows the great potential of healthy urban development, which is not utilized in many cases.

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The subjects of this article are field of activity of public health departments and their functionaries that were established as part of the Act to Standardize the Healthcare System (GVG) from July 3 rd , 1934 during the era of National Socialism and in the early post-war period in Thuringia and Württemberg. The objects of study are the implementation of the new paradigm of «racial and hereditary care» in public health departments defined by the Reich's Ministry of the Interior. Furthermore, this paper also examines the role of public health officers (PHO) and their discretionary powers, the impact of the war on PHO's specific activities, as well as the regional particularities in comparison to other federal states and finally, aspects of structural-, programmatic- and personnel continuity in publicly funded healthcare after the liberation in 1945., Competing Interests: Die Autorin gibt an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

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Public health is a population- and system-based approach that is needed to improve the health of societies and to decrease health inequalities. In the face of global challenges, the public health approach is essential. In Germany, the importance of public health is only partly reflected by its institutions and institutional arrangements. This applies equally to research, teaching and training, as well as to the public health service. Furthermore, the public health perspective is not sufficiently considered in cross-sectional topics that are relevant for health.There have been several initiatives to overcome structural deficits which can partly be traced back to historical circumstances. The White Paper presented here should encourage discussions about future policy options in public health. The authors represent public health in practice, research, and teaching in Germany., (© Georg Thieme Verlag KG Stuttgart · New York.)

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Copyright of Sucht is the property of Hogrefe AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the last years, the Danish debate about priority setting in medicine has gained new strength. This paper shows the main focuses of the current discussion based on a research of Danish primary literature. For the first time since the 1990s the Danish Council of Ethics has been involved with priority setting in medicine in a project running from 2011 to 2013. The Council emphasises the importance of legitimate processes and calls for visible values and criteria. A focus of the debate is how to deal with new expensive drugs. Politicians, physicians, health economists and the Council of Ethics have called for a national institution for priority setting in medicine. They have mainly looked to the Norwegian National Council for Priority Setting in Health Care and the British National Institute for Health and Care Excellence for inspiration. The Danish Government considered establishing a national institute for priority setting, but the plans were not put into practice. In the year 2012 a new national project was launched to create clinical guidelines. Danish doctors welcome the guidelines as a good basis for priority setting. Just like in earlier Danish priority setting debates, a coordinating institution is lacking to bundle the discussion and keep it going. The debate seems to have come to an end once again. The fact that it was seriously considered to establish an institute for priority setting is a new development. It can be expected that the discussion will be resumed in the near future, possibly the idea of an institute for priority setting will be readopted. The general conditions for priority setting in health care have improved., (© Georg Thieme Verlag KG Stuttgart · New York.)

The German statutory health-care system is based on the principle of solidarity and thus it is committed to the objective of 'equal chances'. From an economic perspective it is also important to emphasise that scarcity of resources continuously pushes the services towards cost control and towards increasing cost-effect-iveness. There could be conflicts between the 2 objectives 'equal chances' and 'cost-effectiveness', of course, for example if measures for increasing cost-effectiveness lead to increased financial burdens of the insured. To date it has not been studied if and how this potential conflict is discussed in Germany.In a first step we searched for German publications discussing this potential conflict focusing on 3 major public health journals (Das Gesundheitswesen, Bundesgesundheitsblatt, Ethik in der Medizin) and on the internet portal "gerechte-gesundheit.de". For the main part of the paper, we looked for publications from 4 major health policy actors (Bundesärztekammer, Zentrale Ethikkommission bei der Bundesärztekammer, Deutscher Ethikrat, Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen). All papers published since the year 2000 were included in the system-atic qualitative analysis.The analyses show that the potential conflict between 'equal chances' and 'cost-effectiveness' is rarely discussed in any detail, at most in an implicit way. It would be important, though, to have an explicit discussion, supported by scientifically based analyses and recommendations. One step towards this objective could be, for example, a closer cooperation between social-epidemiologists and health--economists., (© Georg Thieme Verlag KG Stuttgart · New York.)

Patient safety is an important issue in European healthcare policy. Given the fact that healthcare falls within the competence of the EU Member States, this paper highlights the capabilities of the European Commission to promote patient safety. The potential added value for the topic that can arise at the EU level is critically discussed.

