Search

Since 1995, the Poverty and Health Congress has been organized annually by Gesundheit Berlin-Brandenburg e. V. in cooperation with various partners. It is one of the largest regular public health events in Germany. The congress is a platform for exchange between science, practice, civil society, and politics. In 2022, the motto was "What counts now." Public health and health inequalities were discussed in the light of the SARS-CoV‑2 pandemic and the war in Ukraine. Professional exchange on various topics took place in over 100 digital events with more than 2000 participants, among them around 500 speakers.Der Kongress Armut und Gesundheit wird seit 1995 jährlich von Gesundheit Berlin-Brandenburg e. V. in Zusammenarbeit mit verschiedenen Kooperationspartner*innen ausgerichtet. Inzwischen gehört er zu den größten regelmäßig stattfindenden Public-Health-Veranstaltungen in Deutschland. Der Kongress versteht sich als eine Plattform für den Austausch zwischen Wissenschaft, Praxis, Zivilgesellschaft und Politik. Unter dem Motto „Was jetzt zählt“ wurden in diesem Jahr Aspekte gesundheitlicher Ungleichheit und Public-Health-relevante Fragestellungen vor allem vor dem Hintergrund der COVID-19-Pandemie und des Krieges in der Ukraine diskutiert. In über 100 digitalen Veranstaltungen mit mehr als 2000 Teilnehmenden, darunter ca. 500 Referierenden, fand ein vielfältiger Austausch statt.

Hintergrund und Ziel: Ob sozioökonomische Faktoren die Ausbreitung von SARS-CoV‑2 beeinflussen, ist nicht ausreichend beantwortet, da frühere Studien in der Regel kumulative Inzidenzen betrachtet und die zeitliche Entwicklung der Ausbreitung außer Acht gelassen haben. Dieser Beitrag konzentriert sich daher auf die Entwicklung von regionalen Neuinfektionen in Zusammenhang mit sozioökonomischen Faktoren. Ausgehend vom internationalen Forschungsstand präsentieren wir eigene Analysen von Meldedaten aus Deutschland. Methoden: Diese Studie untersucht regionale Daten gemeldeter COVID-19-Fälle für die 401 Landkreise und kreisfreien Städte (Kreisebene) in Deutschland und vergleicht den zeitlichen Verlauf entlang sozioökonomischer Merkmale der Kreise. Betrachtet werden altersstandardisierte wöchentliche Inzidenzen für den Zeitraum 03.02.2020–28.03.2021. Sozial- und Wirtschaftsindikatoren auf Kreisebene stammen aus der INKAR(Indikatoren und Karten zur Raum- und Stadtentwicklung)-Datenbank (z. B. Einkommen, Beschäftigtenquote, Wohnfläche). Ergebnisse: Während in der ersten und zu Beginn der zweiten Welle der Pandemie Kreise mit höherem mittleren Haushaltseinkommen höhere Inzidenzen hatten, stiegen sie in Kreisen mit niedrigem Einkommen ab Dezember 2020 deutlich an. Kreise mit einem hohen Anteil an Beschäftigten allgemein und speziell solchen im Produktionssektor hatten gerade in der zweiten und dritten Welle hohe Inzidenzen. Kreise mit einer geringen Wohnfläche je Einwohner hatten ab November 2020 ausgeprägt höhere Inzidenzen. Schlussfolgerung: Der regionale Verlauf der Pandemie unterscheidet sich nach Sozial- und Wirtschaftsindikatoren. Eine differenzierte Betrachtung dieser Unterschiede könnte Hinweise auf zielgruppenspezifische Schutz- und Teststrategien geben und helfen, soziale Faktoren zu identifizieren, die Infektionen begünstigen. Background and objective: It has not been adequately answered whether the spread of SARS-CoV‑2 is influenced by social and economic factors. Earlier studies generally looked at cumulative incidences up to the analysis date and did not take into account the development of the spread over time. This study therefore focuses on the regional dynamic of new infections and their relationship to socioeconomic factors. Based on the literature we describe the state of knowledge and present our own analyses of administrative data from Germany. Methods: For this study, we examined regional progress data of reported COVID-19 cases for 401 cities and counties in Germany and associated them with socioeconomic characteristics of the areas. Age-standardized weekly incidence rates were calculated for the period from 3 February 2020 to 28 March 2021. Macroindicators were added from the INKAR database (e.g., income, employment rate, and crowding). Results: While areas with higher incomes and lower poverty had higher incidences in the first and at the beginning of the second wave of the pandemic, they increased significantly in low-income regions from December 2020 on. Regions with a high proportion of gainfully employed people in general and especially those in the manufacturing sector had high incidences, especially in the second wave and at the beginning of the third wave. A low mean living space per inhabitant was related to higher incidence rates since November 2020. Conclusion: The regional temporal course of the pandemic correlates with social and economic indicators. A differentiated consideration of these differences could provide information on target group-specific protection and test strategies and help to identify social factors that generally favor infections. An English full-text version of this article is available at SpringerLink as Supplementary Information.

