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Taming the European Leviathan: Health as Politics. A Research Project. This article outlines the research project „Taming the European Leviathan: The Legacy of Post-War Medicine and the Common Good“. It is funded by a Synergy Grant of the European Research Council and unites European researchers comparing health policies (from drug research to prevention) in West- and East-European countries, e.g., Bulgaria, Germany, France, Czechoslovakia, Hungary, and the United Kingdom. The common goal is to provide a different perspective on post-war Europe, a perspective that emphasizes commonalities rather than differences.
Health Data as a Public Good. Routine health data, which are collected by health insurers and other agencies in the health care system, offer enormous potential for health monitoring and research. Germany has been slow to make such data available for socially beneficial purposes, partly due to concerns about privacy and data protection. Against this background, we discuss some of the most important potential uses of routine health data and call for a broader societal debate about the benefits, risks, and appropriate regulation of routine health data usage.We then review theWestern Australian Data Linkage System as an example of a data infrastructure that is characterized by high levels of stakeholder and patient involvement and a sophisticated method of privacy protection. While Germany does not need to copy this approach, we hope that the experiences of Western Australia and other countries will stimulate and inform the overdue debate about a modern, responsible, and sustainable approach to socially beneficial health data usage in Germany.
Prevention: The Concept of Preventive Risk Reduction, Illustrated by the COVID-19 Pandemic. Risk assessment and risk management based on the precautionary principle are instruments to protect humans and the environment against uncertain threats and risks. At the same time, however, trade-offs must always be made in order to maintain cultural, economic and social objectives and to honor the principle of proportionality. Notwithstanding the need for continuous risk reduction, society must distance itself from the idea that science can predict all dangerous events and developments and exclude them through preventive action. At best, risk analyses are able to identify the possible threats and uncover weaknesses in the system. In addition, risk assessments help us to make better decisions in the conflict of objectives between the secondary consequences of taking risks (such as exposure in the event of a pandemic) and the secondary consequences of the protective measures taken (economic, social, cultural consequences). In this sense, decisions about acceptability of risks or risk reduction measures always reflect a combination of scientific knowledge with balancing judgments.
The World Health Organization (WHO), Pandemics, and COVID-19: How to Proceed With a Multilateral Concept of Global Health? The WHO grew to 194 member states, and with globalization, geopolitical shifts, and internal reorganizations, the lines of influence have become more complex. In 2020, the United States severely endangered multilateralism in health. Recently, the Biden administration has revived US commitment as a major global health player. Yet, the lack of coherence in supporting collective action on global health remains a problem. Global health geopolitics are shifting and China and India have acquired enough power to shape the global health agenda. At the instigation of Germany, health has become a regular topic at Group of Twenty (G20) and G7 meetings – a critical factor during the COVID-19 pandemic. The WHO’s director general frequently states that health is a political choice. Many countries made unfortunate, if not questionable political choices in their responses to COVID-19. But as a matter of fact, they took the wrong turn much earlier when they neglected investments in pandemic preparedness and in the WHO. Countries have the political choice right now to seriously strengthen the WHO, its funding, and its legal power, or to weaken or even destroy one of the most important agencies in the UN system.
Images of Health and Disease: the Example of HIV/AIDS. There are two phases in the history of HIV/AIDS in the 1980s and 1990s. In the first of them, which lasted until the mid-1980s, HIV/AIDS was constructed as a disease of the (sexual) other. The second phase began around 1985 when the focus of AIDS prevention programs gradually shifted from „risk groups“ to „risk behavior“. This transformation came along with a reframing of the sexually active individual as self-reliant and socially responsible. Furthermore, the emergence of the risk discourse was accompanied by an iconography of a healthy and athletic „prevention body“. In the 1990s it increasingly replaced the emaciated „AIDS body“ that had dominated in the early years.
Sepsis and the COVID-19 Pandemic: Challenges and Chances for Developing a Better Health System in Germany. Sepsis is the most serious complication of infectious diseases including patients critically illwith COVID-19. In 2017, sepsis was estimated to affect close to 50 million people and to cause or contribute to 11 million deaths, with over 3 million of those deaths being in children or adolescents.The WHO considers that most deaths from sepsis are preventable and therefore urges all member states to integrate sepsis in their national health strategy. However, this is not yet the case for Germany, although – compared to other western industrial countries – sepsis mortality rates in Germany are very high. The COVID-19 pandemic has presented the world with the most serious health threat in living memory, which until July 2021 resulted in more than 4 million deaths and unprecedented social and economic disruption. It has reminded us that infectious diseases still present a major global health threat. In contrast to the poor recognition of sepsis from other infections, the response to the pandemic has also been unprecedented in most countries in terms of instituting effective public health measures, and the global scientific community has come together to produce robust research evidence and novel vaccines in record time. Thus, a positive legacy for the COVID‑19 pandemic in Germany and around the globe would reduce the global burden of sepsis by making pandemic preparedness, infection prevention and control, sepsis and antimicrobial resistance integral parts of national infection control and management strategies.
