Präventionsdilemma auf kommunaler Ebene?

Hintergrund

Von Gesundheitsförderung profitieren häufig vorwiegend sozial privilegierte Personen während sozial Benachteiligte seltener erreicht werden. Ob dieses Präventionsdilemma auch auf kommunaler Ebene besteht, wurde bislang kaum erforscht.

Ziel der Arbeit

Die Studie untersucht anhand von zwei bayernweiten Projektausschreibungen zur kommunalen Bewegungsförderung, ob sozioökonomisch deprivierte Kommunen, die geringe Angebotsstrukturen der Gesundheitsförderung aufweisen, durch solche Ausschreibungen erreicht werden und welche Faktoren die Bereitschaft zur Beteiligung beeinflussen.

Methoden

Es werden Bevölkerungsdaten und sozioökonomische Deprivationsdaten von (n = 171) Kommunen aus drei Gruppen (teilnehmende/interessierte Kommunen und deprivierte Vergleichskommunen) verglichen. Durch eine systematische Internetrecherche werden die Gesundheitsförderungsaktivitäten ausgewählter Kommunen erhoben. Barrieren und Förderfaktoren für die Umsetzung der Projekte werden mittels einer Dokumentenanalyse erfasst.

Ergebnisse

Die teilnehmenden und interessierten Kommunen weisen höhere Einwohnerzahlen und geringere Deprivationswerte als der Durchschnitt der Kommunen in Bayern auf und stellen mehr Angebote der Gesundheitsförderung bereit als deprivierte Vergleichskommunen. Großen Einfluss auf die Teilnahme an den Projekten haben finanzielle Faktoren, politische Unterstützung und engagierte Personen.

Diskussion

Die Ergebnisse dieser Studie deuten auf ein Präventionsdilemma auf kommunaler Ebene hin. Um gesundheitlichen Ungleichheiten zwischen Kommunen vorzubeugen, sollten benachteiligte Kommunen in die Gestaltung von Förderprogrammen einbezogen werden, um diese Programme an deren Bedürfnisse anzupassen.

State of evidence on municipal strategies for health promotion and prevention: a literature and database research (Scoping Review)

Background

There are gaps in the research regarding the implementation and evidence of overall strategies for municipal health promotion addressing communities. The aim of this scoping review is to gain initial findings concerning theoretical models, approaches and evidence on strategies of municipal health promotion, which include self-care, mutual aid and healthy environments. The findings can enrich the development of health promotion services.

Methods

A systematic scoping literature analysis was conducted in the databases PubMed, Web of Science, SAGE-Journals, Wiley-Online, ScienceDirect, LIVIVO and WiSo database as well as in a German project database. Evaluation studies and research reports on strategies in municipal health promotion were included and analysed qualitatively.

Results

According to our predefined inclusion and exclusion criteria, 15 hits were included. Capacity building, planning and the establishment of structures for health promotion were identified as theory-based models and approaches. None of the publications included showed clear evidence of the effects of municipal health promotion measures in terms of classically medically defined evidence.

Conclusions

The use of evidence-based theoretical models and approaches is no guarantee for the success of strategies for municipal health promotion. Challenges with regard to evidence are the execution of study designs corresponding to higher evidence classes and the isolation of effects of health promotion measures in complex environments.

Trial registration

This scoping review was not registered beforehand.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12607-0.

[Alcohol prevention in municipalities: structures, strategies and challenges]

Alcohol prevention in municipalities is an important and complex aspect of drug prevention in Germany. Based on the principle of subsidiarity, prevention measures are characterised by different legal requirements and prevailing conditions. On the one hand, the federal government set a legal framework with the law of prevention (PrävG) in 2015 and established the national strategy of drug policy and prevention in 2012. On the other hand, municipalities are responsible for the detailed design of local drug policy and interventions together with federal states. Furthermore, preventive measures need to fit local challenges and conditions.Hence, we discuss different strategies of alcohol prevention in municipalities and explain how these strategies fit in administrative frameworks. We also look critically at specific local situations and challenges but also at conditions and possibilities to establish a quality-assured local alcohol policy. Promising approaches from pilot projects are contributed to the discussion.Political decisionmakers, scientists and skilled workers accord that alcohol prevention needs to be implemented in municipal settings and that it is a field of growing importance. We conclude that there is a need to improve local prevention measures by creating better access to qualification programs for skilled workers in combination with a constant transfer between science and pratice of current research results and best practices by providing consultation and support from coordinating institutions for local interventions, especially for the identification of challenges and conditions. Local initiatives should receive better access to interventions that are proven to be effective, and these interventions should be sustainable anchored and evaluated in their municipal settings.

