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Germany

Germany

7. Health and Well-Being

7.8 Current debates and reforms

On this page
  1. Forthcoming policy developments
  2. Ongoing debates

Forthcoming policy developments

 

Children's Commissioner in the lower house of the German parliament (Bundestag)

The German Academy of Paediatrics and Adolescent Medicine (Deutsche Akademie für Kinder- und Jugendmedizin e.V., DAKJ), together with its member associations in the field of paediatrics and adolescent medicine, launched a petition in 2015, calling for the appointment of a commissioner for children and young people by the lower house of the German parliament (Bundestag).

For almost two decades, paediatricians and adolescent medicine specialists, but also politicians and numerous family and children's rights organisations have campaigned for a commissioner for children and young people. The DAKJ justifies its petition as follows: "Germany is a wealthy country, but too many children and young people continue to be affected by poverty and, by extension, by poorer health and educational opportunities. Another example of child rights violations is the situation of refugee children in Germany: unsuitable living conditions, limited medical care and restricted social rights, insufficient integration in our educational institutions and lack of minimum standards for age assessment procedures for unaccompanied minors. In short, our country fails all too frequently to respect the internationally demanded principle of the ‘best interest of the child’ in all areas affecting children and young people.”

The DAKJ also hopes that a children’s representative in the German parliament will ensure that young people they are no longer forgotten when laws are passed, as was the case when the last palliative care act was first passed.

Over 116,000 supporters throughout Germany signed the petition, one of the highest numbers of supporters ever reached by a petition sent to the German parliament. The primary goal of the petition, to appoint a commissioner for children and young people in the German parliament, was not achieved. However, in debates about the petition, all parliamentary bodies underlined the need to promote the physical, mental and emotional well-being of children and young people and to eliminate or compensate for existing or future disadvantages.

A commissionership for children’s rights or a children's commissioner at federal level does not currently exist in Germany. Since November 2015, an independent monitoring body appointed by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend) and based at the German Institute for Human Rights (Deutsches Institut für Menschenrechte), has monitored implementation of the UN Convention on the Rights of the Child UNCRC. The monitoring body is financed as a project from funds from the German government’s Federal Child and Youth Plan (Kinder- und Jugendplan). The monitoring body advises policy-makers and civil society on the interpretation and child-friendly implementation of the UNCRC, calls for children’s rights-based research and also informs the UN Committee on the Rights of the Child about the implementation of children's rights in Germany. It does not, however, have the power to investigate complaints or provide legal advice in individual cases – that is to say, it does not hold an ombudsman function.

Election programmes of parliamentary parties on the subject of health

The professional youth workers’ website searched the election programmes of the parties in the 2021 German parliamentary elections for keywords relevant to child and youth services in the area of "health". The results are available here.

Prevention policy

In a statement on prevention, child protection and the promotion of children’s and young people’ health (Stellungnahme zu Prävention, Kinderschutz und Gesundheitsförderung von Kindern und Jugendlichen) from March 2017, the Federal Youth Advisory Board (Bundesjugendkuratorium, BJK) highlights the opportunities and limitations of prevention work. The BJK statement examines current laws and concepts to promote prevention. It acknowledges the importance of prevention when it can be pragmatically implemented, but questions prevention when expectations appear exaggerated. Rather than foregrounding the concept of prevention, it recommends focusing on promoting the health and well-being of children and young people.

To ensure that children grow up healthily and safely, the BJK suggests that responsibilities be assumed on a broad basis across different disciplines, and not be restricted to health policy and child and youth services.

Ongoing debates

Better food for all 

In a motion dated January 2019, the DIE LINKE parliamentary party calls for a “forward-looking and socially sound nutritional policy” for children. Specifically, the motion calls for free government-funded school meals in all schools and day-care facilities, the quality of which should meet the standards of the German Nutrition Society (Deutsche Gesellschaft für Ernährung). In addition, children and adolescents are to be involved in preparing meals and growing food in school kitchen gardens so they receive hands-on education about food and nutrition. DIE LINKE also want to introduce a mandatory strategy to reduce sugar, unsaturated fatty acids and salt in processed foods to prevent nutritious ingredients being substituted by cheap ingredients and additives and to improve the quality of food. Finally, they are calling for the Federal Government to amend the Food and Feed Code (Lebens- und Futtermittelgesetzbuch, LFGB) to include a ban on food advertising targeted at children as well as a ban on sugary and high-calorie processed food, fast food, sweets, savoury snacks and soft drinks.

