Together for better health in Germany. Towards a public health strategy

Abstract   In Germany, the responsibility for public health is divided both between federal levels and between sectors, and there is no national or general strategy for public health. However, a strategy is essential for achieving the overarching goal of ensuring the best possible health for all people, including preventing and addressing significant health challenges such as pandemics and climate change. In 2016, Zukunftsforum Public Health (Future Forum Public Health) was established with the primary goal to enhance coherence and collaboration between public health stakeholders from academia, policy and practice. According to the principle of health in all policies, it also aims to promote collaboration across federal levels and political sectors. Within the platform provided by Future Forum, the public health community agreed that a strategy was necessary for strengthening and uniting the disparate field of German public health even though no official mandate for developing a strategy existed. Thus, Future Forum launched a grassroots process to identify key elements for a strong and resilient public health system, based on the essential public health operations (EPHOs), as defined by WHO Europe. For each of the ten EPHOs, the key issues paper “Towards a Public Health Strategy - Together for Better Health in Germany” presents a description of the current situation and challenges, an introduction to the key players, a definition of the aims and objectives, and concrete proposals on how to achieve these. Through its participative nature, the process of developing the key issues itself was an important factor for strengthening the public health community. This process highlights that even where national public health strategies and structures are missing, grassroots public health movements can be effective in strengthening the public health community as well as producing a visible set of recommendations for a resilient public health system. Key messages • Based on WHO’s essential public health operations, Future Forum Public Health developed a key issues paper with guidelines for a resilient public health system. • The participative process leading to the key issues paper was itself an important factor for networking and strengthening Germany’s public health community.

In Germany, the responsibility for public health is divided both between federal levels and between sectors, and there is no national or general strategy for public health. However, a strategy is essential for achieving the overarching goal of ensuring the best possible health for all people, including preventing and addressing significant health challenges such as pandemics and climate change. In 2016, Zukunftsforum Public Health (Future Forum Public Health) was established with the primary goal to enhance coherence and collaboration between public health stakeholders from academia, policy and practice. According to the principle of health in all policies, it also aims to promote collaboration across federal levels and political sectors. Within the platform provided by Future Forum, the public health community agreed that a strategy was necessary for strengthening and uniting the disparate field of German public health even though no official mandate for developing a strategy existed. Thus, Future Forum launched a grassroots process to identify key elements for a strong and resilient public health system, based on the essential public health operations (EPHOs), as defined by WHO Europe. For each of the ten EPHOs, the key issues paper ''Towards a Public Health Strategy -Together for Better Health in Germany'' presents a description of the current situation and challenges, an introduction to the key players, a definition of the aims and objectives, and concrete proposals on how to achieve these. Through its participative nature, the process of developing the key issues itself was an important factor for strengthening the public health community. This process highlights that even where national public health strategies and structures are missing, grassroots public health movements can be effective in

Problem:
The effective communication between a doctor and a patient is considered to be essential, for providing high-quality medical care. A new model of cooperation and partnership which focuses on the patient is being established in the modern healthcare. Description of the problem: Data collected by empirical study on the doctor-patient communication has been presented and analyzed based on an overview analysis of the phenomenon communication. An anonymous survey among respondents was taken in the period September 1st-30th 2018 in the region of Pleven, Bulgaria. The respondents were patients who visited their GPs during that period. The results were processed with Microsoft Office Excel 2007. The quantitative analysis was done with statistical software programs -SPSS 17.0.

Results:
The respondents in the region of Pleven were 1053. It was found that the patients' satisfaction was poor in the matter of two crucial issues: 481 (46 %) of the respondents were dissatisfied with the time that was spent for a conversation with each patient and 470 (45 %) -with the information given by the GP regarding their health condition. According to 345 of the respondents (32,8 %) GPs do not practice informed consent and it is rarely required from patients according to 317 of the respondents (30,3 %).

Lessons:
The analysis shows that there are a number of flaws and unsolved problems in the doctor-patient communication. The verbal communication of the doctor is a serious problem: the ability to ask and to listen. The need of communication training for the doctors in their gradiate study and postgraduate education is evident. It is recommended that a specific training programs for communication in the primary health care should be developed and evaluated.

Key messages:
At the present time the communication skills of the general practitioner should be acknowledged and regulated as priority criteria for their overall assessment. It is necessary that a profound study on the barriers for effective communication between a doctor and a patient is conducted.