Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Debate

The opportunities for and obstacles against prevention: the example of Germany in the areas of tobacco and alcohol

Authors: Ulla Walter, Marc Suhrcke, Miriam G Gerlich, Till A Boluarte

Published in: BMC Public Health | Issue 1/2010

Login to get access

Abstract

Background

Recent years have seen a growing research and policy interest in prevention in many developed countries. However, the actual efforts and resources devoted to prevention appear to have lagged well behind the lip service paid to the topic.

Discussion

We review the evidence on the considerable existing scope for health gains from prevention as well as for greater prevention policy efforts in Germany. We also discuss the barriers to "more and better" prevention and provide modest suggestions about how some of the obstacles could be overcome.

Summary

In Germany, there are substantial health gains to be reaped from the implementation of evidence-based, cost-effective preventive interventions and policies. Barriers to more prevention include social, historical, political, legal and economic factors. While there is sufficient evidence to scale up prevention efforts in some public health domains in Germany, in general there is a comparative shortage of research on non-clinical preventive interventions. Some of the existing barriers in Germany are at least in principle amenable to change, provided sufficient political will exists. More research on prevention by itself is no panacea, but could help facilitate more policy action. In particular, there is an economic efficiency-based case for public funding and promotion of research on non-clinical preventive interventions, in Germany and beyond, to confront the peculiar challenges that set this research apart from its clinical counterpart.
Appendix
Available only for authorised users
Literature
1.
Fries JF, Koop CE, Beadle CE, Cooper PP, England MJ, Greaves RF, et al: Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium. N Engl J Med. 1993, 329: 321-325. 10.1056/NEJM199307293290506.CrossRefPubMed
2.
Suhrcke M, Arce R, McKee M, Rocco L: Economic costs of ill health in the European Region. 2008, Copenhagen: WHO Regional Office for Europe
3.
Van Baal PH, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, Boshuizen HC, et al: Lifetime medical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med. 2008, 5: e29-10.1371/journal.pmed.0050029.CrossRefPubMedPubMedCentral
4.
Russell LB: Preventing chronic disease: an important investment, but don't count on cost savings. Health Aff (Millwood). 2009, 28: 42-45. 10.1377/hlthaff.28.1.42.CrossRef
5.
Kingdon J: Agendas, alternatives and public policies. 1995, Boston: Little, Brown & Co
6.
Brand DA, Saisana M, Rynn LA, Pennoni F, Lowenfels AB: Comparative analysis of alcohol control policies in 30 countries. PLoS Med. 2007, 4: e151-10.1371/journal.pmed.0040151.CrossRefPubMedPubMedCentral
7.
Joossens L, Raw M: Progress in Tobacco Control in 30 European Countries, 2005 to 2007. 2007, Berne: Swiss Cancer League
8.
WHO (World Health Organziation): Framework Convention on Tobacco Control. 2003, Adopted by the Conference of the Parties to the WHO FCTC. Geneva
9.
WHO (World Health Organization): Draft global strategy to reduce the harmful use of alcohol. Draft resolution (EB126.R11) to the 63rd World Health Assembly. 2010, Geneva
10.
WHO Regional Office for Europe: European Health for All Database (HFA-DB). 2003, Copenhagen
11.
Statistisches Bundesamt [Statistical Office]: Rauchgewohnheiten nach Altersgruppen [Smoking patterns by age groups]. Ergebnisse des Mikrozensus. 1999, Wiesbaden, Statistisches Bundesamt
12.
Bundeszentrale für gesundheitliche Aufklärung: Die Drogenaffinität Jugendlicher in der Bundesrepublik Deutschland 2008. 2009, Cologne, [Drug affinity among adolescents in the Federal Republic of Germany 2008]
13.
Hibell B, Guttormson U: The 2007 ESPAD Report. Substance Use Among Students in 35 European Countries. 2009, Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN)
14.
Anderson P, Baumberg B: Alcohol in Europe: A Public Health Perspective. 2006, London: Institute of Alcohol Studies
15.
WHO Regional Office for Europe: The European Tobacco Control Report 2007. 2007, Copenhagen
16.
17.
Schneider S, Meyer C, Yamamoto S, Solle D: Implementation of electronic locking devices for adolescents at German tobacco vending machines: intended and unintended changes of supply and demand. Tob Control. 2009, 18: 294-301. 10.1136/tc.2008.028035.CrossRefPubMed
18.
