Governance and Capacity Building in German and Austrian Public Health Since the 1950s

The German speaking countries (Germany and Austria) have a strong tradition of universal health insurance since the late 19th century. Germany was one of the leading countries in “social hygiene as health science”, an interdisciplinary field of academic work, health policy and practice, providing a comprehensive scientific basis both for professional education and training in the new academies for social hygiene, the schools of public health in the 1920s, and also for a rapidly growing network of municipal public health services. Public health in Austria at that time was less advanced. There was a rupture in the field of public health in these countries as the Nazi regime and World War II destroyed almost all of the human resources, the scientific basis and the institutional infrastructure required for advancement. In the postwar period Germany was divided with separate social and health systems in East and West Germany until reunification in 1990. Meanwhile, Austria became a democratic federal republic developing a social welfare policy on the basis of a successful economy. Whereas Germany set up national programmes to support the development of a new public health, Austria established a health promotion fund. As a result, there has been more growth in the public health community in Germany than in Austria. However, in both countries strong efforts to strengthen the educational base will be needed to address the complex issues facing public health in the 21st century. For example, health expenditures in Germany and Austria are among the highest in the European Union, but health systems indicators such as healthy life years show values below the European average. The challenge to renew the highly fragmented systems of health/disease care and improve the social determinants of population health underline the need for strengthening public health structures and national policy in the two German speaking countries. Development of the scientific community is underway but has not yet reached the levels of the outstanding achievements of the late 19th and early 20th centuries.