Small-area analyses are increasingly valuable for health-policy planning given the observed regional variation in health care. The combination of data from different sources enables researchers to describe and analyze structural, procedural, and outcome-related variation in health care. For variation that cannot be explained by these data, the attitudes, behaviors, and preferences of important stakeholders in health care-physicians and patients-might play an explanatory role. In this paper, we outline why stakeholder preference elicitation appears to be an important addition to small-area health-care analyses. Its inclusion in various decision-making contexts may help to explain and decrease unwarranted variation in health care. At the individual level, this could happen within any decision on health service use that is taken by physicians, patients, or-within a shared decision-making context-by both. At an aggregate level, the elicitation of preferences in guideline or health program development may increase stakeholder acceptance and consistent implementation. Different approaches to the elicitation of stakeholder preferences and potential areas for application within small-area research are outlined. The role of attitudes and preferences in explaining regional variation should be acknowledged by health-care policy makers and initiatives to include these in health-care decision-making at various levels should be supported.

According to the "Protection against Infection Act", public health services are obliged to supervise and consult the hygienic conditions not only in hospitals but also in ambulatory medical practices in Germany. Firstly, in this paper basic principles on transmission routes of pathogenic germs and general remarks on the infection control visits as well as on the special regulations (i.e., German commission on hospital hygiene and infection prevention) are described. Secondly, crucial points to be considered in all medical practices are mentioned. Finally, special issues in different practices are reported, such as dermatology, gastroenterology, gynaecology, paediatrics etc. This article aims to support the public health departments in their task to prevent infections in patients and personnel in medical practices.·, (© Georg Thieme Verlag KG Stuttgart · New York.)

In 2013, the forum gesundheitsziele.de selected "reduction of alcohol consumption" and "patient safety" as new health targets. Besides the two selected targets, three other topics were considered: health at work, health during pregnancy and childbirth, and health and migration. This paper describes the selection process, which followed several criteria: mortality, morbidity, prevalence, burden of disease, economic impact, potential for improvement, equity in health, empowerment of and priorities of health problems in the population. The analysis particularly focused on the assessment of the feasibility and the readiness of stakeholders to participate in the development and implementation of health targets.

In all highly developed countries, the overall health status of the population has significantly improved within the past 30 years. The most important reason for this is the increase in economic prosperity. Economic wealth, however, today is much more unequally distributed than it was 3 decades ago. Countries with relatively small disparities in the availability of material resources between socioeconomic groups, such as the Scandinavian countries, have better health outcomes on the population level. Health inequalities, however, have also reached a higher level than 30 years ago. As of today, we do not have convincing explanations for the interrelation of economic and health inequality. This paper gives an overview of existing research on a comparative basis. The research results are ambivalent. They show the puzzling result that the Scandinavian countries with their highly distributive welfare policy manage to achieve the comparatively highest level of economic, but not health, equity. Based on these results, we develop proposals for future research approaches. A central assumption is that in rich societies no longer only material, but more and more immaterial determinants are crucial for the formation of health inequality. The promotion of "salutogenic" self-management capabilities in socially disadvantaged groups is considered to be the central element in effective intervention strategies., (© Georg Thieme Verlag KG Stuttgart · New York.)

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Copyright of Sozialer Fortschritt is the property of Duncker & Humblot GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

At the start of the nineteenth century consumption, also called "phthysis", was one of the most dreaded illnesses along with cancer. The term usually referred to the widespread "pulmonary consumption". Metaphorical descriptions of the disease demonstrate the strong cultural significance attached to this medical, and also lay-medical, concept. Based on handwritten case histories and letters from Kaiserswerth deaconesses in the first half of the nineteenth century the author establishes the cultural implications with which sufferers met in the social practice. Consumption was seen as the visible manifestation of deviance. It was assumed that sufferers were also to blame for contracting the disease due to a lifestyle that was "excessive" in dietetic as well as Christian terms. The paper aims to analyze how the attribution of an "immoral" and "sinful" lifestyle was presented to sufferers by physicians and nurses and how this affected them. The attribution of moral implications to dietetic concepts--as the first thesis of the paper will suggest--originated from demographically motivated health policies prevalent around 1800. The paper will further try to show how, in the early nineteenth century, the idea arose that consumption was the disease of the proletariat suffering from metropolitan life.

The recent reform act on long-term care insurance includes plans for the establishment of Community Care Access Centers. This paper addresses chances and challenges of these centers and proposes some important steps for program development.