Controversies Over the Concept of Mental Disorders. Just like persons suffering from somatic diseases, those experiencing mental disorders, maladies, or diseases should be provided with care and protection from certain social demands. Yet, any disease concept should be precise enough to avoid classification of behavior as pathological while it is merely socially undesirable in the current political system. This paper reviews various conflicting concepts of disease, illness and sickness. In addition, it provides a narrower definition of a so-called clinically relevant mental malady. This definition is characterized by a) an impairment of mental functions relevant for human life (the disease aspect of a mental malady) and b) personal harm either due to suffering (the illness aspect) or impaired activities of daily living that severely limit social participation (the sickness aspect). This chapter claims that any definition of disease-relevant mental dysfunctions should be critically reflected regarding its philosophical and anthropological foundation and ethical consequences. Criteria of disease, illness and sickness should no longer be defined by groups of professionals selected by the WHO or other institutions, but instead require public debates that include organizations of patients and relatives.
Mein Blutdruck steigt unter anderem durch Stress. Mein Hausarzt hat bei einer Routineuntersuchung die erhöhten Werte festgestellt – zu meiner Überraschung. Ich war 58 Jahre alt und schlank, am Gewicht lag es daher wohl nicht. Und Zigaretten habe ich immer schon verschmäht. Als ich die Diagnose bekam, war das für mich ein Signal, mich intensiver um meine Gesundheit zu kümmern. Ich wollte mehr über die Ursachen für Bluthochdruck wissen und habe recherchiert. Dabei stieß ich darauf, dass ungesunde Ernährung ein Grund sein kann. Und ich beschloss – auch im Sinne meiner Familie –, in der Küche etwas zu ändern. Das Risiko, dass nicht nur ich, sondern auch die anderen eine Herzerkrankung oder einen Schlaganfall erleiden könnten, wollte ich auf jeden Fall vermeiden. Ich änderte meine Einkaufsliste und machte mich mit den typischen Rezepten der Mittelmeerküche wie einem französischen Ratatouille (Gemüsegericht mit Tomaten, Auberginen, Zucchini und Gurken) vertraut. Glücklicherweise kann ich gut kochen und spezielle Kochbücher haben die Umstellung noch gefördert. Außerdem schaue ich mir gern die „Ernährungsdocs“ an, die montags um 21 Uhr im 3. Programm des NDR „praktizieren“. Sie haben öfters Bluthochdruckpatienten mit erheblichem Übergewicht als Betroffene und verordnen ihnen viele Gemüsegerichte, viel Bewegung. Danach geht es ihnen besser.
Patients’ Perspectives on Health. The following chapter presents a number of patient statements on health and disease provided by several German patient associations. In these statements, patients describe their personal experience with health and disease and how they cope with their situations. Some also emphasize what they have done to improve their wellbeing. These first-hand reports offer a glimpse of the factors that support and inhibit individual people in their everyday struggles to create and maintain their own understanding of health.
Beitrag zum Denkanstoß 8 "Gesundheitsregion Berlin-Brandenburg"
Die Beiträge zum Denkanstoß 8 „Gesundheitsregion Berlin-Brandenburg“ bilden die Grundlage für die in dem Denkanstoß veröffentlichten Empfehlungen für die Gestaltung der Metropolregion Berlin-Brandenburg als Gesundheitsregion. Gesundheit bedeutet in diesem Zusammenhang mehr als die reine Medizin. Eine Gesundheit von morgen impliziert die Integration eines ganzheitlichen und sozial ausgerichteten Blickes auf Medizin und Heilung ganz im Sinne der Nachhaltigkeitsziele der Vereinten Nationen. Wesentlich ist aber auch, dass Innovationen und die Wirtschaft als treibende Kräfte der Gesundheitsregion betrachtet werden. Mit Beiträgen von Bernadette Klapper, Patricia Hänel, Christopher Baum, Christof von Kalle, Ulrich Frei, Annette Grüters-Kieslich, Angelika Eggert et al.