In a motion dated May 2019 (PDF, 129 KB), the FDP parliamentary party called upon the federal government to guarantee more education, exercise and better food. Delegates called for an educational campaign in day-care facilities and schools to teach children about nutrition at an early age. The campaign should also include adult education, given that parents lead by example. In addition, the FDP recommends extending the EU’s school fruit, vegetable and milk scheme and increasing its budget.

On 22 May 2020, the lower house of the German parliament (Bundestag) adopted a resolution on the Nutrition Policy Report 2020 (19/19430, 19/20213). Among other things, the resolution calls on the federal government – within the limits of available resources – to review the organisation of and cooperation between institutions under the authority of the Federal Ministry of Food and Agriculture (Bundesministerium für Ernährung und Landwirtschaft) that are involved with nutrition. It calls for existing nutrition education initiatives to be intensified in partnership with the federal states (Länder) and local authorities as well as all relevant stakeholders. New, target group-based practicable concepts will be developed for this purpose. According to the report, nutrition policy will pay particular attention to vulnerable groups, especially children and young people who have poor diets and suffer from obesity.

Since autumn 2020, food manufacturers in Germany can voluntarily opt to use what is known as the “Nutri-Score. Developed by independent scientists, the Nutri-Score uses a five-level colour-coded scale from A to E which appears on the front of product packaging and indicates the nutritional value of its contents. The system was developed in France and is intended to help categorise foods based on their composition. The German Society for Paediatrics and Adolescent Medicine (Deutsche Gesellschaft für Kinder- und Jugendmedizin, DGKJ) welcomes the introduction of the labelling system, but calls for it to be a mandatory standard rather than an optional label in Germany. The Professional Association of Paediatricians and Doctors of Adolescent Medicine (Berufsverband der Kinder- und Jugendärzte, BVKJ) says that, in addition to the Nutri-Score: "We need a ban on food advertisements targeting children as soon as possible. Sweet drinks should no longer be sold in schools, and we would also like to see a sugar tax. Obesity mainly affects children and young people from poor families with low levels of education. We have to address these groups with systematic prevention measures. We need explicit quality standards for meals in schools and childcare facilities, and also free school meals."

A foodwatch study published in August 2021 found that over 85 percent of the food advertised for children is unhealthy. According to foodwatch, the food industry’s voluntary self-regulation mechanisms for more responsible children’s marketing has therefore failed. The current study includes products from a total of 16 food companies which voluntarily signed an agreement to change the way they target children (EU Pledge) back in 2007 – among them Nestlé, Danone and Unilever. In this pledge, all the companies declared they would make their communications to children more responsible. foodwatch calls for laws to force food companies to reduce the use of sugar. It also demands that advertisements targeting children should only be allowed for healthy food. Numerous medical associations and the WHO support foodwatch in its campaign to restrict advertising and demand that this be enshrined in the coalition agreement.

The right of children to be protected from violence

Protecting young people from violence and the need for concepts for institutional protection are the subject of a statement issued by the Federal Youth Advisory Board (Stellungnahme des Bundesjugendkuratoriums, BJK). In this statement, the BJK calls for a statutory provision which goes beyond the new Act to Strengthen Children and Youth (Gesetz zur Stärkung von Kindern und Jugendlichen, KJSG) of 7 May 2021 and which stipulates that appropriate protection concepts be implemented in all institutions in which the everyday life of children and young people takes place or in which decisions about young people are made. However, the right to protection from physical (bodily), psychological (mental) and sexualised violence does not only mean providing concepts for preventive, interventional or therapeutic approaches for young people threatened or affected by violence. Rather, the protection mandate and implemented concepts should take account of children and young people’s rights to support and participation. According to the concept of inclusion, institutional protection concepts cannot succeed unless the diversity of young people and their protection needs are taken into account. To fulfil this obligation, the BJK stresses the need for interdisciplinary and non-discriminatory support systems as well as barrier-free access to support services for young victims. It also calls for comprehensive advanced learning opportunities for youthwork professionals and public sensitisation of this issue.

Influence of the media on development 

Now an integral part of our society, it is hard to imagine the everyday life of children and young people today without digital media. Growing up today means living between the real and virtual world. The general consensus is that frequent use of tablets, computers, smartphones, etc. can lead to poor concentration, poor motor skills, attachment disorders and social dysfunction patterns in children, as the Blikk Media Study 2017 (Blikk-Medien-Studie 2017) shows. The BLIKK Media project carried out a survey among 5,573 parents and their children on their use of digital media, documenting their physical, developmental neurological and psychosocial condition as part of regular early diagnosis tests. The study highlights the health risks of excessive media consumption for children. They range from feeding and sleeping disorders in babies to language development problems in young children and concentration deficits in primary school children. When media use is especially high among children or parents, paediatricians and adolescent medicine specialists detect disproportionately high rates of behavioural disorders.

