Quelle: WSI
: Issue 03/2024
WSI-Mitteilungen 3/2024, pp. 163-171
Thomas Gerlinger
Health Equity in Health Policy and Health System Design
Abstract
In recent years reducing inequalities in health care has become an issue in health policy which has received increased focus and revaluation. This is primarily evident in the area of health promotion and prevention. However, there is a contradiction between prevention rhetoric and prevention reality; many intended improvements have not yet, or only to an insufficient degree, been implemented. Structural deficits and disadvantages persist. In general, Germany is characterised by good access to health care. However, there are also considerable deficiencies in care, which are accompanied by inequalities in access and thus restrictions to the equity of health opportunities. The reasons for the deficits are primarily due to strong, mainly economic vested interests, the inertia of established institutions and the complexity of the need for change. more … (in German)
WSI-Mitteilungen 3/2024, pp. 172-179
Jens Hoebel, Stephan Müters
Socioeconomic Position and Health. Data Situation, Findings and Developments in Germany
Abstract
The article provides an outline of the data situation and selected findings on the relationship between socioeconomic status and health in Germany. The data situation has improved significantly in recent decades. There is a pronounced social gradient, with poorer health expectations and higher risks of disease for people with a lower socioeconomic position. This health inequality can already be observed in childhood and adolescence, and is ultimately reflected in earlier mortality in socioeconomically disadvantaged groups. Progress in the data situation is evident in the fact that health inequalities can now be described nationwide for different life stages, time trends can be examined over longer periods and international comparisons can be made. Increasingly, secondary data are also being tapped to bridge data gaps on the subject of health inequalities, for example, through data linkage at the spatial level. From the authors’ point of view, there is potential for further improvement of the data situation in Germany, especially with regard to cause-specific mortality data and possibilities of linking them with socioeconomic data at the individual level. more … (in German)
WSI-Mitteilungen 3/2024, pp. 180-185
Julia Roick, Matthias Richter
Social Determinants of Health and Health Care
Abstract
The article provides an overview of the context of health inequalities, which – as is now undisputed – also exist in Germany, although the country has a comprehensive system of social security and medical care. Social determinants can have an impact on health through various mediating factors. Differences in medical care make a significant contribution to the explanation of these health inequalities. Previous research has shown that social inequalities in access to the health care system arise primarily from structural factors, while inequalities in utilisation are predominantly due to personal factors. Interventions in health policy should be targeted at people with more difficult access to the healthcare system or reduced utilisation of healthcare services. more … (in German)
WSI-Mitteilungen 3/2024, pp. 186-192
Siegfried Geyer
Social Inequalities in Medical Care
Abstract
This article provides an overview of the current state of research on the extent to which access to, quality of and utilisation of, medical care is characterised by social inequalities. Social inequalities in medical care are usually examined along three different lines of research. In the case of Germany barriers to outpatient medical care were reported along with membership in the statutory or in the private insurance system, but these studies refer to less severe and deferrable conditions. Only one deals with access to inpatient care, but no evidence for social differences was found. For Germany no studies on social differences in the quality of medical care have been conducted. For the USA evidence is available revealing that social differences may occur within a given insurance scheme but there are also differences in the quality of care between insurance schemes. In contrast to purely system-related differences, health care utilisation is governed by a combination of system-related factors and individual decisions. more … (in German)
WSI-Mitteilungen 3/2024, pp. 193-200
Simone Weyers
The Social Compensatory Function of the Public Health Service for Children
Abstract
Health protection, health promotion/prevention and health management are tasks of the German Public Health Service (ÖGD) at federal, state and local level. In view of health inequalities in the population, the ÖGD works in a socially compensatory manner. The aim of the article is to assess the extent to which this function of the ÖGD has been achieved in recent times. This is exemplified by municipal health authorities and with a focus on child health. Initially, the author focuses on early help, health checks in advance of kindergarten and school admission, group prophylaxis and municipal health promotion. This is supplemented by aspects contributed by persons in a management function within a municipal health department; referring to skill shortages, access, and evidence base. Overall, the socially compensatory work of the ÖGD has faced great challenges, but there have always been paths to reach vulnerable groups. The author argues in favour of further developing and expanding these paths. Evidence-based approaches, especially at the interface of science and practice, are of paramount importance. more … (in German)