In 1997 the new law about Public Health Service (OGDG) in Northrhine-Westfalia was put into operation. It included two new sets of compulsory tasks: local health reporting (GBE) and local health conferences (KGK). These new tasks are installed as planning and steering instruments aiming for a better health-care on the local level. The central object is the knowledge-based formation of local health policies. Thereby, local representatives concerned with health and social services should participate as well as administrators and politicians. Since the middle of the 1990 s both new tasks have been established by the public health department of the county of Heinsberg in Northrhine-Westfalia. The experience of this department over almost ten years is the background for the empirical research project that is described in this paper. The study investigates the vocational practices, the decision-making and the health-related attitudes of the relevant local administrative and political representatives. The impulse for the start of the study was given by the constant reluctance of political and administrative top managers to make use of these new planning instruments in agenda setting and decision making. 44 high-ranking staff members and politicians (mayors, party chairmen, heads of departments far beyond the health office) were personally interviewed. Although they are not part of the health administration they claim to be occupied with quite a few health-related tasks. The overlapping of their set of tasks with the local health policies is evident for the interviewed managers. How-ever, this does not cause them to use the two new planning instruments. In particular, they do not participate in the local health conferences. They rather prefer the traditional path of policy making (parties, committees, fractions) even if these paths are less efficient than the new ones. The health conference is much more used by health-service providers as a platform for setting priorities and organising their implementation effectively. So far, the inclusion of the other local representatives (administrative managers, etc.) although they are concerned with health issues has not been achieved. This is also true for local politicians who are responsible for health-care policies. The authors of the paper see it to be the task of the local public health department to convince all these players that the health conference is a productive tool and a useful platform for the discussion of the health problems in the county and the coordination of necessary actions to be taken. The most important focus point is seen in the intersection of health policies with other local policies.

Until now there are only a few approaches in the German-speaking realm to establish an explicit ethical framework for moral issues of public health--although a need for public health ethics in times of SARS and avian flu is obvious. One deficit of the discussion so far is that there is no systematic separation of medical ethics and public health ethics. Thus, the core and interdisciplinary focus of public health is often not met. However, to frame discussions of moral issues within a specific public health ethics framework seems to be fruitful. This paper deals with the conceptual differences of medical ethics and public health ethics. The discussion helps both applied ethical discourses to sharpen their focus and strengthen their appeal. The author develops and presents a conceptual and normative frame for public health ethics and offers a concise set of ethical principles for the discussion of moral challenges in public health.

There is a broad health policy consensus about the necessity of augmenting and improving primary prevention. To be successful, the current initiatives need to be supported by concepts, categories and classifications, meeting the criteria of logical consistency, political consensus and suitability for administration. This survey paper presents suggestions regarding to the relationship between primary prevention and health promotion, for the definition of different levels and starting-points of primary prevention as well as to concepts of evaluation and quality assurance.

This paper discusses the question, to what extent concepts of an enabling state are realised in the German health policy and wether they meet active citizens with corresponding competencies. The analysis is based on a review of the literature referring to the promotion and development of the self-help movement and citizen participation in the German health care system. The results show, that since 1999 the following enabling health policy measures were adopted: the promotion of independent patient advisory services and shared decision-making, the enactment of participation rules in the rehabilitation system and the compulsory subsidy for self-help groups, self-help organisations and clearing houses for self-help. The active engagement of the citizens both as co-producers of health on the individual level and as participants in processes of communication and decision-making on the system level is still restricted to a small part of the population. An enabling health policy and a broad citizen participation are still in the beginning, but they have the potential to strengthen each other and to realise synergetic effects. Even though some corresponding institutions were already established and attitudes of the health care professionals start to alter, the question wether the health policy will change from a welfare producing state to an enabling state cannot be answered completely yet.

In this paper, we first give an overview of the origins of geriatrics. We then give a description of the development of modern geriatrics in the United States and Great Britain, based on the work of Nascher and Warren. Finally, we give an account of the development of geriatrics in Germany. Clinical geriatrics, which first developed 20-30 years ago, has shown a high rate of growth in the last few years. However, recently there has been a slowing down in this rate of growth--if not a complete halt or, indeed, a counter-movement. The reasons for this somewhat negative development in the past five years are comprehensively discussed. In the last part of the paper, improvements which could be made in geriatrics are described, thus possibly achieving a uniform and self-assured provision of geriatric care in the future, in relation to four priority areas, with regard to outpatient and inpatient care. The first priority area is the care of geriatric patients at home and in nursing homes. To this end, geriatrics in priority areas will be promoted. The second priority is the development of geriatrics in hospitals (acute geriatrics departments and departments with rehabilitation as their focuses of activity). A third priority is geriatric rehabilitation clinics. Finally, we need a few geriatric centers in Germany (centers of excellence), geriatric departments with professorial positions and university clinics with geriatric departments in which geriatrics is taught and from which the impulse for research will be given.