[Development of intervention databases to promote evidence-based prevention and health promotion-methodological considerations]

Municipal actors do not experience sufficient scientific support in the development and selection of preventive and health promoting interventions. Intervention databases can remedy this by presenting scientifically validated and well-documented interventions. This allows local decisions to be informed by scientific evidence on the effectiveness of interventions. The databases can also be used to promote quality development of interventions.This paper explains methodological and conceptual considerations on how preventive and health-promoting interventions can be identified for databases and how they can be classified in terms of their effectiveness and prepared in a way that is appropriate for the target group. It is based on findings from the public health literature and the project "Ageing in Balance" ("Älter werden in Balance") of the Bundeszentrale für gesundheitliche Aufklärung (BZgA).Systematic reviews are of limited use in the search for suitable interventions for the database, partly because the types of interventions listed in them are limited and information relevant to implementation is often incompletely presented. However, it seems promising to include interventions from practice in the database if they are additionally classified with regard to their effectiveness or if consequences for further development and evaluation are formulated. In addition, as much information as possible should be provided on the practical implementation of interventions. A first suggestion shows what a description of the measures could look like. In addition, manuals for the implementation of measures should be available.

[Family-oriented health promotion : A user-oriented approach for health promotion with children and families in municipalities]

Community health promotion with children requires a conceptual framework to support children and families and sustainably improve their health opportunities.Family-oriented health promotion is an approach to implement this demanding task. It focuses in particular on the user perspective of families. It can be conceptually presented along the life-stage approach. Pregnancy, early childhood and adolescence as well as transitions between age-specific socialization institutions are highly vulnerable. Additionally, burdened life situations are presented along familial adversities such as poverty, isolation, single parenting, external placement or illnesses, and life-specific approaches to health promotion and prevention are named. Family-oriented health promotion should avoid stigmatization and support families through municipalities and other settings.

[Analysis of comprehensive community-based health promotion approaches for children : Health prospects in disadvantaged neighborhoods in Germany's Ruhr area]

BACKGROUND

The "Growing up Healthy" research consortium investigated comprehensive community-based approaches to health promotion aimed at children in the cities of Moers and Oberhausen in Germany's Ruhr area.

OBJECTIVES

The aim of this paper is to analyze municipal policies as well as institutional and sociospatial conditions for comprehensive community-based approaches under the following research questions: What is the implementation level of comprehensive community-based health promotion from the perspective of a) key community actors; b) administrators from day care centers, family centers, and primary schools? How do they assess the health prospects of disadvantaged families and families with migration background?

METHODS

In the course of a local stocktaking, expert interviews were conducted with key community actors and administrators from day care centers, family centers, and primary schools (n = 34).

RESULTS

Needs for development exist, particularly in the intersectoral coordination of prevention policies as well as in adequate mandating by municipal policymakers. The major hurdles faced by preschools and schools are an ailing or absent infrastructure and insufficient resources. The challenges faced by professionals in disadvantaged neighborhoods are immense: poverty, integration, and inclusion.

CONCLUSIONS

Comprehensive community-based health promotion is still in its infancy. An explicit legal mandate including the commitment to provide funding does not exist. There are clear indications that children's health prospects vary widely according to urban neighborhood and educational institutions. It is becoming evident that preschools and schools require need-based funding.

[Health promotion networks for children and youth on the local level : An overview of the status quo in Germany]

In recent years, more and more municipalities in Germany have started to establish cross-sectoral health promotion networks for children and teenagers. They are supported by several initiatives at the state and federal level. The aim of this article is to provide an overview of these initiatives and to describe the central barriers for the implementation of health promotion networks on the local level. For this purpose, the authors first outline the role of municipalities in health promotion in Germany in general, and then describe the initiatives in more detail. The authors identify four central obstacles for implementing health promotion networks on the local level: the tight financial situation of many municipalities, difficulties of the local public service in realizing intersectoral cooperation, the traditionally weak role of the local health service, and missing evidence for Germany regarding the effectiveness of networks and integrated strategies. In addition, the article presents two alternative solutions: Great Britain and Västerbotten, a county in Sweden.