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There is a lack of institutional and regulatory structure and coordination in the public health care system in Germany. The current reform approaches to the public health service, the establishment of a Federal Institute for Public Health and the amendment of the Prevention Act offer opportunities to lay the foundations for a modern public health structure within the framework of these reforms. In this context, the present study, based on the field of health promotion and primary prevention, outlines the following five task areas 1. gathering socio-epidemiological data, 2. health communication, 3. implementation of interventions, 4. method development, evaluation and quality development and 5. discursivization; all of these are highly relevant both for practical work of all identified actors and for their coordination. Taken together, these open a window of opportunity for a coherent, nationwide infrastructure for public health that is capable of action and has the ability to adapt as needed in Germany., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The contribution contains the laudation on behalf of the award of the Salomon-Neumann-Medal 2020 of the German Society for Social Medicine and Prevention to Prof. Karl Lauterbach., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objectives: To study the implementation, effects and costs of Break the Chains, a community-based HIV prevention campaign for men who have sex with men (MSM) in Switzerland, from March to May 2015, which aimed to reduce early HIV transmission by promoting the campaign message to adopt short-term risk reduction followed by HIV testing., Design: Non-randomised evaluation and cost analysis., Setting: Gay venues in 11 of 26 cantons in Switzerland and national online media campaign., Participants: MSM in online surveys (precampaign n=834, postcampaign n=688) or attending HIV testing centres (n=885); campaign managers (n=9); and campaign staff (n=38) or further intermediaries (n=80) in an online survey., Primary and Secondary Outcome Measures: The primary outcome measure was the proportion of MSM at risk of HIV acquisition or transmission who adhered to the campaign message. Secondary outcomes were postcampaign test uptake, knowledge about HIV primary infection and sense of belonging to the gay community., Results: Campaign staff estimated that they contacted 17 145 MSM in 11 cantons. Among 688 respondents to the postcampaign survey, 311 (45.2%) were categorised as MSM at risk. Of 402/688 (58.5%) MSM who had heard about Break the Chains 2015, MSM categorised as being at risk were less likely to report adherence to the campaign message than MSM not at risk (adjusted OR 0.24; 95% CI 0.14 to 0.42). Twenty per cent of MSM with a defined risk of HIV acquisition or transmission who adopted risk reduction declared having done so because of the campaign. Costs for one MSM at risk to adhere to the campaign message were estimated at USD purchasing power parity 36-55. The number of HIV tests in the month after the campaign was twice the monthly average., Conclusion: Break the Chains increased HIV testing, implying that community-based campaigns are useful HIV prevention strategies for MSM. Additional interventions are needed to reach MSM at the highest risk of infection more effectively., Competing Interests: Competing interests: At the time of the study, RS, AS and SD were with the Swiss Federal Office of Public Health. They were responsible for HIV prevention of the Swiss government and developed and implemented the ‘Break the Chains’ campaign. KF, SL and RB received salary support from the Swiss Federal Office of Public Health. AL is with the Swiss Aids Federation and was involved in the development and implementation of the ‘Break the Chains’ campaign., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Community participation, recognised as a central feature of successful health promotion and prevention, is often difficult to implement. In this research project internationally recognised methods of participatory health research were applied to demonstrate ways in which community members can be engaged. Participatory health research is characterised by a close collaboration between academic researchers, practitioners and community members in order to generate common knowledge. It is not a question of translating knowledge from research into practice, but rather a question of promoting a collective learning process on the part of all participants for the purpose of developing solutions which address the interests and needs of local people. The result of the project is a new approach for strengthening the quality of prevention and health promotion interventions: participatory quality development (PQD)., (© Georg Thieme Verlag KG Stuttgart · New York.)

"What do we owe each other?" Variously grounded postulates and theories of social justice try to answer this question with regard to health. Equality of opportunity is widely acclaimed and in Germany also anchored in social security laws. From the perspective of equal opportunity, the author examines the state of affairs and the perspectives of equity in health. Although the deficiencies with regard to access and quality of health care are significant, but relatively moderate, they present serious threats to equity and fairness for the future. Regarding non-medical primary prevention, the reduction of inequality in health has barely begun. The largest obstacles to equity in health are to be found in the distribution and dynamics of opportunities for education, work and income. One of the tasks of public health professionals is to place the health consequences of existing policies on the political agenda.

