Effecting institutional change

The paper deals with the need for institutional change and behaviour change in the medical care and social security system of the Federal Republic of Germany. The data reported are from the Oldenburg Longitudinal Study (OLS), in which a thousand males suffering from a first myocardial infarction have been surveyed with mailed questionnaires five times in five years. In this study, special emphasis has been given to the influence of social support from the spouse, the medical care system, and workmates on the coping process. Special emphasis has been given as well to institutional factors and organizational problems in the rehabilitation system of general practitioners, rehabilitation clinics and the social security system. The paper concludes that there is a clear need for comprehensive services and other measures that promote self-reliance and self-help activities among patients and their relatives. In the literature on heart disease, "health promotion" is mostly defined as behavioural change on the part of the individual--i.e. patients or members of what is conventionally called a "higher risk group". In this paper, however, I shall concentrate on another aspect which is no less important: the need for institutional change and behavioural change in the medical care and social security systems. This change, I argue, is needed in order to promote the health of patients who survived a first myocardial infarction.