The subject of digitalisation, media use and media consumption among children became even more prominent in 2020 as a result of the COVID-19 pandemic. Media use by children and young people appears to have increased during the pandemic. Most leisure activities were not possible, schools were closed for weeks and months and teaching took place online. Accordingly, this would also suggest changes in young people’s media behaviour. Various studies show an upswing in the number of hours young people spend on digital media every day. The JIM-Study 2020 carried out by the Media Education Research Network Southeast (JIM-Studie 2020 des Medienpädagogischen Forschungsverbunds Südwest) on media use among 12 to 19-year-olds shows an increase in daily online time from 205 minutes in 2019 to 258 minutes in 2020.

Media use can affect the healthy development of children. However, the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufkärung, BZgA) warns against categorical bans on media use. Indeed, it suggests that the risks of using modern media, just like the opportunities, depend on what and how much media is used. According to the BZgA, media should be just one of many different activities pursued by children, and parents should limit and appropriately monitor media time.

Paediatricians and adolescent medicine specialists recommend – as does the BZgA – that parents, grandparents and other caregivers monitor the way children under their supervision use media. Although the protection of children and young people from potentially harmful media is regulated by the Youth Protection Act (Jugendschutzgesetz) (videos, DVDs, computer games) and the Interstate Treaty on the Protection of Minors in the Media (television), many parents fail to check classification categories, encouraging children and adolescents at risk to consume such media. They call for political measures to be taken on situational prevention. One important step will be a ban on TV advertisements for commercial products and foods aimed at children and young people. This would support education on healthy eating and exercise behaviour.

Improving medical care and drug safety

The Association of Paediatricians and Adolescent Medicine Specialists (Berufsverband der Kinder- und Jugendärzte Deutschlands e.V., BVKJ), the German Society for Paediatrics and Adolescent Medicine (Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V., DGKJ) and the German Society for Social Paediatrics and Adolescent Medicine (Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin e.V., DGSPJ) under the umbrella of the German Academy for Paediatrics and Adolescent Medicine (Deutsche Akademie für Kinder- und Jugendmedizin e.V., DAKJ) approved a joint position paper on Health Equity for Children and Adolescents in Germany – Recommendations for Action (Gleiche gesundheitliche Chancen für Kinder und Jugendliche in Deutschland – Handlungsempfehlungen (PDF, 314 KB) in March 2017. The paper identifies ways to improve the situation of children and young people and their families and recommends specific action for the next legislative period. It is also supported by the Association of Senior Paediatricians and Paediatric Surgeons in Germany (Verband leitender Kinder- und Jugendärzte und Kinderchirurgen Deutschlands e.V., VLKKD).

Once again in 2021, the BVKJ, DGKJ and the Society of Children's Hospitals and Children's Departments in Germany (Gesellschaft der Kinderkrankenhäuser und Kinderabteilungen in Deutschland, GKinD) have drawn attention to increasing deficits in medical care for children and young people in position papers and press releases, stressing the urgent need for political action. The primary objective is to provide children and adolescents in Germany with the best possible medical care and health equity. The health system is focusing more and more on maximising profits, increasing case numbers and reducing staff, which is why it is becoming increasingly difficult to provide high-quality patient care. According to the associations, there is currently a lack of sufficiently flexible financial resources and qualified staff. The actual additional costs of treating children and young people must be covered, including costs for the additional time, staff and space needed in outpatient and inpatient care.

The BVKJ reports that paediatricians and adolescent medicine specialists are already having to turn patients away. They demand more university places for medicine and less bureaucracy so that setting up practices becomes more attractive. Unless this happens, the BVKJ predicts even longer waiting times for parents and children in future and even longer distances to the next practice, especially in rural areas. This trend would be especially problematic for chronically ill children and young people.

In this context, paediatricians and adolescent medicine specialists welcome the resolution of the SPD party to improve health care for children.

In 2006, a commission of experts was set up at the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM) to prepare the higher federal authority’s decisions on the approval of medications for paediatric use. The commission is also responsible for deciding under which conditions medicinal products that have been approved for adults can also be used in children and young people. However, the commission works on a voluntary basis and reactively, by handling enquiries. A Commission for Medicinal Products for Children and Young People (Kommission für Arzneimittel für Kinder und Jugendliche, KAKJ) has also been set up in the area of paediatrics and adolescent medicine, but this commission also only works by request and on a voluntary basis. The DGKJ also demands that these commissions be strengthened and given operational competencies. It argues that this is the only way to improve the safety of medicinal products in the long term, especially for children.