WSI-Mitteilungen 3/2024, pp. 201-209
Karsten Ingmar Paul, Alfons Hollederer
Job Losses among People with Severe Disabilities during the Covid-19 Pandemic
Abstract
The article reports on a study conducted by the authors that analysed whether severe disabilities increased the likelihood of becoming unemployed during the first two years of the Covid-19 pandemic (2020/2021) and whether other relevant personal characteristics became targets of discriminatory processes (migration background, lack of vocational training, age, gender), and moderated the effect of severe disability on unemployment. The analyses were carried out using data from the German Labour Market and Social Security Panel (PASS) of the Institute for Employment Research. The findings showed that an officially recognised severe disability, the absence of a vocational training certificate, and a migration background significantly increased the likelihood of becoming unemployed during the pandemic. Apart from the effect of migration background, these findings were significant only for the year 2021, not the year 2020. In addition, an interaction effect between severe disabilities and migration background could be identified. more … (in German)
WSI-Mitteilungen 3/2024, pp. 210-218
Saara Inkinen, Wolfgang Schroeder
Nursing Crisis in Geriatric Care: Exit, Voice and Loyalty
Abstract
Germany faces a crippling shortage of professional caregivers, not least in the elderly care sector. The nursing crisis not only jeopardises the care of older citizens, it also exacts a toll on the caregiving workforce by exacerbating existing workplace grievances, including poor working conditions, lack of recognition and rationalisation pressures in daily care work. Against this background the article examines reactions of nurses in geriatric care to the afore-mentioned crises, combining evidence from two quantative surveys with in-depth qualitative interviews and addresses the categories of exit, voice and loyalty. It is revealed that the nature of the choice between different modes of reaction is characterised by ambivalence. This ambiguity results in nurses displaying a preference for exit and loyalty over voice. more … (in German)
WSI-Mitteilungen 3/2024, pp. 219-227
Alfons Hollederer, Dennis Mayer
Working Conditions, Health and Exhaustion among Nursing Staff in Germany
Abstract
Nurses are at a considerable risk of developing burnout. In Germany, there is a lack of research on the work and health situation as well as prevention among nursing staff and especially nursing assistants. This article presents the findings of a study which is based on the data basis of the representative BIBB/BAuA employment survey 2018. 532 of the 20 012 employees surveyed worked as nursing professionals and 153 as nursing assistants. 37.1 % of nurse professionals and 21.6 % of nurse assistants reported a frequent occurrence of physical and emotional exhaustion. Logistic regression analyses showed that nurses who were often put in emotionally stressful situations were more likely to experience physical and emotional exhaustion. Higher work intensity also increased the likelihood of the occurrence of physical and emotional exhaustion. Social support was identified as an important protective factor. Overall, ambivalent results are registered regarding work demands and resources, and a substantial risk of burnout becomes apparent. more … (in German)
WSI-Mitteilungen 3/2024, pp. 228-234
Mareike Hüther, Alfons Hollederer
Occupational Health of Social Workers in the Area of Assistance for the Homeless: Results from a Qualitative Interview Study
Abstract
For social workers, the work context of assistance for the homeless is associated with special occupational health risks, including burnout. This article presents the results of a qualitative study for which six social workers of two homeless aid organisations from the German city of Kassel were interviewed about their job demands and resources. In the guideline-based interviews, they report on complex requirements, high case numbers and staff shortages. There are also major bureaucratic and structural problems. The work content is emotionally stressful for the social workers. To protect themselves from stress, they have developed a variety of coping strategies. The ability to set boundaries during and after work is especially important. Workplace health promotion and supervision are perceived as helpful. The interviewees reported the importance of displayed support for their work. Younger social workers and women are often faced with role conflicts and conflict situations. The Covid-19 pandemic increased the workload. It is necessary to strengthen resources and to reduce health risks, so that both the system of aid and the social workers remain able to act. more … (in German)