Between October 1995 and December 1998 the pilot project 'Local Coordination of Health and Social Care' was conducted in 28 communities of the state of North Rhine-Westphalia. The project has been evaluated by two university research teams. The aim of the project was basically to establish new structures of health planning and coordination at the community level, in order to improve health reporting and health care as well as health promotion. To realize this aim round tables, working groups and project-offices were implemented in the communities. The evaluation was focused on the following question: What were the conditions (structures) and processes that influenced the project outcomes? Qualitative and quantitative methods were applied (interviews, standardised self-administered questionnaires, analyses of documents) to this end. Evaluation of structures showed that most communities succeeded in integrating relevant health policy actors into the newly created round tables and working groups. Working climate and achievements were evaluated favourably by most of the involved actors. All communities succeeded in developing and enacting recommendations for programmes, and about 40% of these programmes were implemented during the project. The probability of programme implementation was particularly high if the programme was based on reliable local data and if execution was effected only on the community level. The possibly beneficial effects on health care and welfare produced by the new programmes could not be assessed within the short project period. The paper concludes with a brief discussion of practical consequences for future health policy at community level.

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The paper discusses the question how we recognise existing problems in our rich and wealthy society with particular respect to modern medical care. This is explained by using zoonosis as an example demonstrating the present spirit of the age in its desperate ambivalence between apathy and permanent alarm. It is necessary to understand that the so called crisis of nature which is broadly discussed in public represents in fact a crisis of man.

This paper addresses the issue of the relative absence of anthropologists in the formulation of HIV/AIDS policy and research in Africa. Initially, taking an historical perspective, it looks at the development of the main policy-making forums in the USA before turning to the more recent establishment of UNAIDS and its dominant role in setting the agenda for Africa. The implications for anthropological research are then considered in order to shed light on the reluctance which can be discerned in the discipline to get involved in research on AIDS. Turning to specific case material, the paper then examines AIDS educational strategies in Botswana to provide an illustration of the potential insights anthropology can bring to explain the success or failure of such campaings. Stressing the importance of the cultural constructions of the disease, it shows how the western AIDS message is interpreted by local populations not as neutral scientific „fact“ but as an aspect of political and ideological domination. In turn, this discussion raises the issue of the coexistence of different belief systems, especially in the sphere of medicine, their interrelations and the social contexts in which response to western messages is antagonistic as opposed to complementary. [ABSTRACT FROM AUTHOR]

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Copyright of Sucht is the property of Hogrefe AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Drastic changes are ahead for medical rehabilitation in the wake of austreity measures in the pension insurance domain. This paper presents consequences for rehabilitation hospitals and their current strategies of coping in the German health care system. Quality management now needs long and medium term planning, rather than short-term reactions. Demographic trends and a changing spectrum of morbidity indicate possible survival strategies. These societal developments are already incorporated in Total Quality Management.

Quality, quality assurance, and quality management are becoming more and more dominating topics in German public health. Quality is named as the most important goal of medical care in the public health related political discussions of physicians, hospitals, health insurances, and politicians but is affected by differences in political, economical, medical, and particular interests. To avoid a single-sided discussion about questions of quality (only with the goal of increasing efficiency and reducing costs), the society of physicians of Germany and the society of panel physicians published a common stock of 10 theses about medical quality assurance and quality improvement in the spring of 1996: (1) Medical quality assurance and quality improvement serve the patient. (2) Medical quality assurance and quality improvement do not primarily serve the improvement of economic efficiency. (3) Quality assurance programs have to be problem oriented and coordinated; quality in the ambulant and hospital setting cannot be different. (4) The appropriateness of quality assurance programs has to be evaluated firmly. (5) Transparency, communication, and cooperation are prerequisites of a successful quality assurance and quality improvement. (6) Comprehensive internal quality assurance is the foundation of continuous quality improvement. (7) External quality assurance should initiate the development of procedures for internal quality assurance. (8) Quality assurance has a chance for realization only if it is carried by the conviction and the effort of every participant to perform at relatively high quality, to subject his own doing to continuous checks and improvement, and to compare with others. (9) Quality has it's price. (10) Quality assurance and continuous quality improvement are the cornerstones of a quality policy in public health. The current situation and future developments of quality assurance in ambulant health care are discussed in this paper.