The annual Poverty and Health congress, which has been organized by Gesundheit Berlin-Brandenburg e. V. since 1995, has become one of the biggest public health events in Germany. It offers an exchange platform for science, practice, and politics. This year's congress topic was "From Crisis to Health in All Policies," which aimed to address the SARS-CoV‑2 pandemic's impact on society in general and public health in particular. Overall, 80 panels were organized with close to 500 experts discussing a wide range of subjects and questions, for example, the connection between poverty and COVID-19, the current challenges in the care sector, the situation of homeless people, and the impact of the pandemic on (young) families or students as well as global questions on vaccination strategy and key issues for a public health strategy for Germany.Der Kongress Armut und Gesundheit, der seit 1995 jährlich von Gesundheit Berlin-Brandenburg e. V. in Kooperation mit unterschiedlichsten Partner*innen ausgerichtet wird, gehört inzwischen zu den größten regelmäßig stattfindenden Public-Health-Veranstaltungen in Deutschland (siehe Infobox 1). Er ist eine Plattform für den Austausch zwischen Wissenschaft, Praxis, Zivilgesellschaft und Politik. Unter dem Motto „Aus der Krise zu Health in All Policies“ wurden in diesem Jahr Public Health und gesundheitliche Ungleichheit vor allem vor dem Hintergrund der SARS-CoV-2-Pandemie thematisiert. In über 80 Veranstaltungen mit knapp 500 Referierenden wurde ein breites Spektrum an Themen und Fragestellungen diskutiert: unter anderem der Zusammenhang zwischen Armut und COVID-19, die Herausforderungen in der Pflege, die Situation wohnungsloser Menschen, der Einfluss der Pandemie auf (junge) Familien oder Studierende sowie globale Fragen zur Impfstrategie und Eckpunkte für eine Public-Health-Strategie für Deutschland.

Although the negative relationship between poverty and health is well-documented, it is still unclear whether it can be explained by social causation or by indirect or direct selection. Moreover, most studies measure poverty by income, which is only weakly correlated with the actual material living conditions. This study is the first to examine for Germany whether material deprivation still influences subjective health after accounting for indirect selection METHODS: The analysis is based on the data from the German Socio-Economic Panel (GSOEP) 2001-2015. The sample consists of 54,995 observations on 14,434 men and 60,766 observations on 15,912 women, both with an average age of 50 years. In a first step, pooled OLS (POLS) and random effects models (RE) were applied to confirm the results of previous studies. In a second step, linear fixed effects regressions (FE) were applied to control for indirect selection into poverty as a result of time-constant unobserved heterogeneity.In the POLS models, in line with previous studies, a negative association between material deprivation and subjective health was found for men and women. This relationship was considerably weaker in the FE models. However, even after better controlling for indirect selection, a significant deterioration of health through material deprivation could be observed, which gradually increased with the intensity of material deprivation.The results suggest that a large part of the negative correlation between material deprivation and subjective health can be explained by indirect selection. The remaining negative linear relationship in the FE model also indicates that material deprivation impairs health.Während die negative Beziehung zwischen Armut und Gesundheit vielfach dokumentiert wurde, ist bislang unklar, ob diese auf soziale Verursachung oder auf indirekte oder direkte Selektion zurückzuführen ist. Des Weiteren wird Armut bislang meist aus dem Einkommen abgeleitet, obwohl dieses nur gering mit den tatsächlichen materiellen Lebensbedingungen korreliert ist. Die vorliegende Studie untersucht erstmals für Deutschland, ob sich materielle Deprivation auch unter verbesserter Kontrolle von indirekter Selektion auf die subjektive Gesundheit auswirkt.Die Analyse basiert auf den Daten des für Deutschland repräsentativen Sozio-oekonomischen Panels (SOEP) der Jahre 2001 bis 2015. Das Analysesample enthält 54 995 Beobachtungen von 14 434 Männern und 60 766 Beobachtungen von 15 912 Frauen, jeweils mit einem durchschnittlichen Alter von 50 Jahren. Zunächst wird versucht, die bisherigen Forschungsergebnisse in gepoolten OLS- (POLS) und Random Effects-Modellen (RE) zu bestätigen. Anschließend werden lineare Fixed Effects-Regressionen (FE) berechnet, um für indirekte Selektion in Armut als Resultat von unbeobachteten zeitstabilen Merkmalen zu kontrollieren.In den POLS-Modellen zeigt sich, im Einklang mit früheren Studien, sowohl bei Männern als auch bei Frauen ein negativer Zusammenhang von materieller Deprivation und subjektiver Gesundheit. Diese Beziehung reduziert sich in den FE-Modellen stark. Aber auch nach verbesserter Kontrolle von indirekter Selektion lässt sich weiterhin eine signifikante Verschlechterung der Gesundheit durch materielle Deprivation feststellen, die mit steigender Intensität der materiellen Deprivation graduell zunimmt.Die Ergebnisse legen nahe, dass der negative Zusammenhang zwischen materieller Deprivation und subjektiver Gesundheit zu einem großen Teil durch indirekte Selektion bedingt ist. Der im FE-Modell verbleibende negative und graduelle Zusammenhang deutet darauf hin, dass materielle Deprivation die Gesundheit verschlechtert.

