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Potential limits and risk of digitalization in public health will be a core topic of the High profile Research Area Health Sciences at the University of Bremen in coming years. A white paper was developed to support positioning in this dynamic research. The paper describes the Health Sciences viewpoint on core evaluation criteria for digital public health, identifies interfaces and approaches for interdisciplinary cooperation and discusses cross-cutting themes as well as demarcations with respect to digitalization in medicine (digital health). An abbreviated version of the white paper is presented for discussion., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

This position paper of the German Public Health Association describes current situation and perspectives of public health in Germany with emphasis on research and teaching. It outlines those measures necessary for strengthening of public health research in Germany., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aims: During the COVID-19 pandemic, many health-related questions require rapid answers. In the Competence Network Public Health COVID-19, founded by representatives of several scientific societies in March 2020, rapid reviews are often conducted to generate evidence-based answers that are useful for policy makers. The aim of this paper is to reflect on the practical experience with rapid reviews in the context of the Competence Network Public Health. Methods for high-quality and practicable implementation of rapid reviews were developed, which are particularly helpful for rapid evidence generation based on observational studies., Methods: Using the 8-step approach proposed by Tricco et al. [1], we describe the acute challenges that have arisen in the Public Health Competence Network COVID-19 while conducting rapid reviews on public health-related issues related to the COVID-19-pandemic. The 8 steps are: 1. conceptualization of the research question, 2. literature search, 3. title/abstract and full text screening, 4. data extraction, 5. risk of bias assessment, 6. evidence synthesis, 7. dissemination, 8. update. We develop a methodological approach for conducting rapid reviews by expert consensus of the members (n=42 as of 01/28/2021) of the Rapid Reviews Working Group in the Competence Network Public Health COVID-19., Results: A standardized approach is presented that closely follows the approach of the Cochrane Rapid Reviews Methods Group and takes into account the special requirements of etiological - but often also ecological - observational studies on COVID-19., Conclusions: The proposed approach for conducting rapid reviews can form an important basis for evidence-based policy advice - certainly beyond questions related to COVID-19. Flexible and rapid funding concepts should be made available for the short-term realization of methodologically high-quality rapid reviews on emerging questions. Scientific cooperation in conducting rapid reviews needs to be expanded, and more methodologically high-quality approaches such as prospective meta-analyses should be used., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In this paper we describe the process and content of our ad hoc public health ethics consultation for a Bavarian health authority in relation to Covid-19., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

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.)

