This document discusses the political context of community-based prevention research in Germany. It provides background on Germany's population, economy, and federalist structure. It then outlines key aspects of Germany's social welfare state approach to health care, including its constitutionally based role, health insurance system, and laws around prevention. It also discusses the EU's "Closing the Gap" initiative and the author's work establishing models for participatory quality assurance in community-based prevention projects.

1. The Political Context of Community-
Based Prevention Research in
Germany
Dr. Michael T. Wright, LICSW, MS
Research Group Public Health

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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. 15
Michael T. Wright, October 2006 Research Group Public Health