Poverty and social exclusion are closely related to an increased risk for the deterioration of mental health. In 2018 approximately 19% of the German population were threatened by poverty and the associated social ostracization. Migrant groups in particular often show an increased risk for poverty and are often exposed to multiple socioeconomic stress factors depending on the context of migration, pre-migration and post-migration social factors. Numerous studies have shown that societal exclusion, precarious living conditions and the residential environment negatively affect mental health beyond the effects of pre-migration risk factors. This article provides a review and discussion on the relationship between mental health, poverty and related constructs, such as social cohesion, social capital and social exclusion in general as well as in specific risk groups, such as migrant and refugee populations.

Differences in the health status and health behavior of children and adolescents are analyzed, taking the income situation of the family into account.The data is based on the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). Health outcomes are the subjective health, chronic health limitations, mental disorders, ADHD, consumption of fresh fruit, consumption of sugary soft drinks, physical activity, sports activity during leisure time, overweight, and obesity. The income situation is recorded using the equivalized household income.Poor children and adolescents are more likely to have health problems than their peers from the middle- and, especially, the high-income group; their health behavior is less favorable. The biggest relative income-related differences are found in subjective health. With statistical control for parental education and occupational status, income-related differences in health status remain consistent while being significantly reduced for health behavior.The results confirm that low family income has a significant impact on the health of children and adolescents. Partly, this also applies to their health behavior, whereby the observed differences between the income groups can be attributed mainly to parental education and occupational status. This shows once again that children and adolescents growing up in poverty should be a key target group for prevention and health promotion.

Community health promotion with children requires a conceptual framework to support children and families and sustainably improve their health opportunities.Family-oriented health promotion is an approach to implement this demanding task. It focuses in particular on the user perspective of families. It can be conceptually presented along the life-stage approach. Pregnancy, early childhood and adolescence as well as transitions between age-specific socialization institutions are highly vulnerable. Additionally, burdened life situations are presented along familial adversities such as poverty, isolation, single parenting, external placement or illnesses, and life-specific approaches to health promotion and prevention are named. Family-oriented health promotion should avoid stigmatization and support families through municipalities and other settings.

Poverty is an important problem in Germany. The health effects of poverty can lead to a higher risk of disease and the arising of chronic affections. On the other hand chronic illness may support the development and continuance of poverty. The context of chronic pain and poverty has not been analyzed so far.We investigated the correlation between chronic pain and poverty.In a prospective manner we interviewed 20 patients with pain syndromes during our consultation hour regarding their household income. Further, data from the German Federal Statistical Office were analyzed with respect to the correlation between the incidence of a chronic pain diagnosis and household income.At 1546 €, the average household income of the patients studied was below the poverty level. The analyzed data showed that women suffered from chronic pain more often than men did and also had a lower income. Another economic inequality was found between Eastern and Western Germany. There was a statistically significant correlation between income and the incidence of the diagnostic codes for chronic pain (R52.1, 2, 9) for men.Our investigation showed the correlation between chronic pain and poverty. A commitment and cooperation of German medical associations and federal politics is necessary to overcome this sociopolitical issue.

Nepal is one of the 20 poorest countries in the world. Thus, medical care in Nepal is dependent on significant medical and financial commitment from within and outside the country. Dhulikhel Hospital - Kathmandu University Hospital (DH-KUH) was founded in 1996 by Prof. Dr. Ram and colleagues. Collaboration and support of many people and institutions are, in contrast to the experience in other hospitals of the third world, characterized by an extraordinary sustainability. The reason for this is the spirit lived according to the motto "best service for the poor". The structures in DH-KUH are influenced by a very close cooperation with a number of international (university) hospitals. Most of the DH-KUH departments have an amazingly high technical standard. Assuming this development and progress can be continued, a splendid future for DH-KUH can be predicted.

