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Local Health Authority Day 2020

Health monitoring for evidence-based action

Johann Peter Frank, lithography by Adolph Friedrich Kunike, 1819

Local health authorites are a central pillar for the protection of population health. The work of approximately 400 municipal health authorities has not been sufficiently recognised to date, and staffing levels have been falling for years. For this reason, the RKI proclaimed the Local Health Authority Day for the first time in 2019, on 19 March, which is the birthday of Johann Peter Frank. Johann Peter Frank, a physician and social medicine expert born in the mid-18th century, is regarded as the founder of Public Health Services. There is no precedent of the Local Health Authority Day at  international level. Efficient local health authorities throughout the world are the backbone of all public health efforts. Public Health Services are "local public health", as is stated in their own guidelines.

Motto for the Local Health Authority Day 2020

The Local Health Authority Day motto for 2020 is "Health monitoring for evidence-based action". The recording of health status and health behaviours as well as health reporting based on these indicators are of great importance at communal level. School entry medical examinations are likely the best known example. For decades now, the health authorities have been collecting data on the vaccination status, weight and language development of school beginners and, if necessary, recommending support measures.

Health reporting and health monitoring sice 1980s

Health reporting has successfully been established in many federal states and municipalities since the 1980s. This process has been supported by the legal anchoring of health reporting as a task of the Public Health Service in most federal states. The federal government's health reporting system was conceived more than 20 years ago, prompted by an opinion issued by the expert council for the Assessment of Developments in the Health Care Sector in 1987. Since then, it has been jointly supported by the Robert Koch Institute and the Federal Statistical Office.

Examination during KiGGS-survey 2017, source: © Robert Koch-Institut

From the mid-1980s onwards, the RKI carried out large population studies (health surveys) at federal level at irregular intervals, with a focus on non-communicable diseases. Since 2008, a steadily financed system of RKI health monitoring is operating. In spring 2020, a new major health survey, the gern-study, will be launched, this time in cooperation with the Max Rubner Institute with a focus on health and nutrition. At the regional and local levels, there are also numerous ongoing activities to collect and analyse health data, which are distributed in digital format or in the form of printed GBE reports. Some federal states offer an online platform, where community reports are compiled to support exchange between health reporters and improve the visibility of reports to a wide range of audiences.

Regional focus of health monitoring

The core topics of municipal health reporting are varied and reflect the different focal points chosen at regional level. Important topics are the health of children and adolescents (using the respective school entry examinations), health care, aspects of mental health and the health of the elderly population. Especially at the local level, health reporting can provide important impulses for planning health promotion and prevention and can point out care needs at community level. There are major regional differences in living conditions and thus also in health status. For this reason, it is a great challenge to take a small-scale look at health status, taking into account the regional differences in living conditions. This, too, is only possible with the help of individual aspects of health monitoring.

In "Good Practice Health Reporting - Guidelines and Recommendations 2.0", published in the Journal of Health Monitoring at the beginning of September 2019, it says: "Good Practice Health Reporting is intended to provide orientation for health reporters at local, state and federal levels as well as within other institutions. The central concern is to underline that health reporting is not an end in itself, but has a social function and follows the dated, yet still applicable principle of "data for action". Health reporting has the task of identifying problem areas and needs for action in order to make a contribution to the promotion and maintenance of psychological, social and physical health for all. In "Good Practice", statements from health reporting workers at municipal, state and federal level as well as from other institutions and associations have been incorporated.

New challenges for health reporting and health monitoring

Map of Germany, source: © katty2016 /

The beginning of modern health reporting was marked by a fundamental need for an overview of the health status of the population, accompanied by a simultaneous lack of data in many areas. In contrast, today the health reporting landscape is characterised by a broad spectrum of different actors and reporting formats. In the case of some topics, the abundance of data can hardly be mastered any longer; whilst there is still insufficient data available for other topics. Health reporting and health monitoring today are more clearly characterised by a connection with specific public health issues than in the past, e.g. the prevention of cancer, diabetes or mental disorders. Ageing populations and migration also bring new challenges for health monitoring and health reporting. At the federal level, the Robert Koch Institute responds to these challenges with special surveys (Gesundheit 65+ and IMIRA) and national surveillance activities (diabetes surveillance).

The Prevention Act, which came into force in 2015, has provided an important impetus for further development. It envisages a national prevention report, which includes data from the RKI health monitoring, while also suggesting  the development of region-specific prevention reporting at federal state and local level. Considering the national public health strategy aimed at by the "Public Health Future Forum", health monitoring and health reporting could receive a further development impulse. Against the background of this dynamic, the September 2020 edition of the Bundesgesundheitsblatt will contain an inventory of health reporting in Germany.

Date: 13.12.2019