In June 2015, Germany passed new legislation on disease prevention and health promotion which is unique in the sense that it will create a broad coalition of national health actors on prevention. The latter is not only supposed to create long-term economic benefits for the health system (‘return on prevention’) but will bring concrete benefits to a wide range of individuals.
Crucially, the new prevention law (Praeventionsgesetz) will allow individuals to get reimbursed through their health insurance for preventative physical activity, such as fitness clubs, with the aim of boosting physical resistance. It is also good news for people already suffering from various conditions such as back pain, diabetes and hypotension, who might otherwise not be able to afford regular exercise. The main requirement for eligibility is a recommendation by their treating physician.
However, the new prevention law is much broader than this, aiming to reach individuals of all ages and in (almost) all settings and ‘living environments’ (Lebenswelten), including daycare facilities for children, schools, workplaces, municipalities and inpatient nursing homes.
Another focus is on vaccination – while the law does not introduce mandatory vaccination, parents of young children will be asked to provide proof of having discussed immunisation with their doctor. Moreover, local authorities have the powers to temporarily exclude unvaccinated children during measles outbreaks in public settings, such as schools. Healthcare institutions may also request vaccination cards from their employees.
Healthy workplaces, particularly small and medium sized organisations, are another focal point and will receive support to offer health promotion at work. This could involve offering healthier canteen food, stress management, teaching healthy leadership skills, etc. Children and youth will also be offered greater opportunities to experience nature, engage in physical activities and learn to make healthy life choices (e.g. quitting smoking)
Overall, EPHA welcomes the new prevention law as a potential blueprint for further prevention legislation at national and/or EU level and as a tool to ensure access to the public health cornerstones of prevention and health promotion for disadvantaged individuals and vulnerable groups in particular. The law also extends the possibility for insurers to award bonuses to individuals doing regular check-ups or taking part in prevention courses.
It is also a positive move to link investments in prevention with long-term economic savings for the health system. It is, however, important that this does not get implemented in a coercive fashion given individuals’ different levels of health literacy and their different propensities to become ill in the first place. Since the German prevention coalition foresees a targeted collaboration of public institutions (health, accident, pensions and social care) with private insurers in collaboration with many other partners, a just implementation of the law will be key.
Unfortunately, however, the law does not provide for universal access to healthcare for undocumented migrants and other people formally excluded from the health system, which remains an urgent problem in Germany and in many other Member States.
Besides, the new German law focuses very much on the “key role of medical doctors” in delivering prevention, which is somewhat at odds with the concept of salutogenesis, purported to be central to the legislation. This acknowledges that medical prevention represents only one dimension of its scope as it encompasses not only physical, but crucially also aspects of mental / emotional health. Since salutogenesis has long been promoted and practised by a much wider group of health actors than just physicians, the role of other health professionals in health promotion and prevention is unfortunately less evident in this law.