Inclusive solution

With the entry into force of the Act to Strengthen Children and Youth (Gesetz zur Stärkung von Kindern und Jugendlichen, KJSG) in June 2021, Section 1 of Book VIII of the Social Code (Sozialgesetzbuch, SGB VIII) stipulates that in order to enforce the right under Section 1, child and youth welfare services should in particular [...] “enable or facilitate young people to interact in a self-determined manner in all areas of life that affect them, in accordance with their age and individual abilities, and so participate in life in society on an equal footing [...]”. This not only adopts a requirement of the Federal Act on Participation (BTHG), but also formulates a new, far-reaching requirement for all fields of practice and administrations that child and youth welfare must enable inclusive services and measures. While it was already responsible for children and young people with emotional disabilities or children and young people at risk of emotional disability, the same now also applies provisionally and to a limited extent to children and young people with mental and physical disabilities. The new regulations refer in particular to general standards, the inclusive design of services (e.g. daycare for children, youth work and educational support), the planning of appropriate provision, quality development, as well as cooperation and interaction between child and youth welfare on the one hand and integration support on the other. To this end, youth welfare offices are responsible for ensuring that facilities, services and events put in place to meet the (inclusive) tasks of Book VIII of the Social Code “interact in accordance with the needs identified in the context of youth welfare planning (Section 80 of Book VIII of the Social Code) and that binding cooperation structures are established and further developed to this end” (Section 79(2)(2) of Book VIII of the Social Code (SGB VIII)).

The regulations adopted in Book VIII of the Social Code (SGB VIII) in 2021 are just the first step, however. Separate responsibilities remain in substance for the time being, with integration support responsible for children and young people with physical and mental disabilities, and child and youth welfare responsible for children and young people with mental disabilities and all other children and young people. However, the political will is that support for all children and young people should in future come from a single source – the child and youth welfare services. This merging of responsibilities at municipal level for all children and young people is referred to as the “inclusive solution” (previously designated the “big solution”). But this calls for even further-reaching statutory regulations.

For this reason, the new Section 107 of Book VIII of the Social Code (SGB VIII) provides for a second phase of legislation. Here, the group of persons entitled to benefits, the type and scope of the benefits, the nature of cost sharing for these benefits and procedural structure must be defined in greater detail as a matter of priority. The same paragraph stipulates that this new federal law must be available by 31 December 2027, in order for it to enter into force on 1 January 2028. Under the current coalition agreement for the current legislative period between SPD, Die Grünen and FDP, the negotiating partners have also agreed that this law should be passed within the current legislative period, i.e. before mid 2025. In light of this, it was announced during an online kick-off event on 27 June 2022 concerning the new legislative process and preparatory participation process that the federal government plans to present the new draft legislation in good time.

 

Impact of the COVID-19 pandemic on children and young people

In March 2021, the German parliament (Bundestag) examined for the first time four motions put forward by the parliamentary parties FDP and Bündnis 90/Die Grünen on how to deal with the effects of the COVID-19 pandemic on children and young people’s education and health. The FDP called for a "help plan to support the physical and mental health of our children and young people" (19/27810) and a "catch-up programme" to "eliminate learning gaps and prevent COVID-related disadvantages for children and young people" (19/27808).

Die Grünen tabled motions entitled "Ways out of the education crisis – future perspectives for our children" (Wege aus der Bildungskrise – Zukunftsperspektiven für unsere Kinder, 19/27826) and "Youth in crisis – perspectives for young people in times of Covid-19” (Jugend in der Krise – Perspektiven für junge Menschen in Zeiten der Covid-19-Pandemie) (19/27825). The German parliament referred the latter motion and the FDP’s first proposal to the committee in charge of family affairs, senior citizens, women and youth for further review, the other two motions were referred to the committee responsible for education, research and technology assessment.

The lower house of German parliament (Bundestag) rejected the motion put forward by the AfD "for a childhood without social distancing and masks" (19/23129) with the votes of the other parliamentary parties on the basis of a proposed resolution by the family committee (19/27893).

According to the debates – and confirmed by scientific studies – the life situation of many children has deteriorated as a result of the COVID-19 restrictions. Children and adolescents have experienced more violence at home, both mental and physical. They have been unable to keep up with school work and they have been restricted in their personal development. Lack of exercise and poor diets have also become more prevalent in children.

