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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.)

Resource allocation decisions in health care require the consideration of ethical values. Major ethical theories include Amartya Sen's capability approach, Norman Daniels's theory of justice for health, and preference utilitarian theory. This paper argues that while only preference utilitarian theory explicitly considers the impact of an individual's actions on others, all 3 theories agree in terms of providing individual autonomy. Furthermore, it shows that all 3 theories emphasise the role of informed preferences in securing individual autonomy. Still, stressing personal autonomy has limited direct implications for priority setting. 2 priority rules for resource allocation could be identified: 1) to give priority to patients with mental disability (over those with pure physical disability); and 2) to give priority to patients with a large expected loss of autonomy without treatment., (© 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.)

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 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.

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.

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.

Self-help groups strengthen an individual's sense of autonomy and self-determination, and help to recover from diseases and other health-related problems. Participants mutually support each other within the group to promote a healthier approach to socio-psychological issues; they also conduct activities outside the group, especially counselling services for peers dealing with similar problems. In recent years, the number of groups throughout Germany rosen to approximately 60,000. The groups are mainly supported by self-help clearinghouses which have sprung up in many regions of western and eastern Germany over the last few years. This paper provides an overview of the development of self-help groups as well as the current state of support and funding in this area. Furthermore, it describes in detail the work performed by clearinghouses and the possibilities for cooperation with these new "liaison institutions".

Public Health is a social innovation of the modes how society deals with health risks before and after their occurrence. In this paper the essence of this innovation is sketched out with regard to the four stages of the Public Health Action Cycle (assessment, policy formulation, assurance, evaluation). Based on both literature surveys and own research findings several critical aspects of innovation are identified at each of these stages. At present, the bottle-neck of the intended social innovation seems to be the implementation, stabilisation, and generalisation of interventions.

This article is based on a study using different approaches to examine the links between urban development on the one hand and health promotion on the other. The background and basic concepts underlying this study are briefly explained. Programmatic papers from both spheres of approach result in the basic thesis that both urban development and health promotion are aiming at improving the quality of life in city districts (objective conditions of living and subjective feeling tone, i.e. subjective well-being) in the overall sense of a health-promoting general policy. Because of these common goals cooperation between both spheres is hypothesised. However, the study as a whole shows (especially an analysis of the documents of the files of the sanitation committee) that this is not so. To understand this finding better the freedom of both parties concerned to act as they should, is analysed, namely, that of the sanitation committee and of the regional health and environmental office. It becomes evident that in both these spheres the requisite monitoring capacities, such as legal support, finances, information service and counselling activities, are fundamentally lacking or indeed limited. Hence, there are limited chances of success in the spheres of health promotion and preventive care by means of sanitation of city districts. Finally, the authors point to long-term trends and developments that would make a future approach between the two spheres mandatory and (at least partially) possible.