BDTA: Der BDTA im Überblick [An overview of the BDTA]. 2009, Bundesverband Deutscher Tabakwaren-Großhändler und Automatenaufsteller e.V. (BDTA)
19.
Kraus L, Pabst A, Steiner S: Die Europäische Schülerstudie zu Alkohol und anderen Drogen 2007 [The 2007 European School Survey Project on Alcohol and other drugs (ESPAD). 2008, Munich: Institut für Therapieforschung, Report for Germany
20.
Muller-Riemenschneider F, Bockelbrink A, Reinhold T, Rasch A, Greiner W, Willich SN: Long-term effectiveness of behavioural interventions to prevent smoking among children and youth. Tob Control. 2008, 17: 301-302. 10.1136/tc.2007.024281.CrossRefPubMed
21.
Chisholm D, Doran C, Shibuya K, Rehm J: Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. Drug and Alcohol Review. 2006, 25: 553-565. 10.1080/09595230600944487.CrossRefPubMed
22.
van Baal PH, Brouwer WB, Hoogenveen RT, Feenstra TL: Increasing tobacco taxes: a cheap tool to increase public health. Health Policy. 2007, 82: 142-152. 10.1016/j.healthpol.2006.09.004.CrossRefPubMed
23.
Sims M, Maxwell R, Bauld L, Gilmore A: Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction. BMJ. 2010, 340: c2161-10.1136/bmj.c2161.CrossRefPubMedPubMedCentral
24.
Kotler P, Roberto E: Social Marketing: Strategies for Changing Public Behavior. 1989, New York, NY: Free Press
25.
Abelson P: Returns on Investment in Public Health - An Epidemiological and Economic Analysis. 2003, Prepared for The Department of Health and Aged Care by Applied Economics
26.
Grosse SD, Teutsch SM, Haddix AC: Lessons from cost-effectiveness research for United States public health policy. Annu Rev Public Health. 2007, 28: 365-391. 10.1146/annurev.publhealth.28.021406.144046.CrossRefPubMed
27.
Babor TF, Kadden RM: Screening and interventions for alcohol and drug problems in medical settings: what works?. J Trauma. 2005, 59: S80-S87. 10.1097/01.ta.0000174664.88603.21.CrossRefPubMed
28.
McDaid D, Needle J: Economic Evaluation and Public Health: Mapping the Literature. 2006, Prepared for the Welsh Assembly Government/Health Promotion Division
29.
Rush B, Shiell A, Hawe P: A census of economic evaluations in health promotion. Health Educ Res. 2004, 19: 707-719. 10.1093/her/cyg092.CrossRefPubMed
30.
Schwappach DL, Boluarte TA, Suhrcke M: The economics of primary prevention of cardiovascular disease - a systematic review of economic evaluations. Cost Eff Resour Alloc. 2007, 5: 5-10.1186/1478-7547-5-5.CrossRefPubMedPubMedCentral
31.
Schwappach DL, Boluarte TA: HEE-GER: a systematic review of German economic evaluations of health care published 1990-2004. BMC Health Serv Res. 2007, 7: 7-10.1186/1472-6963-7-7.CrossRefPubMedPubMedCentral
32.
Zelen K, Kimmel A, Strippel H: Präventionsbericht 2009 - Leistungen der gesetzlichen Krankenversicherung in der Primärprävention und der betrieblichen Gesundheitsförderung (Berichtsjahr 2008) [Prevention Report 2009. Services of the compulsary health insurance funds in primary prevention and work related health promotion]. 2009, Essen: Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS)
33.
34.
Buxton MJ, Drummond MF, Van Hout BA, Prince RL, Sheldon TA, Szucs T, et al: Modelling in economic evaluation: an unavoidable fact of life. Health Econ. 1997, 6: 217-227. 10.1002/(SICI)1099-1050(199705)6:3<217::AID-HEC267>3.0.CO;2-W.CrossRefPubMed
35.
Goeree R, Burke N, O'Reilly D, Manca A, Blackhouse G, Tarride JE: Transferability of economic evaluations: approaches and factors to consider when using results from one geographic area for another. Curr Med Res Opin. 2007, 23: 671-682. 10.1185/030079906X167327.CrossRefPubMed
36.
37.
Andreß H, Heien T: Four Worlds of Welfare State Attitudes? A Comparison of Germany, Norway and the United States. Eur Sociol Rev. 2001, 4: 337-356.
38.
Altgeld T: Gesundheitsfördernde Pflichten und Verbote - Wie viel staatliche Autorität ist zumutbar? [Health promotion-related duties and rules-the acceptance of governmental authorities in the private sphere of health]. Gesundheitswesen. 2010, 72: 3-9. 10.1055/s-0029-1237736.CrossRefPubMed
39.
Krebsforschungszentrum Deutsches: Nichtraucherschutz wirkt - eine Bestandsaufnahme der internationalen und deutschen Erfahrungen [smoke-free legislation works - an overview of international and german experiences]. 2010, Heidelberg
40.
Kip Viscusi W: Fatal Tradeoffs. Public & Private Responsibilities for Risk. 1992, New York: Oxford University Press
41.
Sjoberg L: Risk perception of alcohol consumption. Alcohol Clin Exp Res. 1998, 22: 277S-284S. 10.1111/j.1530-0277.1998.tb04380.x.CrossRefPubMed
42.