In this article the focus of analysis lies on power relations in everyday life in one of Glasgow's Pauper Lunatic Asylums at the turn of the twentieth century. Taking a sample of patient case files I examine the daily processes of negotiation between inmates and their relatives, physicians, attendants and nurses as well as the poor law administration. Some cases especially exemplify the complex relationships between the actors. They show which opportunities and boundaries existed for "power brokering" for the more powerless. At the same time these cases illustrate the formal and practical limits of enforcement by doctors and nursing staff. Without turning a blind eve to hierarchies and power imbalances the analysis shows that even in settings like "total institutions" power remains volatile. Even there the more powerful actors have to actualize, seize and prevail on a regular basis.

This contribution focuses on the medical practice of the policlinics in Würzburg and Göttingen in the first half of the nineteenth century. In these institutions patients were treated free of charge by medical students and assistant physicians who, in turn, were able to gain further experience and develop their skills. The policlinics were therefore an important part of poor-healthcare in both these cities. The essay tries in particular to illustrate healthcare for poor patients against the background of their everyday lives and working environment. Based on the situation of individual poor patients, the concepts of 'sickness' and 'poverty' are discussed as mutually dependent determinants of the 'reality of life' among the urban lower classes. This contribution combines the evaluation of medical practice journals and patient histories with the analysis of source materials on urban poor relief and healthcare. It looks particularly at the children and elderly people who attended the policlinics. The encounters between physicians and poor patients documented in the sources not only provide valuable insights into historical patient behaviours, they also open up new perspectives of the physician-patient relationship during the nineteenth century transition from the 'sickbed-society' to hospital medicine.

Homelessness is a social phenomenon of increasing frequency in Germany and of high relevance for an inclusive society. Its expression is both caused psychosocially and moderated socioeconomically, often with negatively reinforcing feedback-loops. This overview describes health effects and strategies for improvement, using the example of the "Mainzer Modell". The comprehensive availability of adequate medical care are both an individual right and a social duty for an inclusive society.

Social inequalities in health and health care services represent issues of major concern. Findings in this area reveal inequalities in health and health care indicating disadvantages for individuals with a low socioeconomic background. Although the health care system plays a marginal role in the explanation of inequalities in health, health services research can be an important part in the development of equal health opportunities. The current article describes the causal associations between social inequalities, health inequalities and the health care service. Health services research can make a contribution to increasing equal opportunities in health and health care service. Against this background, we discuss the existing potential and need of research in the area of health services.

To develop an intervention concept for the management of uninhabitable homes.Retrospective analysis of 186 cases of the community mental health service in Dortmund (Germany) presenting with a destitute situation of the domestic environment as core problem.All patients suffered from psychiatric illnesses, mainly from addiction (F1: 41 %), psychosis (F2: 17 %), depression (F3: 17 %), and hoarding disorder (F63.8: 12 %). Main socio-demographic characteristics of our sample are: middle age (45-65 years, 48 %), male gender (73 %), isolated situation (only 7 % married, 84 % living alone), normal schooling (only 4 % without completion of schooling, 7 % attended a school for special needs), after initial integration into employment nearly all patients suffered vocational disintegration (5 % employed, 44 % unemployment benefit, 7 % welfare, 39 % pension or invalidity benefit).Psychosocial interventions differed between the 4 main diagnostic groups: F1: treatment of dependence (rehab) and treatment of concomitant somatic diseases; F2: admission to a psychiatric hospital and implementation of guardianship; F3: mediation of conflicts with neighbours/landlords and implementation of guardianship; F63.8: direct practical help by members of the community mental health team and organisation of home help/waste disposal. In all diagnostic groups, acceptance of help was impaired due to social withdrawal, resistance and psychiatric symptoms. At 13 %, compliance with help and interventions was lowest in the hoarder group (F1: 27 %, F2: 26 %, F3: 38 %). Consequently, in this group the poor outcome categories "nothing accomplished" and "lost flat/eviction" were more frequent (44 %, F1: 27 %, F2: 26 %, F3: 38 %).Concurrent to the deterioration of the domestic situation, patients suffer vocational disintegration as well as family and social isolation. Uninhabitable homes occur in the course of various severe and chronic psychiatric diseases. They don't constitute a syndrome and they are not characteristic for one specific diagnosis. It is important to recognise the underlying psychiatric disease as diagnosis influences acceptance of help, choice of appropriate interventions, outcome and prognosis. Tab. 1 shows our suggestion for a diagnosis differentiated approach, relating appearance of the home and behaviour of the patient to diagnosis, appropriate interventions and prognosis. Hard to reach is the group of hoarders. Patients with a psychotic illness and with hoarding disorder require implementation of long-term outreach help in their homes.

