Download PDF
Gesundheitswesen 2020; 82(11): 829-835
DOI: 10.1055/a-1276-0847
Zur Diskussion

COVID-19: Besondere Herausforderungen an Public Health in Theorie und Praxis

COVID-19: Special Challenges for Theoretical and Practical Public Health
Jens Holst
1   Fachbereich Pflege und Gesundheit, Hochschule Fulda, Fulda
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Die COVID-19-Krise bietet sowohl einzigartige Chancen als auch besondere Herausforderungen für Public Health in Theorie und Praxis. Das Management der Pandemie war anfangs überwiegend von Virologen dominiert, unterstützt von Epidemiologen, die nicht immer die grundlegenden Anforderungen ihrer Wissenschaft erfüllten. Interdisziplinäre gesundheitswissenschaftliche Fachkenntnisse und komplexe Betrachtungen aus einer breiteren Public-Health-Perspektive hatten hingegen keine spürbaren Auswirkungen auf die COVID-19-Debatte und noch weniger auf die Strategien zur Eindämmung der Pandemie. Public Health ist universell und mehr als Gesundheitssicherheit bzw. Gesundheitsschutz. Als explizit politische Disziplin verfolgt Public Health einen weitreichenden gesellschaftspolitischen Ansatz und darf sich nicht auf biomedizinische Aspekte verkürzen lassen. Medizinische und biotechnologische Lösungen allein werden den Herausforderungen der Corona-Krise nicht gerecht. Unerlässlich für eine nachhaltige Bewältigung der Pandemie ist die Analyse der politischen, wirtschaftlichen, sozialen und ökologischen Determinanten, die zur Krise geführt haben. Um die Gesundheit der Bevölkerung zu verbessern und das Risiko zukünftiger Infektionsausbrüche zu verringern, ist eine umfassende Politik erforderlich, die auch Hegemonien und Machtverhältnisse thematisiert.

Abstract

The COVID 19 crisis offers unique opportunities and poses special challenges for practical and theoretical public health. Management of the pandemic was initially dominated by virologists, supported by epidemiologists who did not always exercise the necessary scientific rigour. Expertise in interdisciplinary health sciences and complex considerations from a broader public health perspective, however, did not have noticeable impact on the COVID 19 debate and even less on the strategies for containing the pandemic. Public health is universal and more than health security or health protection. As an explicitly political discipline, public health takes a far-reaching socio-political approach and must not be reduced to biomedical aspects. Medical and biotechnological solutions alone will not meet the challenges of the corona crisis. The analysis of the political, economic, social and ecological determinants that led to the crisis is indispensable for the sustainable management of the pandemic. In order to improve population health and reduce the risk of future outbreaks of dangerous infections, a comprehensive policy is needed that also addresses hegemonies and power relations.

Schlüsselwörter

Public health - COVID-19 - Biomedizinischer Reduktionismus - Soziale Determinanten - Gesundheitspolitik - Gesundheitliche Ungleichheit

Key words

Public health - COVID-19 - Biomedical reductionism - Social determinants - Health policy - Health inequality


