Das Gesundheitswesen
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Das Gesundheitswesen · Apr 1997
[Health promotion by the public health service--problem areas and perspectives].
For more than ten years policy makers and researchers in the field of health policy have been requesting the local health departments in Germany to focus primarily on population-oriented and structural strategies in health promotion. Based on empirical findings of a study carried out in Berlin, this article argues that several structural and organizational factors in practice influence the implementation of these strategies by the local health departments. ⋯ More than ever, the definition of their tasks and targets needs to be linked to questions of organizational change and personnel. Moreover, the local health departments should define their role more clearly in relation to the other institutions in the sector of public health and in relation to the citizens.
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One of the common features of the five Public Health Research Centres of Germany lies in quality assurance and quality improvement of their research activities. The institutionalisation of systems of quality improvement of Public Health Research has to be regarded as innovative, hitherto unparalleled, in the German context. The article deals with the demands on quality improvement confronting empirical research, the possibilities of coming to terms with this challenge, and still unresolved problems of implementation. ⋯ The concept of quality improvement, developed in the Munich Public Health Research Centre, applies two basic strategies to meet these demands: enhancement of the transparency of the research process, and the training of research staff. Instruments for quality improvement are introduced: some of them may be applied by the research team itself (such as study protocol, research diary, team discussion) some of them have to be realised by external staff, especially responsible for the process of quality improvement, in cooperation with the research team (quality circles, training, compilation of written material). In conclusion, the implementation of instruments of this kind is discussed, concentrating on the problematic cooperation between research team and external staff.
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The financing of personal health care services has become the crucible to test elected governments in the 21st century. Governments are caught between slow economic growth, lower personal income for most workers, and the clamour of health care for more money. The Western world with an aging population, marginal employment and rising unemployment, does not appear to have the capacity to pay for all that science and technology can produce and the public wants. ⋯ The art and science of medicine coupled with the human quest for health may simply exceed our productive capacity. The organisation and financing of twenty-First Century science and technology is nearly dysfunctional, bound by Nineteenth Century values, traditions and custom, as we face the next century. This may be the question.