Flaherty B, Homel P, Hall W: Public attitudes towards alcohol control policies. Aust J Public Health. 1991, 15: 301-306. 10.1111/j.1753-6405.1991.tb00351.x.CrossRefPubMed
43.
Latimer WW, Harwood EM, Newcomb MD, Wagenaar AC: Sociodemographic and individual predictors of alcohol policy attitudes: results from a US probability sample. Alcohol Clin Exp Res. 2001, 25: 549-556. 10.1111/j.1530-0277.2001.tb02249.x.CrossRefPubMed
44.
Slovic P, Finuance M, Peters E, McGregor D: Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality. Risk Analysis. 2004, 24 (2): 311-322. 10.1111/j.0272-4332.2004.00433.x.CrossRefPubMed
45.
46.
Kip Viscusi W, Rovira J: Smoking Risks in Spain: Part II Perceptions of Environmental Tobacco Smoke Externalities. Journal of Risk and Uncertainty. 2000, 21 (2): 187-212. 10.1023/A:1007859307096.
47.
Bachinger E, McKee M, Gilmore A: Tobacco policies in Nazi Germany: not as simple as it seems. Public Health. 2008, 122: 497-505. 10.1016/j.puhe.2007.08.005.CrossRefPubMedPubMedCentral
48.
Mackenbach JP: Odol, Autobahne and a non-smoking Fuhrer: reflections on the innocence of public health. Int J Epidemiol. 2005, 34: 537-539. 10.1093/ije/dyi039.CrossRefPubMed
49.
Proctor RN: Commentary: Schairer and Schoniger's forgotten tobacco epidemiology and the Nazi quest for racial purity. Int J Epidemiol. 2001, 30: 31-34. 10.1093/ije/30.1.31.CrossRefPubMed
50.
Schneider NK, Glantz SA: "Nicotine Nazis strike again": a brief analysis of the use of Nazi rhetoric in attacking tobacco control advocacy. Tob Control. 2008, 17: 291-296. 10.1136/tc.2007.024653.CrossRefPubMedPubMedCentral
51.
Ministerium für Arbeit, Gesundheit und Soziales des Landes Nordrhein-Westfalen (NRW): Nichtraucherschutzgesetz NRW - NiSchG NRW. 18-7-2009. 2010
52.
Bundesverfassungsgericht (Federal Constitutional Board): 1 BvR 3262/07, Absatz-Nr (1-94). 2008, BVerfG Bundesverfassungsgericht
53.
Rasch A, Müller-Riemenschneider F, Vauth C, Willich C, Greiner W: Föderale Strukturen und damit verbundene verhaltensbezogene Maßnahmen zur Prävention des Zigarettenrauchens [Federal structures and related behavioural measures for the prevention of cigarette smoking]. GMS Health Technology Assessment. 2008, 4: Doc11 (20081023)
54.
55.
Deutsches Krebsforschungszentrum (DKFZ) and Institut für Gesundheitsökonomie und Klinische Epidemiologie der Universität zu Köln: Auswirkungen der Tabaksteuererhöhungen von 2002 bis 2004 [Effects of the tobacco tax increase 2002-2004]. 2005, Heidelberg and Cologne
56.
Stafford N: Germany reviews its policy on HPV vaccination for 12-17 year olds. BMJ. 2009, 338: b1692-10.1136/bmj.b1692.CrossRefPubMed
57.
Dranove D: Is there underinvestment in R&D about prevention?. J Health Econ. 1998, 17: 117-127. 10.1016/S0167-6296(97)00015-5.CrossRefPubMed
58.
Weatherly H, Drummond M, Claxton K, Cookson R, Ferguson B, Godfrey C, et al: Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendations. Health Policy. 2009, 93: 85-92. 10.1016/j.healthpol.2009.07.012.CrossRefPubMed
59.
Jones A: Evaluating public health interventions with non-experimental data analysis. 2006, CHE Research Conference, Manuscript, HEDG
60.
Jones A: Panel Data Methods and Applications to Health Economics, HEDG Working Paper 07/18. Med Care. 2007, York, University of York
61.
UK Clinical Research Collaboration: 2006, UK Health Research Analysis
62.
Weinbrenner S, Wörz M, Busse R: Gesundheitsförderung im europäischen Vergleich. 2007, [A European Comparison of Health Promotion]. Bonn/Bad Homburg: KomPart Verlagsgesellschaft mgH & Co. KG
Metadata
Title
The opportunities for and obstacles against prevention: the example of Germany in the areas of tobacco and alcohol
Authors
Ulla Walter
Marc Suhrcke
Miriam G Gerlich
Till A Boluarte
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-500

Other articles of this Issue 1/2010

BMC Public Health 1/2010 Go to the issue

Research article

Interacting with the public as a risk factor for employee psychological distress

Erratum

Erratum to: Awareness of school students on sexually transmitted infections (STIs) and their sexual behaviour: a cross-sectional study conducted in Pulau Pinang, Malaysia

Research article

"Well, it's nobody's responsibility but my own." A qualitative study to explore views about the determinants of health and prevention of knee pain in older adults

Research article

HCV co-infection in HIV positive population in British Columbia, Canada

Research article

Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries

Research article

Primary syphilis cases in Guangdong Province 1995-2008: Opportunities for linking syphilis control and regional development