Publication History

Article published online:
13 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Heymann D, Shindo N. COVID-19: what is next for public health?. Lancet 2020; 395: 542-545
    Google Scholar
  • 2 Martín-Moreno J. Facing the COVID-19 challenge: When the world depends on effective public health interventions. SEEJPH 2020; XIV. DOI: 10.4119/seejph-3442.
    CrossrefPubMedGoogle Scholar
  • 3 Schaefer C, Bitzer EM, Okan O. et al. Umgang mit Falschnachrichten in Medien. Bremen: Kompetenznetz Public Health COVID-19; 2020. Im Internet: https://www.public-health-covid19.de/images/2020/Ergebnisse/2020_05_11_Factsheet_Fake_News-V1.pdf. Stand: 10.06.2020
  • 4 Nielsen N Coronavirus: Tech giants must stop Covid-19 ‘infodemic’, say doctors. EUObserver 2020. Im Internet: https://euobserver.com/coronavirus/148281. Stand: 04.06.2020
  • 5 JHU COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE). Johns Hopkins University; 2020. Im Internet: https://coronavirus.jhu.edu/map.html. Stand: 25.05.2020
  • 6 World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Genf: WHO; 2020. In Internet: https://covid19.who.int. Zugriff 30.05.2020
  • 7 EbM Netzwerk. COVID-19 – Wo ist die Evidenz? Deutsches Netzwerk Evidenz-basierte Medizin; 2020. Im Internet: https://www.ebm-netzwerk.de/de/veroeffentlichungen/covid-19. Stand 06.06.2020
  • 8 Püschel K, Aepfelbacher M. Obduktionen sind keinesfalls obsolet. Dt Ärztbl 2020; 117: 268-270
    PubMedGoogle Scholar
  • 9 Schäferhoff M, Yamey G, McDade KK. Funding the development and manufacturing of COVID-19 vaccines: The need for global collective action. Washington DC: Brookings; 2020. Im Internet: https://www.brookings.edu/blog/future-development/2020/04/24/funding-the-development-and-manufacturing-of-covid-19-vaccines-the-need-for-global-collective-action. Stand: 10.06.2020
    Google Scholar
  • 10 Kupferschmidt K, Cohen J WHO launches global megatrial of the four most promising coronavirus treatments. Science Mag 2020. In Internet: https://www.sciencemag.org/news/2020/03/who-launches-global-megatrial-four-most-promising-coronavirus-treatments. Zugriff 31.05.2020
  • 11 Holst J. Global Health – emergence, hegemonic trends and biomedical reductionism. Globalization Health 2020; 16: 42. doi: 10.1186/s12992-020-00573-4
    CrossrefPubMedGoogle Scholar
  • 12 Horton R. Offline: Don’t let COVID-19 divert us completely. Lancet 2020; 395: 1534
    CrossrefPubMedGoogle Scholar
  • 13 Aggleton P, Parker R. Moving beyond biomedicalization in the HIV response: Implications for community involvement and community leadership among men who have sex with men and transgender people. Am J Publ Health 2015; 105: 1552-1558
    CrossrefPubMedGoogle Scholar
  • 14 de Lusignan S, Dorward J, Correa A. et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study. Lancet Inf Dis 2020; 20: 1034-1042. DOI: 10.1016/S1473-3099(20)30371-6.
    CrossrefPubMedGoogle Scholar
  • 15 Chen T, Wu D, Chen H. et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020; 368: m1091. DOI: 10.1136/bmj.m1091.
    CrossrefPubMedGoogle Scholar
  • 16 Ho FK, Celis-Morales CA, Gray SR, et al. Modifiable and non-modifiable risk factors for COVID-19: results from UK Biobank. medRxiv 2020. In Internet: https://doi.org/10.1101/2020.04.28.20083295. Stand: 07.06.2020
  • 17 Chan O. COVID-19 Is a Wake-Up Call for Public Health Preparedness in the Climate Crisis. New York: The Century Foundation; 2020. Im Internet: https://tcf.org/content/commentary/covid-19-wake-call-public-health-preparedness-climate-crisis. Stand: 05.06.2020
    Google Scholar
  • 18 Labonté R, Gagnon M. Framing health and foreign policy: lessons for global health diplomacy. Globalization Health 2010; 6: 14. doi: 10.1186/1744-8603-6-14
    CrossrefPubMedGoogle Scholar
  • 19 Bengtsson L, Rhinard M. Securitisation across borders: the case of ‘health security’ cooperation in the European Union. West European Politics 2018; 42: 346-368
    CrossrefPubMedGoogle Scholar
  • 20 Yong K, Shakow A, Mate K. et al. Limited good and limited vision: multidrug-resistant tuberculosis and global health policy. Soc Sci Med 2005; 61: 847-859
    CrossrefPubMedGoogle Scholar
  • 21 Karlson N, Stern C, Klein D Sweden’s Coronavirus Strategy Will Soon Be the World’s Herd Immunity. Is the Only Realistic Option – the Question Is How to Get There Safely. Foreign Affairs 12.05.2020. https://www.foreignaffairs.com/articles/sweden/2020-05-12/swedens-coronavirus-strategy-will-soon-be-worlds. Stand: 24.06.2020
  • 22 OECD. OECD Policy Responses to Coronavirus (Covid-19). Evaluating the initial impact of COVID-19 containment measures on economic activity. Paris: Organisation for Economic Co-operation; 2020. https://www.oecd.org/coronavirus/policy-responses/evaluating-the-initial-impact-of-covid-19-containment-measures-on-economic-activity-b1f6b68b; Stand: 20.06.2020
