When the traffic light parties announced in the coalition agreement that Germany should get a new public health institute, many people in the health sector interpreted this as a signal of departure. Finally, their diverse expertise would be bundled in one place. Germany could finally do justice to what public health means, according to its definition, more comprehensively than before: efforts across society for the health of everyone. But the plans now presented by Health Minister Karl Lauterbach sorely lack the impression of something like totality, unification and departure. Rather, they seem regressive, and it sounds more like breaking up than unifying.
The Robert Koch Institute (RKI) will continue to exist, but will now only be responsible for infectious diseases. The areas that deal with non-communicable diseases are to be separated from the RKI and merged into a new house called the Federal Institute for Prevention and Education in Medicine (BIPAM). The focus is on preventing cancer, dementia and cardiovascular diseases.
As important as prevention is, the splitting up of the RKI means a massive weakening of the established institution that is widely known among the population. Especially since it is incomprehensible why there should now be two different houses for departments that are closely related. For example, look at the highly topical topic of climate change. The RKI has just shown in extensive reports that global warming promotes both communicable and non-communicable diseases, which can reinforce each other in a very complex way. So what is this artificial separation?
And why does the institute now have medicine in its name and not public health care? That may sound subtle, but the designation as a medical institute ultimately suggests a narrowing of the view. Public health, however, means broadening the focus not only beyond medicine, which is more focused on the individual, but into all areas of society and politics. Urban planning, the environment, work, development aid – there is hardly an area that does not influence people’s health in some way. However, there is nothing of this classic public health idea in Lauterbach’s plans.
Even diseases that don’t kill you need attention.
It is also strange how old-fashioned the suggestions sound. Above all, the concept of education is so emphasized – even though public health research has known for decades that it is unhelpful. What is effective is to change the circumstances and not to focus primarily on people’s behavior. Smoking bans and healthier school meals are good examples of this.
The focus on diseases with a high risk of death also follows old practices. Lauterbach justified the emphasis on heart disease and cancer with the average life expectancy in Germany. However, public health scientists have long shown that even diseases that do not kill you place enormous burdens on patients and society. This includes mental illnesses, for example. You will also look for them in vain in Lauterbach’s focus.
So what became known about the plans ultimately leaves a worrying impression: yesterday, narrow, small. This is not what Germany needs to master the massive and complex health challenges of the future. This is a betrayal of the fundamental findings of public health science.