Over the past 70 years, several million people have immigrated into Germany-from different countries of origin and for different reasons. The categories used by society to label immigrants ("guest workers", "persons with a migration background") have changed over time. This change has occurred in parallel with changes in the societal attitude towards immigrants and in their legal position. There is unequivocal evidence that the forms that migration takes, in addition to the societal responses towards immigrants, have an effect on their health. The spectrum of migration to Germany is likely to remain fluent because of the continuing process of globalization; also, societal responses to migration will change over time. Thus, migration will continue to pose challenges to society and to health. Only through continuous attentiveness will it be possible to identify, and then avoid or reduce, health disadvantages faced by persons with a migration background.

Malnutrition is unhealthy: obesity, type 2 diabetes, cardiovascular diseases, some cancers, and premature mortality are reliably associated with poor nutrition. However, literature reveals that some population groups are at higher risk of poor nutrition than others. More specifically, evidence shows that people with low social status are more likely to have poor nutrition than those with higher status, what may contribute to health inequalities. In this article, selected reviews and meta-analyses on social inequalities in nutrition are presented. By showing current data from the Second National Food Consumption Study, the situation in Germany is highlighted. Further, potential causes of social inequalities in nutrition are discussed, drawing on the results of current research. More specifically, socioeconomic and structural deprivation (e.g., poverty, living in deprived neighborhoods) in addition to unfavorable psychosocial (e.g., poor knowledge of nutrition, low levels of social support) and sociocultural factors (e.g., unfavorable nutritional traditions) might be associated with poor nutrition in people with low social status. Interventions promoting nutritional quality in disadvantaged groups should take into account the various influences on nutrition and meet good practice criteria for health promotion. Using three examples of interventions, conceivable concrete measures that can reduce social inequalities in nutrition are presented.

The analysis of inequalities in health care provision in Germany is of high sociopolitical relevance. For medical rehabilitation, which is an essential part of health care provision, only a few studies exist.With the example of psychosomatic and orthopedic medical rehabilitation, the present article investigates how features of social inequality influence different aspects of medical rehabilitation.The database consists of a written survey on the quality assurance of medical rehabilitation in northern Germany that includes 687 patients aged between 21 and 87 years. Aspects of the access to rehabilitation (e.g., the motivation for application), the process (participation in therapies) and the outcomes (e.g., subjective health and occupational risk) of rehabilitation were investigated in relation to social inequality. Social inequality was measured by means of a social class index. For the analysis, Chi-squared tests, t tests and a repeated measures analysis of variance, adjusted for sex and age, were conducted.Initially, the analyses indicate that social inequality is of minor importance for access to rehabilitation and processes within rehabilitation. As subjective health is unequally distributed at the beginning of rehabilitation, however, equal treatment has to be discussed critically in terms of demand-driven treatment. In rehabilitation outcome distinct differences between social classes exist. To reduce these differences, rehabilitation aftercare close to the individual's living environment is necessary, which promotes the empowerment of vulnerable social groups in burdensome living conditions.

Social differences in morbidity and mortality have always been a central topic in public health research. In recent years, there has been a growing research interest that has clearly resonated with the general public and the political arena as well. This article describes the development and establishment of social epidemiology in Germany and presents the current status of research. In addition, it describes different models for explaining health inequalities. On this basis, selected challenges and prospects of socio-epidemiological research are demonstrated. The reason why the analysis of social differences in morbidity and mortality will continue to be a key task of public health research in the national and international context in the future is also explained.

Prevention and reduction of poverty are key elements of social welfare policy in Germany. This study is the first analysis of self-rated health of individuals that escape poverty by benefiting form public transfers.Analyses are based on the German Socio-economic Panel (GSOEP) of 2010. Self-rated health was based on subjective assessment of general health status. Subjects were directly asked about receipt of public transfers. Income poverty was based on the equalized disposable income and is applied to a threshold of 60% of the median-based average income. We analyzed the association between self-rated health and pre- and post-transfer poverty by means of descriptive analyses and binary logistic regression.After adjusting for age, we found a significantly higher risk of poor self-rated health among those who escaped income poverty due to the receipt of social transfers compared to others (ORWomen: 1.85; 95%-CI: 1.27-2.69; ORMen: 2.57; 95%-CI: 1.63-4.05), in particular to those at risk of post-transfer poverty. These poverty-related inequalities in health were predominantly explained by nationality, occupational status, household type and long-term care within the household.This study provides first evidence that the receipt of public transfers is associated with increased risk of poor health in the light of impending income-poverty. This study adds to the current debate about the social and health implications of public transfers in the relationship between poverty and health.

