The public health service in Germany has not had a good time for many years. It was devalued as “state medicine”, lost staff, was neglected by science, even by the public health institutes set up in the 1980s, and it was unable to develop any viable reform perspectives that would make it a truly relevant partner, for example Environmental protection, health promotion or health planning would have made it interesting.
That has changed noticeably in the last 10 years. A series of crises, from the EHEC crisis to the refugee crisis to the corona crisis, have shown that the ÖGD is an indispensable element of public health. It wasn’t just lip service to the ÖGD. The Conference of Health Ministers adopted a mission statement for the ÖGD in 2018, which gave the ÖGD a sustainable face, combined with development prospects. The mission statement is based on a suggestion from Sybille Scriba from Mecklenburg-Western Pomerania, was drawn up on her behalf by a cross-state working group under the leadership of Bavaria and brought “to the people” by the Academy for Public Health in Düsseldorf, i.e. in the ÖGD. Reform discussion. This mission statement has become a reference paper not only for many programmatic publications, but also for the “Pact for the ÖGD”, with which a total of 4 billion euros will be invested in the expansion of the ÖGD by 2026, both in terms of the overdue digitalization and the Financing additional staff.
An important point in both the mission statement and the pact is strengthening the connection between science and ÖGD. Almost all of the ÖGD’s tasks are now highly science-based and rely on scientific support. There are now the first “ÖGD professorships” at some universities; there are, supported by the pact, many joint research projects between ÖGD and universities and – consequently – there has been a scientific specialist society of the ÖGD, the “German Society for Public Affairs”, since spring 2023 Healthcare” (DGÖG). It was founded by the Federal Association of Doctors in the Public Health Service (BVÖGD).
Curiously, shortly afterwards a second scientific specialist society of the ÖGD, the “German Society for Public Health and Population Medicine” (DGÖGB), was founded by veteran ÖGD members.
The background is a dispute about what influence non-doctors should have in a scientific society of the ÖGD. The DGÖG is more liberal here, the DGÖGB more restrictive. On their website it says:
“The members of the German Society for Public Health and Population Medicine are doctors who work or have worked in population medicine or public health, those with research experience and medical students.”
Anyone who wants to become a member must be a doctor or, here it comes, confirm the following: “I am not a doctor, but I can demonstrate research experience”.
I have great respect for the wealth of knowledge of doctors in the local health authorities, who have to deal with a really wide range of topics, from environmental medical issues to infection protection and school health care. But “research experience” is usually not one of the strengths of doctors in the ÖGD, at least not in the local health authorities. The research in the ÖGD is largely carried out by social scientists and health scientists, although there are currently very few of them in the local health authorities. The pact for the ÖGD wants to change that, the DGÖGB is obviously in a different corner here.
In addition, the ÖGD mission statement highlights multi-professionalism in the ÖGD as a particular strength. The ÖGD is not just a medical organization and it does not only perform medical tasks. Doctors make up around a fifth of the 21,000 employees in the ÖGD, around the same number come from social education and a tenth are hygiene inspectors. As already mentioned, social and health scientists only make up a marginal proportion. Unfortunately, the 2020 and 2021 personnel survey carried out by the Federal Statistical Office as part of the pact for the ÖGD on the basis of the 2010 classification of professions is not very productive when it comes to the breakdown of non-medical academic professions in the ÖGD; the KldB 2010 is not particularly suitable for this .
The signal that the DGÖGB sends with its professional policy orientation is fatal for both the strengthening of science in the ÖGD and the further development of multi-professionalism and interdisciplinarity in the ÖGD. Unlike the federal and state authorities of the ÖGD, the local health authorities are not lavishly equipped with scientific resources anyway, and a split into two specialist societies is extremely dysfunctional.
Both societies want to join the Working Group of Scientific Medical Societies. V. (AMWF), the organization that is supposed to ensure, among other things, the quality of guidelines in medicine in Germany. If the protagonists of the DGÖGB were afraid that non-medical scientists could have too much influence on the development of guidelines for medical activities, this could have been regulated by the professional society’s guideline committees.
Sometimes you can’t help but get the impression that the ÖGD has a special talent for getting in its own way.