7.2 Administration and governance
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Information on the system of institutionalised health promotion in the Federal Republic of Germany can be found at the website of the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BzgA).
At government level (federal government and state governments):
The Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) is one of the top federal authorities in the Federal Republic of Germany. It is responsible for many areas of policy. It mainly develops draft bills, legislative acts and administrative acts.
The Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend, BMFSFJ)is responsible for child and youth health issues, specifically prevention, the Early Prevention programme and the development of strategies to promote health.
The Federal Ministry of Food and Agriculture (Bundesministerium für Ernährung und Landwirtschaft, BMEL) is responsible for nutritional issues. BMEL places equal emphasis on ensuring balanced, healthy diets with safe foods, clear consumer information when shopping, strong and sustainable farming, forestry and fishing industries, opportunities for the many rural areas, animal welfare and safeguarding the world's food supplies.
The Federal Office for Agriculture and Food (Bundesanstalt für Ernährung und Landwirtschaft, BLE) employs around 1,400 staff throughout Germany and at sea. BLE fulfils a wide range of tasks in the areas of agriculture, fisheries and food. It is a central implementing authority (zentrale Umsetzungsbehörde) within the Federal Ministry of Food and Agriculture (Bundesministerium für Ernährung und Landwirtschaft, BMEL).
Under the umbrella of the Federal Office for Agriculture and Food, the federal centre for food (Bundeszentrum für Ernährung, BZfE) informs specific target groups about all aspects of food and drink. The BZfE offers scientifically sound, neutral and target group-specific advice in all phases of life from pregnancy, infancy, toddler years, school years and adulthood through to senior years. For example, the BZfE provides reliable information on safe and sustainable food choices, it supports multipliers with soundly based information, helps find ways to prevent food waste and develops teaching modules for use in childcare facilities and schools.
The Department for Child Nutrition at the Max Rubner Institute, Federal Research Institute of Nutrition and Food (Institut für Kinderernährung am Max Rubner-Institut, Bundesforschungsinstitut für Ernährung und Lebensmittel) was opened in February 2019. The newly established institute is studying the interaction of different factors that influence early susceptibility to disease, including the development of obesity and diet-related diseases, as well as the nutritional behaviour of children from birth to the age of 18. Research focuses on factors that affect interaction between parents and children and the nutritional and eating behaviour of school children and adolescents.
The Federal Information Centre for Agriculture (Bundesinformationszentrum Landwirtschaft, BZL) was created through a merger between the former organisation aid Infodienst e.V. with BLE. BZL serves to provide neutral, science-based information so as to create a better understanding of modern agriculture and promote a wider public debate on farming and its role in society.
The Federal Ministry of the Interior and Community (Bundesministerium des Innern, für Bau und Heimat, BMI) looks after the field of sports, in particular the promotion of elite sport in Germany. See also 7.3 Sport, youth fitness and physical activity.
In the federal states (Bundesländer), the respective state ministries are responsible for the respective area. The topic of health is addressed in a number of different ways. Promoting physical activity in formal education is the responsibility of the various education authorities: Example: Rhineland-Palatinate.
The following ministries are responsible for health at the federal state (Länder) level:
- Baden-Württemberg: State Ministry of Social Affairs and Integration (Ministerium für Soziales und Integration)
- Bavaria: Bavarian State Ministry of Health and Care (Bayrisches Staatsministerium für Gesundheit und Pflege). There is a separate department for children and adolescents.
- Berlin: Senate administration for health, care and equal opportunities (Senatsverwaltung für Gesundheit, Pflege und Gleichstellung)
- Brandenburg: Ministry of Labour, Social Affairs, Health, Women and Family Affairs (Ministerium für Arbeit, Soziales, Gesundheit, Frauen und Familie)
- Bremen: Senator for science, health and consumer protection (Die Senatorin für Gesundheit, Frauen und Verbraucherschutz)
- Hamburg: Ministry of Health and Consumer Protection (Behörde für Arbeit, Gesundheit, Soziales, Familie und Integration)
- Hesse: Ministry of Social Affairs and Integration (Hessisches Ministerium für Soziales und Integration). There is a separate department for children and adolescents. .
- Rhineland-Palatinate: Ministry of Social Affairs, Labour, Health and Demography (Ministerium für Soziales, Arbeit, Gesundheit und Demografie)
- Mecklenburg-Western Pomerania: Ministry for Economic Affairs, Labour and Health (Ministerium für Wirtschaft, Arbeit und Gesundheit)
- Lower Saxony: Lower Saxon Ministry for Social Affairs, Health and Equal Opportunities (Niedersächsisches Ministerium für Soziales, Gesundheit und Gleichstellung)
- North Rhine-Westphalia: Ministry of Labour, Health and Social Affairs (Ministerium für Arbeit, Gesundheit und Soziales). There is also a separate department for child health.