The risks of the occurrence of most chronic diseases are unequally distributed. The highest risks occur in men and women with the lowest incomes, the lowest educational qualifications, and in occupations with the lowest decision latitude. Education, occupational position, and income as indicators of socio-economic position differ with regard to their latent content and can thus not be considered to be interchangeable. The relative magnitudes of their effects differ according to the diseases considered, but all three are not available in all studies. After an explanation of the latent content of the most frequently used indicators of social differentiation, health inequalities are considered by using four groups of chronic illnesses: oral, type 2 diabetes, cardiovascular diseases, and cancers. The description is not designed to be an exhaustive assessment of the available empirical findings, but rather a representative presentation of the results and the explanatory value of education, occupation and income.

The aim of this study was to analyze whether health-related characteristics of elderly differ considering their income situation.N=322 elderly were included in a quantitative survey (e. g., SF36, GDS, Barthelindex, IADL). The evaluation was conducted in consideration of housing (independent, outpatient, nursing homes, district).There were significantly higher values of diseases in the lower income than in higher income groups (F(316)=2,971; p=0,008; eta²=0,053). Furthermore the lower income groups were more often classified into long-term care level 2 (Chi²=25,36; p=0,009; C=0,283) associated with reduced abilities of daily living and lower scores on physical and mental wellbeing. Gender differences could not be found.Low-income elderly have a poorer health status than high-income elderly. Endeavors should be undertaken to improve prevention strategies to retain independence and quality of life of low-income elderly.

A common indicator of the measurement of relative poverty is the disposable income of a household. Current research introduces the living standard approach as an alternative concept for describing and measuring relative poverty. This study compares both approaches with regard to subjective health status of the German population, and provides theoretical implications for the utilisation of the income and living standard approach in health research.Analyses are based on the German Socio-Economic Panel (GSOEP) from the year 2011 that includes 12 290 private households and 21106 survey members. Self-rated health was based on a subjective assessment of general health status. Income poverty is based on the equalised disposable income and is applied to a threshold of 60% of the median-based average income. A person will be denoted as deprived (inadequate living standard) if 3 or more out of 11 living standard items are lacking due to financial reasons. To calculate the discriminate power of both poverty indicators, descriptive analyses and stepwise logistic regression models were applied separately for men and women adjusted for age, residence, nationality, educational level, occupational status and marital status.The results of the stepwise regression revealed a stronger poverty-health relationship for the living standard indicator. After adjusting for all control variables and the respective poverty indicator, income poverty was statistically not significantly associated with a poor subjective health status among men (OR Men: 1.33; 95% CI: 1.00-1.77) and women (OR Women: 0.98; 95% CI: 0.78-1.22). In contrast, the association between deprivation and subjective health status was statistically significant for men (OR Men: 2.00; 95% CI: 1.57-2.52) and women (OR Women: 2.11; 95% CI: 1.76-2.64).The results of the present study indicate that the income and standard of living approach measure different dimensions of poverty. In comparison to the income approach, the living standard approach measures stronger shortages of wealth and is relatively robust towards gender differences. This study expands the current debate about complementary research on the association between poverty and health.

Due to a higher prevalence estimates of risk factors, it is assumed that socially disadvantaged persons have a considerable need for health-related information and prevention. Yet this target group is hardly ever reached. There is a need to examine whether available health-related information is appropriate for the needs of socially disadvantaged people. On behalf of the Institute for Quality and Efficiency in Health Care (IQWiG) a qualitative study was conducted to evaluate published health-related information by socially disadvantaged people. Semi-structured interviews were carried out with 28 persons with low income, low occupational status and a very low education level. 7 different types of health information (4 texts and 1 film, quiz and flyer each) were evaluated regarding their suitability. The interviews were audio-taped, transcribed according to protocol, and qualitatively analysed in view of the central questions. Respondents evaluate the film format most positively, because of the vividness of the contents. In text-based information, a clear structure of the text and the use of case examples are particularly advantageous. All respondents accept the credibility of the given information. Problems occur regarding the comprehensibility and sentence structures with complex information. Numerous technical terms and foreign words remain misunderstood, even though explanations are given in the text. Compact contents and the description of several alternative therapy options are experienced as overstraining. Furthermore, the recognition of hazard potentials is hindered by misinterpretation of percentages or negated descriptions of frequencies. Some respondents doubt that they would read text-based health information voluntarily in their everyday life, especially when texts are lengthy. The respondents wish clear guidance, which relieves them of an active informed decision-making. They prefer advice they can apply in their everyday life and to recognise their personal affliction in the information. It becomes apparent that the health-related information published by the IQWiG only partly meets the needs of socially disadvantaged people. But a mere simplification of the content seems insufficient. Instead a more detailed consideration of the personal circumstances of the target group and a better communication of practical information are needed.