Many dimensions of public health are now global. Therefore, global public health is essential for facing cross-border health problems, promoting health chances and reducing health inequalities on a global level. The aim of this interdisciplinary research field is to improve the health of the population and its subgroups in a global context, taking into account a variety of factors. The importance of global public health is shown in this paper. Central topics, concepts and methods, as well as challenges for global public health are identified and recommendations for the academic profiling of global public health in Germany are given., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Methods: The United Nations Convention on the Rights of Persons with Disabilities determines amongst others the right of access to information. Information for the general public must be made accessible for persons with disabilities in formats and technologies appropriate to different kinds of disabilities. The language poses the largest barrier for people with learning difficulties. Therefore, we translated parts of the Public Health Report 2015 of North Rhine-Westphalia into an Easy-to-Read language.The translation was performed by a professional translation agency in cooperation with an assessment group, composed by people with learning problems, and the NRW Centre for Health (LZG.NRW).During the translation the population health monitoring group of the LZG.NRW experienced several challenges. The scope of these challenges and the chosen solutions are described in detail in this paper., Results: 3 challenges were experienced clearly during the translation of the Public Health Report: (1) (Large) numbers and rates are a key element in population health monitoring but they should be avoided in texts in Easy-to-Read language. (2) The translation of the age-standardization approach and the related effects appeared to be difficult. (3) Finding the right balance between the description of lifestyle influences and the influence of the wider health determinants as well as finding a non-discriminatory wording regarding the influence of social health determinants were challenging.The following approaches were chosen to counteract these challenges: (1) We avoided to report numbers and rates. In some cases simple fractions are presented. In addition, all of these fractions were explained and visualized in the introductory section of the translated report. (2) We resigned to describe time trends. In some cases time trends were mentioned as crude rates and an explanation of potential effects (e.g., demographic change) was added. If gender specific differences occurred in the crude and age-standardised rates, we described the age-standardised differences. (3) The relativization of direct and striking formulations regarding the influence of the social health determinants and the inclusion of recommendations related to the scope of upstream determinants needed to be recognized and incorporated., Conclusion: Translating a public health report into Easy-to-Read language is a challenging process. Continuous and smooth cooperation between translators, the assessment group and the authors of the original report is mandatory to be successful., Competing Interests: Die Autorinnen geben an, dass kein Interessenskonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The Public Health White Paper draws up a vision of public health as a living, decentralized network that can help improve the health of the population in a sustained fashion. However, the central question remains open as to which prerequisites public health networks should fulfill in order to be effective in the long term. The aim of this paper is to provide a sociological view of the issue and offer some discussion ideas. Parsons' structural functionalism leads to the thesis that science networks in public health require structures that ensure that the 4 basic functions of viable social networks - (1) adaptation, (2) goal attainment, (3) integration and (4) latent pattern maintenance - are fulfilled. On this theoretical basis, suggestions are made to establish functional formal structures in public health networks., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© 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.)

For the last 30 years the appropriateness of social strata concepts has been discussed controversially in Germany. It was hypothesised that changes in the social structure resulting in a greater heterogeneity of social living conditions has decreased the relevance of social strata concepts. However, socio-epidemiological research still revealed a strong social gradient, indicating that health risks are still depending on individual social background. Nevertheless, enhanced models of social stratification could be fruitful for socio-epidemiological research, particularly with respect to the objective of reducing health inequality. The 'concept of living conditions' is one of the continuative social strata approaches, which is based on a multidimensional concept of social inequality. First use of this concept provided promising results in obtaining a more precise description of health-related living conditions. In this paper, the concept is presented in more detail, spotlighting on questions about conceptual realisation as well as empirical implementation. The paper aims to encourage a wider discussion about the use of these concepts for socio-epidemiological research and medical sociological theory., (© Georg Thieme Verlag KG Stuttgart · New York.)

This paper explores the problem of dealing with normalisation in public health concepts, using the example of the relaunching of anti-aging-medicine in Germany. The analysis mainly draws upon qualitative analyses of publications of different anti-aging-medicine organisations. The German branch of anti-aging-medicine's new concepts of the nature, the morality and the self-design of aging are delineated. These are the concepts of aging as a medically controllable health risk (nature), the emphasis of the moral duty to responsible personal risk control (morality) and the self-design through individual risk profiles and prevention programmes. The analysis shows that the proposed bio-political programme cannot only be induced from biologically, societally or medically given facts, but that it is - as all public health concepts - a normative concept. It is argued that the normative aspects of public health concepts cannot be avoided but should be explicated and negotiated. This paper therefore concludes with an exploration of what there is to negotiate concerning the German anti-aging-physicians' surprisingly uncontroversial plea for a shift of emphasis from the collective right to health to a new individual duty for health maintenance in old age., (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.

