Lokale Gesundheitspolitik und Gesundheitsplanung aus der Sicht der EntscheidungsträgerInnen des kommunalen politisch-administrativen Systems

Abstract

In 1997 the new law about Public Health Service (OGDG) in Northrhine-Westfalia was put into operation. It included two new sets of compulsory tasks: local health reporting (GBE) and local health conferences (KGK). These new tasks are installed as planning and steering instruments aiming for a better health-care on the local level. The central object is the knowledge-based formation of local health policies. Thereby, local representatives concerned with health and social services should participate as well as administrators and politicians. Since the middle of the 1990 s both new tasks have been established by the public health department of the county of Heinsberg in Northrhine-Westfalia. The experience of this department over almost ten years is the background for the empirical research project that is described in this paper. The study investigates the vocational practices, the decision-making and the health-related attitudes of the relevant local administrative and political representatives. The impulse for the start of the study was given by the constant reluctance of political and administrative top managers to make use of these new planning instruments in agenda setting and decision making. 44 high-ranking staff members and politicians (mayors, party chairmen, heads of departments far beyond the health office) were personally interviewed. Although they are not part of the health administration they claim to be occupied with quite a few health-related tasks. The overlapping of their set of tasks with the local health policies is evident for the interviewed managers. How-ever, this does not cause them to use the two new planning instruments. In particular, they do not participate in the local health conferences. They rather prefer the traditional path of policy making (parties, committees, fractions) even if these paths are less efficient than the new ones. The health conference is much more used by health-service providers as a platform for setting priorities and organising their implementation effectively. So far, the inclusion of the other local representatives (administrative managers, etc.) although they are concerned with health issues has not been achieved. This is also true for local politicians who are responsible for health-care policies. The authors of the paper see it to be the task of the local public health department to convince all these players that the health conference is a productive tool and a useful platform for the discussion of the health problems in the county and the coordination of necessary actions to be taken. The most important focus point is seen in the intersection of health policies with other local policies.