Systematic review of psychosocial interventions for high-risk family members with mental health problems in highly developed industrialized countries.Systematic search in electronic databases as well as manual search for intervention studies.Interventions were effective in significantly reducing symptoms of depression and anxiety and strengthening social skills.Backing in situations of distress, as well as elements of selective primary and secondary psychosocial prevention, has temporary effectiveness among high-risk group members.

Multiple trauma is an independent injury pattern which, because of its complexity, is responsible for 25 % of the costs for the treatment of all injured patients. Because of the often long-lasting physical impairment and the high incidence of residual permanent handicaps, it is apparent that multiple trauma can lead to a reduction in patient quality of life.The aim of this study was to give an overview of the known data concerning the change in quality of life for multiple trauma patients. Furthermore, predictors for the reduction of quality of life after multiple trauma will be identified.A MedLine search was performed to identify studies dealing with the outcome after multiple trauma.In addition to functional outcome parameters, the term quality of life has become more important in recent years when it comes to evaluating the outcome following injury. While the mortality after multiple trauma could be significantly reduced over the years, there is no comparable effect on the quality of life. Predictors for a worse quality of life after multiple trauma are female gender, high age, low social status, concomitant head injuries and injury to the lower extremities.The fact that mortality after multiple trauma has decreased but not impairment of the quality of life makes it clear that in addition to the acute medical treatment, a follow-up treatment including not only physiotherapy but also psychotherapy is crucial for multiple trauma patients.

This study evaluated a setting-based programme whose goal was to promote the healthy upbringing of children in a disadvantaged district through the empowerment of mothers. Women from the neighbourhood were trained as community mothers (CM) to impart their knowledge in home visitations to other mothers. 67 CMs were trained. They gained access to 118 families via home visits and to 191 families in single contacts. Information and support resulted in positive changes in all families available for interviews (n=44). The families also gained access to the professional help system.

ADHD is a controversial concept, which provokes educational counselling to position in an explosive stress field of school system, health care system and youth welfare. This positioning could be sharpened by a discourse theoretical perspective and used for counselling in the sense of empowerment. Based on the clinical controversy of ADHD the institutional coherence of school system, youth welfare and health care system gets reconstructed as the societal basis of this clinical discourse, this for showing how the clinification of infantine experience and behaviour, connected with the ADHD-diagnosis, on the one hand is following the constriction of normality and on the other hand is aiming to assure equal opportunities.

Eia Asen developed multi-family-therapy (MFT) in the context of pediatric psychiatric work with predominantly poor and marginalised families from very different cultural, religious, linguistic, and social traditions in inner-city London. This work began with families affected by globalisation, migration, segregation, criminality, and other adverse social and economic effects of Thatcherism. Asen replaced the expert-led diagnostics, patterns of illness and individual medical indication of the case-by-case based model of treatment with a systemic practice developed across decades together with a large multi-professional and multicultural team, which places the family, the social, economic, and educational contexts, as well as traditions and the every-day situations of children and their parents, at the centre of the support. MFT makes particular use of the mutual solidarity, willingness to help and competence of families in comparable situations. The article describes how the child-guidance service has transferred this concept of multi-family training to the outpatient (non-residential) educational support work of the Youth Welfare Department of Ludwigshafen, a medium-sized city with above average social risks. The successes of this pilot project across two-and-a-half years are encouraging and suggest the further development and expansion of this approach.

The association between deprivation in the residential environment and the prevalence of type 2 diabetes has been evaluated by applying two approaches to measure neighbourhood deprivation.Individual data were extracted from the Dortmund Health Study (n=1 312) and combined with administrative data on 62 neighbourhoods in the city of Dortmund. Deprivation indices were constructed by applying principal component analysis with a set of 8 demographic and socio-economic context variables on the low city level. 2-level cross-sectional logistic regression analyses were conducted, adjusted for age, sex, social class and employment status.The study population had a type 2 diabetes prevalence of 7.2%. The principal component analysis provided a 2-factor solution of which one factor was given in the multivariable analysis. Individuals, residing in neighbourhoods with a very high level of unemployment rate or socio-economic deprivation, showed a higher chance to have type 2 diabetes [OR: 4.44 (95% CI: 1.29-15.33) or, respectively, OR: 2.79 (95% CI: 1.10-7.07)], independent of individual characteristics.Beyond individual characteristics, the residential environment contributes to the chance of type 2 diabetes. The unemployment rate operated as a strong predictor of the chance of type 2 diabetes.