- Saarland: Ministry of Health, Social Affairs, Women and the Family (Ministerium für Soziales, Gesundheit, Frauen und Familie)
- Saxony: Saxon State Ministry of Social Affairs and Consumer Protection (Sächsisches Staatsministerium für Soziales und Gesellschaftlichen Zusammenhalt). There is also a separate health portal.
- Saxony-Anhalt: Ministry of Labour and Social Affairs and Integration (Ministerium für Arbeit, Soziales und Integration)
- Schleswig-Holstein: Ministry of Social Affairs, Health, Youth, Family and Senior Citizens (Ministerium für Soziales, Gesundheit, Jugend, Familie und Senioren)
- Thuringia: State Ministry of Social Affairs, Family and Health (Ministerium für Arbeit, Soziales, Gesundheit, Frauen und Familie)
The Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) provides health education services at a federal (national) level as the specialist authority in the portfolio of the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG). The Decree of 20 July 1967 assigns specific tasks to BZgA, in particular:
- Elaboration of principles and guidelines relating to the content and methods of practical health education
- Vocational training and continuing education of persons working in the field of health education
- Coordination and intensification of health education in Germany
- International collaboration
The Robert Koch Institute (Robert-Koch-Institut, RKI) resulted from the former Federal Health Office (Bundesgesundheitsamt), which was dissolved in 1994. It is the federal government's central body for identifying, protecting against and combating diseases. Based in Berlin, the institute researches public health issues and advises the federal government. RKI regularly carries out the German Health Interview and Examination Survey for Children and Adolescents (KiGGs study).
The German Collaborative Network for Equity in Health (Kooperationsverbund Gesundheitliche Chancengleichheit) was initiated by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA). It now has 66 partners in Germany. Its key objectives are to improve equity in health in Germany and promote good health among the socially disadvantaged.
The National Quality Centre for Nutrition in Daycare Centres and Schools (Nationales Qualitätszentrum für Ernährung in Kita und Schule, NQZ) coordinates existing programmes and initiatives for good nutrition in schools and child day care, develops quality standards and concepts for catering quality controls, and raises awareness of the importance of good quality food and nutrition education among the relevant target groups. The aim is to improve the quality of meals provided in child day care and schools.
The National Centre on Early Prevention in Childhood (Nationales Zentrum Frühe Hilfen, NZFH) was created in 2007 by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend, BMFSFJ). Its main goal is to protect children against dangers better and earlier by efficiently networking public health care support services and child and youth services. To meet this goal, access to risk groups in particular must be improved. NZFH is supported by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA), in cooperation with the German Youth Institute (Deutsches Jugendinstitut e.V.).
The German Society of Paediatrics and Adolescent Medicine (Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V., DGKJ) is a scientific association for all paediatric and adolescent medicine in Germany. It has over 15500 members working in clinics, medical practices, scientific institutions, research institutes and public health care and brings together 39 companies specialising in paediatric medicine, from diabetology and sports medicine to tropical paediatrics.
The German Academy of Paediatrics and Adolescent Medicine (Deutsche Akademie für Kinder- und Jugendmedizin e.V., DAKJ) is the umbrella association for companies and professional bodies in the field of paediatrics and adolescent medicine, which:
- coordinates the joint non-profit goals and tasks of its members for the well-being of children and young people
- represents these goals to the public and policymakers
- is committed to the best possible health care for children and young people
- is committed to children's rights as contained in the UN Convention on the Rights of the Child
The German Association of Social Paediatrics and Youth Medicine (Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin e.V., DGSPJ) is a scientific association with about 2000 members, mainly paediatricians and doctors of adolescent medicine, but also paediatric nurses and carers, medical doctors with other specialisations, psychologists, therapists, educators and legal entities. The Association's goals are to:
- promote research, teaching, training and further training in the field of social paediatrics and adolescent medicine
- initiate and promote health-based prevention programmes for families, children and young people
- establish initiatives to improve interdisciplinary networking in health care and health sciences and contact with relevant national and international institutions and associations
- serve socially disadvantaged, chronically ill and disabled children and young people by offering prevention, treatment, rehabilitation and integration
- advocate the rights of children in line with the UN Convention
The Research Centre for School Sport and the Physical Education of Children and Young Adults (Forschungszentrum für den Schulsport und den Sport von Kindern und Jugendlichen, FoSS) carries out practical research into exercise, play and physical activity among children and young people to develop tried-and-tested, forward-looking exercise and teaching programmes.