For regional planning and approval procedures for building projects of a certain order of magnitude and power rating according to the German Federal Act on the Prevention of Emissions with Integrated Environmental Impact Assessment (EIA), the German public health departments, acting as public authorities, increasingly perform health impact assessments (HIA). The amended Act on Environmental Impact Assessment, the Decree on industrial plants which require approval (4th Federal Decree on Emission Prevention) and the Health Service Acts of the Federal States of Germany form the legal basis for the assessment of health issues with regard to approval procedures for building and investment projects. In the framework of the "Action Programme for the Environment and Health", the present article aims at making this process binding and to ensure responsibility and general involvement of the Public Health departments in all German Federal States. Future criteria, basic principles and procedures for single-case testing as well as assessment standards should meet these requirements. The Federal Ministry for the Environment and the Federal Ministry for Health should agree on Health Impact Assessment (HIA ) as well as on the relaxant stipulations in their procedures and general administrative regulations for implementing the Environmental Impact Assessment Act (EIA). Current EIA procedures focus on urban development and road construction, industrial investment projects, intensive animal husbandry plants, waste incineration plants, and wind energy farms. This paper illustrates examples meeting with varying degrees of public acceptance. However, being involved in the regional planning procedure for the project "Extension of the federal motorway A 14 from Magdeburg to Schwerin", the Public Health Service also shares global responsibility for health and climate protection. Demands for shortest routing conflict with objectives of environmental protection which should be given long-term consideration. Assessing the direct impact of projects on human beings should be rank first in the list of priorities. The Hygiene Institute supports the efforts of the Public Health departments by providing professional consultant services to ensure consistency in the application of procedures.

The special committee for "Environmental Medicine" established by the Federal Association of Doctors in the German Public Health Service presents its paper entitled "Environmental Medicine in the Public Health Service--A Social Responsibility and its Consequences: Propositions with regard to the situation, aims, strategies, and opportunities for action". The paper includes core ideas and responsibilities in the public health service. It aims at providing a number of guidelines for implementing "Environment and Health" ("Umwelt und Gesundheit"), an action programme by the Federal Ministry of Environmental Protection and the Ministry of Health, as well as "Health 21" ("Gesundheit 21"), the framework concept "Health for all" for the WHO's European Region. The paper also aims at initiating and facilitating steps for joint action by the Public Health Service. These theses were passed on to Mrs. Andrea Fischer, the Federal Minister of Health, during a meeting with the Board of the Association. In Germany, environment-related public health protection is well established in the Public Health Departments and state institutes/departments within the scope of public health provision and disease prevention. Typical responsibilities include environmental hygiene and environment-related medical services which have increased in importance. The range of responsibilities and its current political importance are a result of environment-related public health risks, the social situation of the population, also with regard to health issues, and the scope of responsibilities and competencies by doctors and staff in the public health departments. With the people's demands for health, quality of life and life expectancy, this need for action increases. In this paper, judicial, professional, and personal consequence are presented which arise as public health authorities assume these responsibilities.

The results of the German National Health Interview and Examination Survey will be of great importance for health policy and research. Therefore, internal quality management was supplemented by an external quality control which was carried out by a private company (Bernhard Schwertner Feld organisation, Augsburg). The interviewer training, sampling and response, field work and data management were included into the external quality control. For each of these four areas, measures of control and detailed check-lists were provided by the external quality control. The aim was to find sources of potential and real errors and to arrive at recommendations for internal quality management. The general concept of external quality control is briefly presented and experiences and results from the quality control of the field work are described in the present paper.

First of all the author gives a historical review of the importance of social work in public health service. The complementary cooperation between medical doctors and social workers is also described. The author then examines the activities of social workers in public health service on the basis of selected journals and the titles of these papers by graduates from medical "officer of health" courses of the Akademie für öffentliches Gesundheitswesen Düsseldorf. The results show that social work is still a part of counsel and care by the pubic health service. Offers for new target groups are suggested. Another important aspect is the cooperation with other interest groups such as resident doctors or institutions outside the public health office. Better presentation of the profession of social workers is also an important issue.

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. These factors can constrain or enable the implementation of the strategies. The paper draws the conclusion that several requirements must be fulfilled for the local health departments to define themselves in health politics and policy. 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.