Gerontology is not yet part of education or research in Tanzania. Descriptive analyses are valuable to determine the status quo of the living conditions of elderly people and thereby the basis for prospective gerontological discussions. The purpose of this article was to inquire about available data to describe the living conditions of old people in Tanzania, their problems, and potentials. Thereby, age definitions and the demographic development are examined and data sources from the Tanzanian statistical coverage, the SAGE pilot study as well as data from various research projects are discussed. The article closes with recommendations for a more extensive scientific analysis of the topic "Aging in Tanzania" as well as references for its implementation.

Families from migration backgrounds often live in difficult social and economic circumstances. This paper focuses on the resulting strengths of migration rather than increased needs. Systemic approaches can help in dealing with different cultural attitudes and may assist in developing intercultural competencies in counseling. This in turn may support parents in finding their own way of living with their disabled child.

Noma (cancrum oris) is an unspecific bacterial infection in the oro-facial area. In the industrial countries noma is generally unknown, but in the 3rd world - especially in West Africa - it is widespread and one of the main causes of mortalitiy and reason for disability in children. Pathogenesis, clinical course, management and treatment of noma are described with the consequences for anaesthesia.

In Germany the risk for relative poverty has increased profoundly during the last 15 years, especially among single parent families. As poverty is often associated with bad health we examined the physical and mental health as well as health-related behaviour, housing and environmental conditions in children with lone mothers versus children in couple families.In 3 cross-sectional surveys conducted during 2004-2007 in 3 cities and 3 rural areas in Bavaria data on 19 039 pre-school children (47% female) were collected. Health, behaviour and exposure assessment was based on parental reports. The 18 327 cases with complete information on family status were analysed. 10% of the children grew up with single mothers.Single mothers evaluated the general state of health of their children more often as moderate to very poor than couple parents (OR [95% CI]: male: 1.37 [1.07-1.77], female 1.77 [1.33-2.35]). Sons with single mothers were more often obese (1.44 [1.09-1.90]). They scored significantly higher in the SDQ total difficulties score (1.94 [1.44-2.62]), on the emotional problem scale (1.91 [1.40-2.59]) as well as on the hyperactivity scale (1.82 [1.35-2.47]) compared to boys from couple families. No difference was found in prosocial behaviour. Girls with single mothers revealed more often conduct problems 1.36 [1.02-1.81] compared to those from couple families. They also showed a significantly higher prevalence of asthma (2.06 [1.29-3.30]). Children living with their single mothers were less often members of sports clubs and the boys were less physical active. No difference was found regarding the consumption of fruits and vegetables. Single mother family was associated with children's environmental tobacco smoke exposure at home (2.03 [1.79-2.29]). Single mothers perceived higher environmental exposures to noise and air pollution, suffered more often from a lack of accessible green spaces in the neighbourhood and reported a higher traffic load on the residential street.Children with single mothers reveal increased health risks and live under significantly poorer housing and environmental conditions. Further analyses are necessary to identify the mediating factors.

The German mortality statistics are an important data source in terms of research and health policy but might be influenced by different sources of error such as ICD-10 coding by regional authorities. The aim of this study was to identify state-specific coding problems using the example of ischaemic heart disease (IHD) and myocardial infarction (MI).After obtaining age-standardised mortality rates (1998-2008), outlier analyses were used to identify German states with suspect changes in mortality from IHD or MI over time or suspect proportional mortality from an unspecific cause-of-death (ICD-10 R00-R99). Values outside the 3-fold interquartile range (IQR) from the IQR boundaries were considered as outliers. The impact of these discrepancies was studied by using an ecological correlation between state-specific poverty rates and mortality from IHD or MI as an example.During the study period, mortality rates dropped by 38.1% for IHD and by 38.7% for MI. Suspect mortality trends or proportional mortality rates were identified in Berlin, Bremen, Hamburg, Schleswig-Holstein and Saarland. The association between state-specific poverty rates and mortality from IHD or MI increased after exclusion of the suspect states.The ICD-10 coding by regional authorities seems to be an important source of error. A standardisation of coding procedures is urgently needed.