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The Political Context of Community-Based Prevention Research in Germany
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    The Political Context of Community-Based Prevention Research in Germany The Political Context of Community-Based Prevention Research in Germany Presentation Transcript

    • The Political Context of Community- Based Prevention Research in Germany Dr. Michael T. Wright, LICSW, MS Research Group Public Health
    • Population: 82.4 Million • Wide distribution Size: 357,000 km² • (cf. NL: 405,000 km²) Largest Economy in Europe • (3rd largest internationally) Federalist Structure • 16 states Regional Centers Important • No recognized cultural center 2 Michael T. Wright, October 2006 Research Group Public Health
    • German health care and prevention structures Constitutionally based social welfare state Health as a state issue Insurance structure and §20 SGB V Prevention Law EU Initiative “Closing the Gap” 3 Michael T. Wright, October 2006 Research Group Public Health
    • Constitutionally Based Social Welfare State Core concept in the German understanding of social responsibility and the role of government Principle not alligned with a particular party or ideology Related concepts: • Solidarity • Subsidiarty 4 Michael T. Wright, October 2006 Research Group Public Health
    • Health as a State Issue The issue of health is principally the responsibility of the federal states Federal jurisdiction is limited, for example, regarding the financing and structuring of prevention interventions 5 Michael T. Wright, October 2006 Research Group Public Health
    • Health Insurance Structure Not a nationalized system Not a central payer system Statutory health insurance funds (circa 300) • Owned by the insured • Self-administered by elected representatives • Acting under public law Prevention and self-help are financed by these companies (§20 SGBV) 6 Michael T. Wright, October 2006 Research Group Public Health
    • Health Insurance, Prevention and Self-Help A particular focus on addressing social inequalities in health Workplace prevention, individual prevention, community-based prevention for socially disadvantaged groups, self-help (not just prevention) Total: € 148 million/year Circa € 2.60 per person insured Community-based work: € 35 million/year Self-help: € 35 million/year Decentralized disbursement Common guidelines and core documentation Wide variation in practice and lack of professional capacity 7 Michael T. Wright, October 2006 Research Group Public Health
    • Prevention Law (???) German Health Care System Medical Care Nursing Rehabilitation Prevention Clear structures at all levels Specifying roles of each stakeholder Clarifying the responsiblity of Federal Government and states Existing prevention law as a basis (community-based work important) 8 Michael T. Wright, October 2006 Research Group Public Health
    • Closing the Gap – Strategies for Action to Tackle Health Inequalities in Europe EU Initiative: Exchange and documentation of effective policies and interventions National Level: Federal Center for Health Education • Good Practice Criteria for Community-Based Interventions • Regional Coordinators for Community-Based Interventions • National Alliance on Prevention for Socially Disadvantaged Groups (focus: community-based interventions) Setting the stage for a next attempt at a Prevention Law 9 Michael T. Wright, October 2006 Research Group Public Health
    • Our Work: National Demonstration Projects to Establish Participatory Models for Quality Assurance Filling the structural gap for quality assurance in community work Partners: Deutsche AIDS-Hilfe and Gesundheit Berlin Funders: Federal Center for Health Education (Ministry for Health); Ministry for Education and Research Focus on Quality Assurance, not Evaluation • Consensus on supporting processes of quality development 10 Michael T. Wright, October 2006 Research Group Public Health
    • Project Components Skill-Building Workshops on Participatory Methods • partcipatory curriculum Methods Handbook • internet based, interactive Individualized Consulting • project-driven focus Peer Review Process Good Practice Criteria • systematic input from CBOs at the regional level Network of Researchers Interesting in participatory methods • opening a new discursive space in German 11 Michael T. Wright, October 2006 Research Group Public Health
    • As politically engaged researchers: We participate actively in the political discourse. We reference structural and political factors in grant writing and project implementation. We do not separate behavioral from structural (social) factors. We position our work in order to make the strongest contribution possible to social change for the public’s health. We reject claims of scientific objectivity but maintain an analytical stance. 12 Michael T. Wright, October 2006 Research Group Public Health
    • Methodological and Theoretical Implications of a Politically Engaged, Community-Based Science We view community experience as the source of knowledge. We explicitly recognize all levels of change being targeted by community groups, including political goals. We see the primary role of science as facilitating the process of transforming local knowledge to local theory in the interest of generating local evidence. The primary focus of our scientific inquiry is the community learning process and developing methods to facilitate this process. 13 Michael T. Wright, October 2006 Research Group Public Health
    • Looking Toward the Future The explicit connection between political processes and political goals and community-based science needs to be openly acknowledged. The scientific argument for community-based research needs to be further developed, addressing issues of theory, particularly of epistemology (how is knowledge generated, for whom and to what effect?) Community-based research needs to be judged on its own terms, which requires that standards be set for this kind of work. This we can do together! 14 Michael T. Wright, October 2006 Research Group Public Health
    • 15 Michael T. Wright, October 2006 Research Group Public Health