Regional population forecasts are on average even more uncertain than nationwide projections, due to the greater importance of migration and the unstable smaller absolute numbers. Other than national projections, local or regional calculations do normally have an explicit goal. In this paper, a projection of the population and age structure in the region of Augsburg is used to demonstrate some specific aspects of local population projections used for public health purposes. If institutions of childhood ages are to be projected the results are primarily determined by the assumptions on migration. If questions of old age are to be answered, the main factor of influence is the development in mortality. Depending on the specific alm of a local population projection, the principal insecurity about the future should be integrated by calculating confidence bands for those demographic parameters, that are most important for the specific question.

The rise of social hygiene in Mecklenburg before 1945 is described via examples of three scholars of the Rostock University (Julius Uffelmann, Hans Reiter, Werner Kollath). By contextualising this rise, the paper attempts to demonstrate both the transformation of medical items into disciplines and the change of social values of illness and health. This was accompanied by an increasing dissemination of medical-biological values and concepts, from which eugenics emerged and subsequently served as a general model for constructing a well-organised and developing society. Thus a growing number of social disciplines became subjected to these ideas.

In a state of the art paper a four step approach is made in order to investigate the question why public health research is necessary at all. 1. Expectations concerning public health research: The classical topics of public health research will continue to be relevant. Additionally, health promotion especially for low income and other risk groups should become important. For this purpose public health should try to relate to politics. Considering available resources and the quality of services goals should be determined as regulative criterias for the health system. Public health research will only remain relevant in the future if it turns from the traditional approach of public health medicine to what is called the new public health paradigm and if it adds the system approach to the population approach. 2. Target groups of public health research are policy makers and institutions as well as persons in the health care system. It has to be checked if these target groups are reached. Policy impact is more important than science impact. 3. Expectations to public health research concern the transfer of public health into other areas of science, the establishment of new institutions and teaching programmes and its inter-disciplinarity. Deficits exist in the selection of relevant topics and in the innovative power of projects. 4. Proposals for further public health actions refer to politically dominant issues which are to be defined by consensus conferences.

This paper deals with the establishment of the National Breastfeeding Committee at the Robert-Koch-Institut and its activities. As the highest level scientific and advisory board for the German Federal Health Ministry the institute obtained permission from the state authorities to carry out a survey of the local health offices. A finding of this survey was that the different health offices apparently place different priorities on advising mothers in regard to breastfeeding. Some health offices offer medical counselling and others indicate that their counselling is carried out by non-medical personnel. In some cases the health offices reported a supply but no demand. We believe that the public health services should at least provide information on breastfeeding counselling in the community and on training opportunities for counsellors. The National Breastfeeding Commission will collect such information and provide it to the health offices and also give advice in the case of problems with regard to breastfeeding.

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".

Health impact assessment (HIA) is defined in this paper as the adequate coverage of health aspects within the context of environmental impact assessment. HIA is a typical task for the public health service. A project on HIA undertaken by the North Rhine-Westphalian Research Compound for Public Health found out that presently the opportunity to use HIA for preventive health purposes is still largely neglected. However, in a survey local health departments expressed great interest in receiving HIA-training. A workable concept and supporting tools are both necessary prerequisites for the practice of HIA becoming routine. This paper presents a ten step HIA-conceptl. Supporting tools are presently under development and testing.

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.

In a period of transition from industrial to post-industrial society with its focus on the service and information sector the nature of work is changing as well as the impact of work on human health. This paper describes leading concepts which were developed in social sciences to better account for this impact, especially so the so called job strain model. Moreover, it gives a selective, but representative review of recent empirical findings based on these concepts with coronary risk and disease as main outcome criteria. Finally, the paper discusses practical implications with regard to public health: preventive measures which aim at structural rather than individual intervention. The main focus of these measures is on work organisation and manpower policy.

This paper gives a short presentation on some of the difficulties a public health officer has to face concerning questions of town-planning. The focus is on giving an expert opinion on development plans. It may be said that the public health service and "health" often play minor roles in town planning. The article presents some suggestions for a change of this situation.

