Defining national health goals
Health goals are a supplementary steering tool in the health care system. Their objective is to achieve improvements in health, in defined areas or for specific groups, as well as improvements in the existing structures. Precisely in a complex health care system such as Germany's that is characterised by myriad players, decision-makers and regulations, their purpose is to contribute to the quality of prevention, curation and rehabilitation, as well as to the efficient use of resources. Health goals also help to define priorities for the development of long-term perspectives in the health care system and for networking activities with intervention areas outside of the health care system; they also facilitate better monitoring of the efficiency of resource utilisation.
In 2000, the Federal Ministry of Health, together with the Laender, took the initiative to establish national health goals and initiate their implementation into every-day life. The Association for Social Security Policy and Research (Gesellschaft für Versicherungswissenschaft und -gestaltung e.V.) was entrusted with a corresponding pilot project called ‘Forum gesundheitsziele.de' ('Health Goals Forum.de’). The results were so good – between 2000 and 2006, six national health goals were developed and in some cases their implementation had already commenced – that the parties involved decided to continue this process that is backed by all of the most important stakeholders in the health care system.
Since 2007, 'gesundheitsziele.de' has existed as a permanent co-operation network funded by the involved parties themselves. In the meantime, over 120 organisations are co-operating within this framework to advance the further development and implementation of health goals. Since its launch, the co-operation network has updated several national health goals and developed two more, specifically 'Healthy ageing' ('Gesund älter werden') and 'Reduction of alcohol consumption' ('Alkoholkonsum reduzieren').
The co-operation in this network is based on the 'Joint Declaration' that was adopted in 2007. In its updated 2010 version, the sponsoring agencies and partners of this network reaffirm their resolve to continue their successful co-operation. Moreover, they undertake, each within its remit,
to match their own activities to the health goals,
to implement measures conducive to these goals and, in doing so, follow the approaches and concepts set out in gesundheitsziele.de,
to award major priority to networking and co-operation with other goal-based processes and programmes on the Federal, Laender and local levels,
to jointly champion the achievement of the health goals and
to develop additional priority health goals, particularly considering the goal initiatives put in place in the Laender.
The Federal Ministry of Health is supporting gesundheitsziele.de and actively co-operating on the drafting of the new health goals. Society at large must be actively engaged into discussions of public health policies so that a consensus on the thrust of these goals can be established among the various partners involved. Health equality and easy access to health information for all population groups are high on the agenda. Therefore, the health goals take a comprehensive approach to enhancing public health that includes preventive measures and the early detection of illness as well as improved patient care. Another major health policy aspect is the strengthening of self-help, personal responsibility and patient empowerment in the health care system.
So far, aims, targets and measures of the individual health goals have been implemented mainly by the partners of gesundheitsziele.de. Owing to their public health policy significance, the health goals identified by the co-operation network have also been incorporated into the Act to Strengthen Health Promotion and Disease Prevention (Präventionsgesetz).
In addition to the health goals on the Federal level, all of the Federal Laender pursue their own specific health goals or priority fields of action.
Internationally, too, health goals are an important steering tool for the development of long-term perspectives and the identification of priorities in the health care system. In 2010, the GVG (the Association for Social Security Policy and Research), the Federal Ministry of Health and the Laender hosted a conference that discussed best practices for implementing health targets - European experience and outlook ("Gesundheitsziele erfolgreich umsetzen – europäische Erfahrungen und Perspektiven“).
National Health Goals
With the collaboration of the Federal Government, the Laender, the statutory health insurance, pension insurance, private health insurance, doctors and additional service providers in the health care system, as well as patient organisations and self-help groups, the following national health goals have been agreed on thus far:
Type 2 diabetes mellitus: reduction of disease risk, early recognition and treatment of patients (2003)
Breast cancer: reduction of mortality, increase in quality of life (2003, updated in 2011 and 2014)
Reduction of tobacco consumption (2003, updated in 2015)
Growing up healthy: life skills, exercise, nutrition (2003, updated 2010)
Enhancing health competence, strengthening patient sovereignty (2003; updated 2011)
Depressive disorders: prevention, early detection, provision of long-term treatment (2006)
Healthy ageing (2012)
Reduction of alcohol consumption (2015)
On adoption, the Federal Ministry of Health had them published in the Federal Gazette, the Bundesanzeiger.
The health goals are based on a wide range of specialist expertise and are developed in a consensual manner. Targets, intermediate targets and recommendations for the implementation on the ground are elaborated for each health goal.
The health goal 'Reduction of tobacco consumption' was updated and three targets were formulated to best address the current situation.
In 2013, it was decided to make 'Patient safety' a new health goal. The working group started to draft it in 2014.
2013 saw the identification of another health goal, 'Reduction of alcohol consumption'. The goal was published in 2015. At present, the working group is preparing, among other things, recommendations for structural interventions and behavioural prevention measures to implement the goals and targets.
In the context of the health goal 'Growing up healthy: life skills, exercise, nutrition', another target which translates as 'All about birth' has been prepared since 2013. Moreover, an evaluation of 'Growing up healthy in the kindergarten setting' was carried out and published in 2015.
In the context of 'Breast cancer: reduction of mortality, increase in quality of life', target 5, 'Quality of life', was updated in 2014.
In 2014, a Guide on approaches to accommodating the cross-cutting requirement for health equality was developed and published.
Currently, it is being considered whether the health goal 'Depressive disorders: prevention, early detection, provision of long-term treatment', needs to be revised.
The overall process of gesundheitsziele.de was evaluated in 2013 together with the Berlin School of Public Health. The focus was on the added value of gesundheitsziele.de for the co-operation partners and on the interfaces and interactions among them. Overall, the evaluation results reveal a high degree of approval among the actors and highlight the added value of the health goals process. Many participants came out in favour of further intensifying the co-operation and networking among the partners, sharing a focus on the consistent implementation of the health goals, defining outcome indicators and regularly monitoring progress on the basis of such indicators.