The Federal Association for Health Promotion and Prevention (Bundesvereinigung Prävention und Gesundheitsförderung e.V., BVPG) is a non-profit, politically independent, non-denominational association. Its members include federal health care associations (such as the German Medical Association [Bundesärztekammer], the umbrella associations of the health insurance providers, associations of healing professionals and ancillary medical staff, and educational institutions and academies) that work in prevention and health promotion. One focus of its activities is on children and young people. BVPG receives institutional funding from the Federal Ministry of Health (Bundesministerium für Gesundheit) for the objectives and tasks set out in its articles of association and on the basis of the latest annual work programme. Irrespective of this, projects are financed from public funds and sponsorship money.
Citizens advice bureaux (Verbraucherzentralen) are found in all federal states (Bundesländer) with a wide range of services available from about 200 bureaux. Consumers can use the bureaux to access up-to-date, reliable information and independent advice on topics such as health and nutrition, including specifically for children and young people.
The German Nutrition Society (Deutsche Gesellschaft für Ernährung e.V.) was established in 1953. It deals with all issues relating to nutrition and identifies areas where research is needed. Its publications include a nutrition report every four years.
Germany's leading provider of information about agriculture, food and nutrition are the Federal Office for Agriculture and Food (Bundesanstalt für Landwirtschaft und Ernährung, BLE) and the Federal Centre for Nutrition (Bundeszentrum für Ernährung).
The German Centre for Addiction Issues (Deutsche Hauptstelle für Suchtfragen, DHS) was created in 1947 as a platform for all associations and charitable organisations active in the field of addiction intervention in Germany. With a handful of exceptions, all institutions providing outpatient counselling and treatment, inpatient treatment and self-help are represented at DHS.
The Federal Working Group for More Safety for Children (Bundesarbeitsgemeinschaft Mehr Sicherheit für Kinder e.V.) develops programmes to prevent childhood accidents and performs a networking role.
The Child Health Foundation (Stiftung Kindergesundheit) actively promotes the healthy upbringing of children and adolescents. It provides the public with information on major health issues and works with partners and recognised specialists to develop prevention measures for, e.g., day-care centres, kindergartens and schools. It facilitates a professional dialogue among doctors and researchers and provides expert input in the field of paediatric prevention.
German Sports Youth, which is part of the German Olympics Sports Confederation (Deutsche Sportjugend (dsj) im Deutschen Olympischen Sportbund e.V., DOSB) represents the interests of about 10 million children, adolescents and young people aged up to 26 years old who are organised in 90000 sports clubs in 16 state youth sports organisations (Landessportjugend), 53 youth organisations of the sports associations and 10 youth organisations of the associations with special tasks (Jugendorganisationen der Sportverbände mit besonderen Aufgaben).
The federal government, in this case the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend, BMFSFJ) funds German Sports Youth (dsj) as a youth organisation from the budget for the government’s Child and Youth Plan (Kinder- und Jugendplan des Bundes), the central funding instrument for child and youth services at a federal (national) level. German Sports Youth (Deutsche Sportjugend), its member organisations and their subdivisions provide sports programmes across Germany to help young people with their personal development.
Distribution of responsibilities
The Federal Ministry of Health (Bundesministerium für Gesundheit, BMG), has a key role in drafting and creating proposed legislation on a federal (national) level. BMG develops government health policy and transposes this into legislation.
With the Advisory Council for the Assessment of Developments in the Health Care System (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen), the federal government or, more specifically, BMG has a panel of advisors whose expert opinions have a strong influence on health policy discussions.
The responsible ministries in the federal states (Bundesländer) play a central role in two main areas of German health care: inpatient care and the public health service. An important focus of activities in the federal states is on prevention, i.e. programmes and initiatives to maintain and promote public health and the health of specific target groups such as children and young people.
Traditionally, the public health service has been responsible for health care and prevention (such as check-ups when starting school, counselling for mothers and pregnant women), psychiatric and socio-psychiatric community care, monitoring and counselling services relating to hygiene, infectious diseases, the movement of pharmaceuticals and environmental medicine. These tasks are usually carried out by the local health authorities (Gesundheitsämter) in the districts and towns/cities or by specialist facilities at county or federal state level.
A task that has been expanded a great deal in recent years is health reporting at state and, in some cases, local community level. The health reports provide facts and figures on the health of the general population and on health care structures and services. The Robert Koch Institute (Robert-Koch-Institut) reports on health at a federal (national) level.
The federal states (Bundesländer) control the structure and responsibilities of their public health services in state laws.
A particular characteristic of the German health system is the important role given to the associations and bodies linked to statutory health insurance (Gesetzliche Krankenversicherung, GKV) and/or health care services funded by statutory health insurance. The state has delegated responsibility for direct organisation and administrative control to self-governed bodies and their associations. They also take on a key function in prevention and counselling work for children and young people.
Health conferences are an important tool for managing health policy. In Germany, the establishment of health conferences can mainly be traced back to funding initiatives in individual federal states (Bundesländer) or local communities that have existed to varying degrees and with different emphases since the 1990s. Implementation strategies in the federal states range from local one-off initiatives through to nationwide roll-outs in all areas.