  • 23 OECD. OECD Interim Economic Assessment Coronavirus: Living with uncertainty. Paris: Organisation for Economic Co-operation; 2020. Im Internet: https://www.oecd-ilibrary.org/docserver/34ffc900-en.pdf; Stand: 17.09.2020
  • 24 Aledort J, Lurie N, Wasserman J. et al. Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base. BMC Public Health 2007; 7: 208. DOI: 10.1186/1471-2458-7-208.
    CrossrefPubMedGoogle Scholar
  • 25 Errett N, Sauer L, Rutkow L. Integrative review of the limited evidence on international travel bans as an emerging infectious disease disaster control measure. J Emerg Manag 2020; 18: 7-14. doi: 10.5055/jem.2020.0446
    CrossrefPubMedGoogle Scholar
  • 26 Mateus A, Otete H, Beck C. et al. Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review. Bull World Health Organ 2014; 92: 868-880. DOI: 10.2471/BLT.14.135590.
    CrossrefPubMedGoogle Scholar
  • 27 Foldspang A. Towards a public health profession: the roles of essential public health operations and lists of competences. Eur Journal Publ Health 2015; 25: 361-362
    CrossrefPubMedGoogle Scholar
  • 28 Moon S. Power in global governance: an expanded typology from global health. Globalization Health 2019; 15: 74. doi: 10.1186/s12992-019-0515-5
    CrossrefPubMedGoogle Scholar
  • 29 Shiffman J. Global Health as a Field of Power Relations: A Response to Recent Commentaries. Int J Health Policy Manag 2015; 4: 497-499
    CrossrefPubMedGoogle Scholar
  • 30 Greer S, Wismar M, Figueras J. eds. Strengthening Health System Governance. Better policies, stronger performance. Berkshire, England: Open University Press McGraw-Hill Education; 2016
    Google Scholar
  • 31 Galeo S. Power and Public Health. Dean’s Note March 16, 2018. Boston: University School of Public Health; Im Internet: https://www.bu.edu/sph/2018/03/16/power-and-public-health. Stand: 11.06.2020
    Google Scholar
  • 32 Geene R, Kurth BM, Matusall S. Health in All Policies – Entwicklungen, Schwerpunkte und Umsetzungsstrategien für Deutschland. Gesundheitswesen 2020; 82: e72-e76. doi: 10.1055/a-1138-0389
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 FT Editorial Board. Virus lays bare the frailty of the social contract. Radical reforms are required to forge a society that will work for all. Financial Times 03.04.2020. Im Internet: https://www.ft.com/content/7eff769a-74dd-11ea-95fe-fcd274e920ca. Stand: 21.05.2020
  • 34 Greer S, Bekker M, Evelyne de Leeuw E. et al. Policy, politics and public health. Eur J Public Health. 2017; 27: 40-43. DOI: https://doi.org/10.1093/eurpub/ckx152.
    PubMedGoogle Scholar
  • 35 Furceri D, Loungani P, Ostry J. How Pandemics Leave the Poor Even Farther Behind. Washington DC: IMF website; 2020. Im Internet: https://blogs.imf.org/2020/05/11/how-pandemics-leave-the-poor-even-farther-behind/?utm_medium=email&utm_source=govdelivery. Stand: 20.05. 2020
    Google Scholar
  • 36 Wachtler B, Hoebel J. Soziale Ungleichheit und COVID-19: Sozialepidemiologische Perspektiven auf die Pandemie. Gesundheitswesen (efirst) DOI: 10.1055/a-1226-6708.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Furceri D, Loungani P, Ostry J et al. COVID-19 will raise inequality if past pandemics are a guide. VOX CEPR Policy Portal website; 2020. https://voxeu.org/article/covid-19-will-raise-inequality-if-past-pandemics-are-guide. Stand: May 20, 2020
  • 38 Yates R In the era of Covid-19 healthcare should be universal and free. Mail & Guardian 09.052020. https://mg.co.za/coronavirus-essentials/2020-05-09-in-the-era-of-covid-19-healthcare-should-be-universal-and-free/. Stand: 22.05.2020
  • 39 Heymann J, Raub A, Waisath W. et al. Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries. Glob Public Health. 10.1080/17441692.2020.1764076. Stand: 23.05.2020
  • 40 Burrow S Social protection systems underpin the most successful government responses to COVID-19. Medium, 8. April 2020. Im Internet: https://medium.com/@SharanBurrow/social-protection-systems-underpin-the-most-successful-government-responses-to-covid-19-ba121815a4b2. Stand: 08.06.2020
  • 41 Friedman E, Gostin L, Maleche A et al. Global Health in the Age of COVID-19: Responsive Health Systems Through a Right to Health Fund. Health and Hum Rights; 04.05.2020. Im Internet: https://www.hhrjournal.org/2020/05/global-health-in-the-age-of-covid-19-responsive-health-systems-through-a-right-to-health-fund. Stand: 04.06.2020
  • 42 Leopoldina/acatech/Union Akad. Dt. Wissenschaften (2015). Strukturen, Entwicklungen und globale Herausforderungen. Halle/München/Mainz: Nationale Akademie der Wissenschaften Leopoldina/Deutsche Akademie der Technikwissenschaften/Union der deutschen Akademien der Wissenschaften; 2015. Im Internet: https://www.leopoldina.org/uploads/tx_leopublication/2015_Public_Health_LF_DE.pdf. Stand: 12. Juni 2020
  • 43 Holst J, Razum O. Public Health als Weg zur Optimierung des Menschen im Sinne besserer Resilienz? Die Stellungnahme der Leopoldina zu Public Health in Deutschland. Gesundheitswesen 2015; 77: 593-595
    Article in Thieme ConnectPubMedGoogle Scholar