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Public health in Germany: structures, dynamics, and ways forward.
Hajo Zeeb1, Julika Loss2, Dagmar Starke3
1Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany; Health Sciences, University of Bremen, Bremen, Germany.
The Lancet. Public Health
|March 6, 2025
Summary
Germany
Area of Science:
- Public Health Policy
- Health Economics
- Comparative Health Systems
Background:
- Germany exhibits strong economic and healthcare spending but lags in health indicators.
- High prevalence of modifiable risk factors for non-communicable diseases in Germany.
- Existing health policy analysis reveals systemic challenges despite a robust social welfare system.
Purpose of the Study:
- To analyze public health development, structures, and actors in Germany.
- To identify reasons for underperforming health indicators.
- To propose a path forward for improving public health outcomes.
Main Methods:
- Policy analysis of public health operations in Germany.
- Examination of governance structures and institutional frameworks.
- Review of funding, data collection, and inter-sectoral coordination.
Main Results:
- Key challenges include lack of a central public health institution, insufficient funding for prevention, and poor data interoperability.
- Decentralized governance leads to fragmented responsibilities and limited coordination.
- Focus on curative care and economic interests impede effective public health policy.
Conclusions:
- Recommendations include establishing a distinct public health identity and strategy.
- Fostering a culture of prevention and addressing commercial determinants of health is crucial.
- Strengthening links between medicine, public health practice, and research is essential.
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