Community health conferences are steering committees that advise on needs-based, community analyses and action recommendations on health and make decisions on implementation. The community health conferences and the associated working groups take joint action on community strengths and weaknesses, identify demand and look for the right solutions. Children and young people also play a role in this regard.
Conference of health ministers
The federal structure of Germany means that the federal states (Bundesländer) are responsible for public health services. The Working Group of the Supreme Federal States' Public Health Offices (Arbeitsgemeinschaft der Obersten Landesgesundheitsbehörden) was set up as part of the conference of health ministers (Gesundheitsministerkonferenz) to ensure uniform administration across all federal states. Chairmanship 2022: Sayony-Anhalt. This working group consists of 11 task forces:
- Emergency services
- Environment-related health protection
- Health reporting, prevention, rehabilitation and social medicine
- Pharmaceuticals, pharmacies, transfusions and narcotic drugs
- Health care professions
- Medical devices
- Hospitals (including nursing fee issues)
- Public health services
- European Union (EU) – according to the decision of the 78th conference of health ministers, the EU task force was set up as an independent working group reporting directly to the Conference of Federal State Ministers (Amtschefkonferenz).
There is no separate task force for children and young people.
Conference of sports ministers
The conference of sports ministers (Sportministerkonferenz) represents the sporting interests of the federal states (Bundesländer). It coordinates the interests of the federal states in developing sports with the tasks of the European Union, the federal government, the local communities and non-profit sports. The federal state of Rhineland-Palatinate chairs the conference of sports ministers in 2021 and 2022.
Cooperation and partnerships
The Youth Strategy of the federal government
In its joint Youth Strategy (Jugendstrategie), the federal government shows that it takes into account the interests and concerns of the young generation. The Youth Strategy is based on 163 measures in nine thematic areas and involves all federal government ministries. One of these measures is an expert dialogue aimed at strengthening prevention and health promotion among adolescents. This dialogue is led by the Federal Ministry of Health (Bundesministerium für Gesundheit) and the Federal Ministries of Labour and Social Affairs, Education and Research, Food and Agriculture, and Family Affairs, Senior Citizens, Women and Youth (Bundesministerien für Arbeit und Soziales, für Bildung und Forschung, für Ernährung und Landwirtschaft sowie für Familie, Senioren, Frauen und Jugend). This dialogue encourages stakeholders from science, industry and politics to collaborate across all age groups, target groups and subjects to jointly promote the health of young people. Altogether 27 measures are being implemented by various stakeholders in the area of "Health".
Health and child and youth services
In 2006, the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend, BMFSFJ) launched the action programme "Early Support for Parents and Children and Social Early-Warning Systems" (Frühe Hilfen für Eltern und Kinder und soziale Frühwarnsysteme). The aim of the programme was to improve protection systems for children from families particularly at risk of neglect and abuse through early prevention measures. This was done, above all, by coordinating health-related services and youth services more effectively. The National Centre on Early Prevention in Childhood (Nationales Zentrum Frühe Hilfen, NZFH) was therefore established at the federal level. The NZFH is supported by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZfGA) and the German Youth Institute (Deutsches Jugendinstitut, DJI).
Health and sport
The responsibilities of the federal government and the federal states (Bundesländer) under Germany's federal structure place tight constraints on the direct funding of cooperation and partnerships at a federal (national) level. Agreements exist between state ministries and the state sports federations on school and sport partnerships.
At the federal (national) level, the German Olympic Sports Confederation (Deutscher Olympischer Sportbund, DOSB) and the Standing Conference of the Ministers of Education and Cultural Affairs (Kultusministerkonferenz, KMK) adopted joint recommendations for further developing physical education and school sports for 2017-2022 (Gemeinsame Handlungsempfehlungen der Kultusministerkonferenz und des Deutschen Olympischen Sportbundes zur Weiterentwicklung des Schulsports 2017-2022) containing recommendations and suggestions on cooperation between schools and clubs.
A number of agreements exist between sports organisations and, for example, health insurance providers as to who covers course fees for health-related sports programmes.
Several federal ministries (Environment, Nature Conservation, Building and Nuclear Safety (Umwelt, Naturschutz und nukleare Sicherheit), Health (Gesundheit), Food and Agriculture) (Ernährung und Landwirtschaft)) and top-level federal agencies (Federal Office for Radiation Protection, Federal Institute for Risk Assessment, Robert Koch Institute, and the German Environment Agency (Bundesamt für Strahlenschutz, Bundesinstitut für Risikobewertung, Umweltbundesamt)) cooperate as part of the Action Programme on Environment and Health (Aktionsprogramm Umwelt und Gesundheit, APUG).
The programme funds research projects and information campaigns relating to environmental, health and consumer protection. Children and young people are its key target group.