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Berlin The Federal Government’s Expert Council on Health and Resilience has called for a fundamental rethink in health policy in two statements: the focus should no longer be on treating diseases, but on keeping citizens healthy.

We advocate a paradigm shift towards a comprehensive understanding of health that goes beyond a pure focus on illness, says the statement Health: Think holistically, act in a networked manner. Measures to protect and maintain health must therefore address both the individual and the population or population groups.

To this end, a comprehensive understanding of health must be anchored in law, which serves as the basis for implementation by all policy areas and departments, authorities and institutions as well as for the provision of financial and human resources, the statement says.

The holistic perspective on health aims to create healthy and sustainable living environments. Networked thinking and action are essential for this. Health, transport, labor, social, environmental, economic, educational and digital policy as well as spatial and urban planning must work together to pursue the common goal of health equity.

The expert council was set up by the federal government in March of this year as the successor organization to the Corona Expert Council. It consists of 23 members, some of whom were part of the Corona Expert Council or are part of the Government Hospital Commission.

Key to a resilient society

A change of perspective that understands health not only as the mere absence of illness is the key to a resilient and just society, commented the council’s co-chair, Susanne Moebus, from the University Medical Center Essen, after the publication of the statement.

We are currently using up enormous financial and human resources to treat people only to send them back to the living conditions that made them sick. In 2021 alone, 203,000 deaths in Germany were considered preventable. Instead of always just fighting the symptoms, we need to address the causes. Instead of just treating people with diabetes, we should invest more in health-promoting environments.

Health must be actively considered and shaped in all policy areas through targeted framework conditions. Decisions made by the finance, economics, education or transport ministries have a direct impact on our health, stressed Moebus.

Greater promotion of active mobility could, for example, reduce air pollution and prevent diabetes. We must make the healthy choice the easy choice. To do this, health must be firmly anchored in our social norms and laws. Because a healthy population is the best investment in our future.

Health equity

Today, people’s living environments and health opportunities differ considerably, the statement says: poverty, social pressures, unfavourable housing and environmental conditions, lack of access to health care and education, and a lack of solidarity make it difficult to achieve health in everyday life.

Therefore, special attention must be paid to improving health and environmental equality. The active participation of people in their living environments is essential in this.

Healthy people form the basis for a productive, innovative and resilient society, it continues. They can participate actively in life for longer, overcome crises and contribute to social and economic development. For society as a whole, better health leads to lower health costs, a need-based number of skilled workers and wider effects such as strong social communities.

Consistently focus on prevention

The second statement from the expert council deals with strengthening the resilience of the healthcare system through preventive medicine. The level of sickness absence in Germany is at an all-time high. At the same time, the healthcare system is facing enormous challenges due to demographic change, a shortage of skilled workers and rising costs.

The answer can only be to consistently focus on more prevention and health promotion, stressed Wolfgang Hoffmann from the University Medical Center Greifswald, coordinator of the statement. All population groups must be able to benefit from preventive medicine. Because it improves the health and quality of life of patients and strengthens the resilience of the healthcare system. There is still room for improvement in this area in Germany.

What is needed are individualized prevention programs that specifically address each individual. This only works with targeted communication and good monitoring, explained Hoffmann.

The measures must reach where they are intended and be effective there. We must use suitable methods to investigate whether this is successful. Only evidence-based preventive medicine is effective, sustainable and economical. That is why both basic research and health services research must be strengthened.

Remuneration for medical preventive consultations

The statement points out that demographic change is also leading to a change in morbidity. Over the next 20 to 30 years, without more prevention, more and more people will suffer from cardiovascular disease, diabetes, cancer, depression and dementia, and the frequency of (nosocomial) infections will also increase, it says.

At the same time, the proportion of the population suffering from several illnesses at the same time is growing. In addition, there are many people whose illnesses become chronic. This age-related multimorbidity makes medical and nursing care more complex and more expensive for the solidarity system. The increasing need for qualified staff is offset by a growing shortage of skilled workers.

In Germany, curative measures aimed at curing a disease are often prioritized, while health promotion and prevention are of secondary importance. Consistently promoting these measures could save considerable costs in the health system, the statement says.

This creates potential for health economic incentive systems at the level of service providers, for example remuneration for preventive medical consultations. Incentives are also possible at the patient level, for example in the context of individual target agreements and through bonus regulations. © fos/aerzteblatt.de