On 5 May 2021, the federal government launched the action programme “Catching up after corona” (Aufholen nach Corona für Kinder und Jugendliche) worth two billion euros in 2021 and 2022. It includes a catch-up programme for pandemic-related gaps in learning and a raft of measures to promote young people's social skills and general personal development.

To monitor the effects of the pandemic on the health of children and young people over a longer period, the federal government set up a task force, presided over by the Federal Ministry of Health and the Federal Ministry of Family Affairs. In its report of 15 September 2021, the inter-ministerial task force "Effects of COVID-19 on the health of children and adolescents" (Gesundheitliche Auswirkungen auf Kinder und Jugendliche durch Corona) points out that children and young people need open schools and day-care centres as well as sports facilities in their free time even during the pandemic. To make this possible, existing protection concepts must be implemented and children and young people should be regularly tested, preferably with the “lollipop” pool test procedure. It is also vital that all children have access to prevention measures and those with special burdens receive more targeted support.

Child and youth policies relating to the situation of children and young people in the COVID-19 pandemic are diverse. Examples of some statements are listed here:

  • In an open letter “Young people defy corona – opportunities for young people” (Junge Zukunft trotz(t) Corona – Chancenpaket für junge Menschen), Prof. Dr Karin Böllert (Child and Youth Welfare Association (Arbeitsgemeinschaft für Kinder- und Jugendhilfe, AGJ)), Lorenz Bahr (federal working group for state youth welfare offices (BAG Landesjugendämter)) and Prof. Dr Wolfgang Schröer (Federal Youth Advisory Board, (Bundesjugendkuratorium)) have commented on the package of measures the federal government plans to introduce to compensate for the damages young people have suffered as a result of the pandemic. They stress that children and young people are more than kindergarten children and schoolchildren, and that a comprehensive programme of measures is needed for all fields of child and youth services at federal, state and local levels. They table seven demands relating to the federal government's package of measures. Open letter from Child and Youth Welfare Association from 23 April 2021.
  • In a statement from 12 May 2021, the Federal Youth Advisory Board (Bundesjugendkuratorium) discusses what can be learned from the COVID-19 crisis for future child and youth policy-making and for childhood and youth infrastructures now and in the long term. The Federal Youth Advisory Board puts forward proposals for a sustainable child and youth policy programme, with short-, medium- and long-term measures that recognise young people's experiences during the COVID crisis and foster social cohesion.
  • The Evangelical family working group (Evangelische Arbeitsgemeinschaft Familie, eaf) calls for a stronger prioritisation of the situation of families. eaf also demands greater solidarity in society for children, adolescents and young adults. Press release from the Evangelical family working group (eaf) from 3 September 2021
  • At its general meeting, the Child Protection League drafted an interim appeal entitled "Finally prioritising the rights, health and protection of children". "We must stop ignoring children and young people in the pandemic," demands the Child Protection League (Kinderschutzbund). The Child Protection League also criticises the lack of will among policy-makers to actively stand up for and prioritise children and young people. Interim appeal from the Child Protection League of 4 September 2021
  • The German Society for Paediatricians and Adolescent Medicine Specialists (Berufsverband der Kinder- und Jugendärzte, BVKJ), the German Society of Paediatrics and Adolescent Medicine (Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V., DGKJ) and the German Society for Paediatric Infectology (Deutsche Gesellschaft für Pädiatrische Infektiologie e.V., DGPI) in favour of keeping schools open and they name the conditions for this to happen. BVKJ press release from 10 September 2021
  • The Future Forum for Families (Zukunftsforum Familie e.V., ZFF) calls for concepts that offer long-term support to children, young people and their families and guarantee reliable schooling and after-school care. Statement of the ZFF from 13 September 2021

A public debate has flared up not only about the lockdown restrictions which children have to tolerate also about protecting children’s health. The recommendations of the Standing Commission on Immunisation (Ständige Impfkommission, STIKO) are decisive in the debate about COVID vaccinations for children and young people. Initially, STIKO recommended vaccinating only children over 12 who had certain pre-existing health conditions, an increased risk of infection or close contact to persons who could not protect themselves. Children could also be vaccinated after a medical consultation, by personal request and if they or their guardian accepted the risks. On 19 August 2021, the STIKO updated its recommendation. Based on current data and a thorough risk-benefit assessment, it recommends COVID-19 vaccination with two doses of an mRNA vaccine (Comirnaty® or Spikevax®) for all children and adolescents aged 12 years and older. Discussions about vaccination options for younger children are ongoing. If the outcome of the study is positive, BioNTech and Pfizer will apply for approval of their Covid-19 vaccines for use in children as soon as possible. Health Minister Spahn expects approval in early 2022.