According to the Federal law concerning the prevention and control of epidemics (Bundes-Seuchengesetz) and according to the third enforcement law about the standardisation of the public health system (Dritte Durchführungsverordnung zum Gesetz über die Vereinheitlichung des Gesundheitswesens) it is incumbent upon the local Public Health Authorities to supervise the sewage treatment plants within their respective administrative district. In practice, that task is hardly ever realised since it is often not clear exactly which hygienic aspects should be checked and what the benefit of such supervision could be. The following paper is an attempt to make suggestions how to carry out such supervising activities in practice. Furthermore, the paper shows the results of the 1993 supervising activities in the sewage treatment plants in the Limburg-Weilburg area. This is illustrated on the basis of the checklist which has been developed at the public health office of Limburg.

An irresponsible "approval on request" in favour of waste incineration written by a consulting committee of the German Federal Board of Physicians has meanwhile been widely distributed both nationally and internationally. The aim of this politically motivated paper is to dramatically increase the present number of 49 waste incinerators in Germany. It is our duty to warn of this intention. Health problems are known to exist both in workers at waste incinerators and in humans living in their vicinity. Furthermore, in the long run negative impact also to ecosystems should be expected from the emissions. Health problems in patients living downwind of waste incinerators repeatedly have been reported on by physicians. "Lack of statistical significance", often used as counter-argument, is only due to absence of funding of comprehensive epidemiological studies in Germany. Analyses of soil samples reveal the pollution from waste incineration. Considering the pre-load of the region, additional emissions caused by waste incineration and other sources have to be assessed. The application of preventive limit values is imperative. The presently used "limit values", being about 100 times too high, bear an unacceptable risk. Therefore, reliable regional registers of emissions have to be established immediately. Limit values continuously have to be adjusted to the progress of scientific knowledge. In this respect it is imperative to consider that the actual composition of emissions is unknown; isolated risk assessment of single compounds underestimates the total risk; the negative impact, e.g. of dioxins, on both the immune and hormone systems occurs at concentrations 100 times lower than those causing carcinogenic effects; the assumption of "threshold values" is obsolete; a considerable lack of knowledge exists about accumulation in food webs and in ecosystems; the demand of preservation of natural, geogenic situations is indispensable in assessments of soil and water pollution. Essential prerequisites for risk assessments of emissions from waste incineration are 1. actual, continual and comprehensive qualitative and quantitative analytical knowledge of the composition of emissions; 2. region-specific meteorologic dispersion models of the emissions; 3. evaluation of the complex mixtures in emissions for their kinetics in and toxicity for ecosystems and humans. Neither of these demands is so far fulfilled. Facing these problems, the present propagation of waste incineration must be stopped. As an alternative, efforts to optimize waste-avoiding and recycling concepts considerably have to be reinforced, and low-risk procedures, like compost and other decomposing methods, hydrogenation or freeze-griding of plastics, have to be widely promoted.

While looking for enough living quarters for the town people regional planners are often confronted with high levels of noise due to traffic, highways and railways near the planning area. This may change or even stop the procedure of town planning. Generally, health authorities--who are more or less involved in the process of planning--should take the chance to demand compatibility of special planning with health care regarding noise. However, most guidelines on health-compatible noise levels are not legally binding. This paper describes the variety of health problems accompanied by moderate to high levels of noise. In regions with traffic noise problems efforts should be directed at maximum health compatibility coupled to highly imaginative planning. It is suggested that levels of noise of 55 dB(A) (daytime) and of 45 dB(A) (nighttime) should be tolerated near to the building. This would ensure tolerable levels of noise of 35 dB(A) (daytime) and of 30 dB(A) (nighttime) in the dwellings. Examples of different arrangements of buildings are shown. They demonstrate that these tolerable noise levels could even be observed in areas with traffic problems. It mostly depends on the planner's imagination whether the need for dwelling houses in problem areas could be met in keeping with health demands.