The rising number of new HIV infections in Germany, particularly among men who have sex with men, raises the question whether the previously successful prevention strategy should be revised. This strategy has been based on a New Public Health approach which arose from the specific historical context in Europe at the start of the epidemic. The hallmarks of this approach are: the active involvement of the target groups; the central role of non-governmental organizations; the combination of population level and targeted, context specific interventions; and an emphasis on social integration and voluntary participation in the work with target group members. Current challenges include: changes in risk perception (at least in part due to the availability of more effective treatments); a diversification of prevention behavioral strategies among target group members; the formation of new sexual subcultures and target groups; as well as changes in hard-to-reach populations such as immigrants and people of lower socioeconomic status. In order to meet these challenges the following measures are necessary: an increased investment in prevention research (with a particular focus on interventions specific to social contexts in which risk behavior is increasing); further development of the institutional infrastructure for prevention, including the full implementation of UNAIDS guidelines for national prevention strategies; and improving the prevention work of local AIDS service organizations and public health authorities through an increase in funding and the implementation of quality assurance measures based on participatory action research.

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.

The occurrence of AIDS led in every Western European country to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained above all by the fact that not only was a health catastrophe feared but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise, signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. Four phases are distinguished between in this process, given nationally different patterns of development: Approx. 1981-1985: emergence of exceptionalism. The reasons underlying exceptionalism are investigated. Approx. 1986-1991: consolidation and performance of exceptionalism. The investigation centers on the exceptionalist policy model. Approx. 1991-1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The forms and perspectives of the changes made in the management of HIV and AIDS are elucidated using examples from the fields of health care, primary prevention and drug policies. AIDS health-policy innovations, their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with AIDS for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which AIDS exceptionalism has been institutionalized and the distance of these innovations from medical, therapeutic events.

Findings of health science as to the incidence and dynamics of health problems and the knowledge to optimize health promotion, prevention and patient treatment as well as international comparisons indicate that the potentials of nursing--understood as a system of nurses, nursing institutions and nursing science differentiated in itself--are not exhausted to their full extent within the German system of social health assurance. Following the introductory reflections on the relation between public health and nursing, being relatively young multi-disciplines of health science in Germany, this paper tries to identify and to describe the related deficiencies and approaches for their rectification by means of the four phases of the Public Health Action Cycle--assessment: of problems and fixing of priorities; policy formulation: selection, negotiation and fixing of strategies; assurance: organisation, implementation and control as well as evaluation: evaluation of the strategy and its results. This paper is the revised version of the basic lecture that the author gave on the occasion of the Fourth International Symposium of Nursing Science in Osnabrück in November 1996.

Associations between work and health can be found at many different levels. Work itself can have health hazardous as well as health promoting effects. Work defines status and life-style as well as social security and occupies a large proportion of time in our lives. Until now the process to integrate issues of worksite prevention and health promotion into Public Health proceeds slowly in contrast to other countries e.g. the USA. Weak connections between occupational medicine and Public Health as well as relative few projects focussing on work site in the Public Health Research Associations reflect this trend. Work site public health research according to the guidelines of the Ottawa Charta (WHO) could enhance the transition of approaches justified now in terms of risk and legal liability towards an orientation on health resources and preventive potentials. This transition is promising in regard to the science of public health. However, bottleneck facilities can be identified: the development of appropriate health reports in companies, the implementation and further development of new steering models for worksite interventions (especially the organizational development) and the implementation and further development of appropriate form of quality assurance which can be evaluated.

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.

Given the present circumstances and considering the foreseeable development of medical knowledge, the primary prevention of AIDS is the sole field of health policy in which the spreading of the disease and the subsequent number of victims can be reduced. AIDS prevention as a time-stable behaviour control in potentially risky situations is therefore primarily a task which has to be tackled in a social scientific manner. It has to be handled on the basis of available medical knowledge of infectious disease situations. Viewed realistically, the prospective goal is not the elimination of the disease, but the greatest possible reduction and minimization of risk, both individually and epidemiologically. Proceeding from realistic estimates of the desired and undesired effects of health policy measures, this principle is being applied through the strategy (achieved through informational campaigns) of encouraging the use of condoms when having sexual intercourse in non-monogamous relationships and of informing intravenous drug abusers of the need to employ sterile hypodermic needles. Elements of this preventive strategy are discussed under four central questions: What should/must be learn? Who should/must learn? What objective and subjective factors facilitate or hinder this learning? How can this learning process most optimally be organized? The efficiency-reducing interference of other kinds of strategies (e.g. orientation toward zero risk concepts, repression, and mass screening for HIV-anti-bodies) is thereby worked out.