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The Prevention Act – relaunch planned – health check

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After several unsuccessful attempts, the Prevention Act came into force in Germany in 2015. On the one hand, it has given a tailwind to prevention and stimulated a large number of projects, it has also had a structural effect, for example in terms of the promotion of situational preventive setting approaches, the state framework agreements on the regional implementation of the Prevention Act, the establishment of the National Prevention Conference and the Prevention Forum or the regular national prevention report , but on the other hand it also had serious design flaws from the start. For example, it was integrated into SGB V and, as a result, primarily a law for social insurance, which does not do justice to the task of prevention for society as a whole. Important fields of action such as the environment, transport or education were beyond the reach of the Prevention Act and the interfaces to the other “prevention laws”, such as the Occupational Safety and Health Act, the Infection Protection Act or the health-related environmental protection regulations could not be designed synergistically. Due to its SGB-V framework, the National Prevention Conference was not able to develop a national prevention strategy worthy of the name. For “Health in all Policies”, as formulated by the WHO, the social security framework was too restrictive a corset. In addition, over the years, new aspects such as digitization, the consequences of globalization, the rediscovered relevance of the public health service or the increasingly pressing problem of climate change have made a relaunch of the Prevention Act seem sensible.

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This project was rightly anchored in the traffic light coalition agreement, alongside the intention to launch a “National Prevention Plan” and a “Federal Institute for Public Health”, however these things may be brought together. On July 1, 2023, the second prevention report will be submitted to the Ministry of Health by the National Prevention Conference. It is then forwarded to the Bundesrat with a statement from the federal government, where it is also commented on by the federal states. Against this background, the BMG is preparing an amendment to the Prevention Act.

There was an article in the medical newspaper today entitled “Coalition wants to revise the Prevention Act”. The occasion was the BMC Congress in Berlin. However, the article shows that there is no obvious basic consensus on the direction in which the amendment of the Prevention Act should go.

The article in the Ärztezeitung emphasizes the role of good data. Good data is of course also important for prevention. But it’s not just about new digital products such as apps to educate people about health risks. A mere commodified handling of data would be a fatal misunderstanding of the role of health data in prevention. Especially since it is often not data that is lacking, but actions. It would make sense, however, if the Public Health Action Cycle, i.e. the interlocking of needs assessment, action planning, implementation and evaluation, were implemented more efficiently using suitable data, if you will, as a contribution to a positively oriented “epistemization of the political”.

Needs-oriented control of prevention on the basis of existing evidence is necessary. The article in the medical journal shows very well that there is a lack of it. It starts with the first sentence: “Incidences of diabetes and obesity have been going through the roof for years.” That is empirically incorrect as far as the incidence of diabetes in Germany is concerned. It’s stagnant, maybe for years. And it is no different when it comes to obesity, at least among children, even if the frequency of obesity has increased again here as a result of the corona crisis.

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Likewise, the recommendation for mass use of HPV self-testing is misleading. A speaker from Boston Consulting is quoted as saying that this was successful in Sweden: “This step led to a high test rate and a high rate of infections identified, which otherwise could not have been treated early.” But when it comes to HPV, it works about increasing vaccination rates and early detection of genital warts and early stages of HPV-induced tumors. Most infections heal on their own, and there is currently no treatment for the infection.

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