Editorial
Ulrich Baumgarten
Reforming public and global health in Germany
For the public health statement see http://www.leopoldina.org/ uploads/tx_leopublication/2015_ Public_Health_LF_EN.pdf
Germany is not fulfilling its full potential in public and global health, according to a new statement from three of the country’s leading scientific academies. Their report— Public health in Germany: structures, developments and global challenges—was produced by an international working group of scientists who assessed what is needed to better the health of the population from the perspectives of academic public health, global health research, supporting institutions and structures, and the translation of science. Germany has had notable successes in public health in recent decades, including reductions in infectious diseases and the protection of non-smokers, but, like other countries, it faces new challenges from communicable and non-communicable diseases, an ageing population, health inequalities, and pressures on health-care systems. However, addressing these challenges is hampered by a lack of coherent structure for public health education and research in Germany, declining resources, and absence of political commitment to health policy recommendations, states the report. Furthermore, Germany has the experience
to increase its contribution to global health challenges, especially in areas such as universal health coverage and social protection, but it has not seized this opportunity. The statement makes several recommendations, including the coherent national provision of education programmes in public and global health, an emphasis on interdisciplinary research in public health, development of an innovative global health research agenda, and a commitment from academia to not only generate knowledge but also to identify ways in which it can be implemented through policy development, public dialogue, and international collaboration. That Germany lags behind in public health should be viewed in a historical context of past, as the report states, “disastrous approaches” in this area that have taken decades to recover from. However, it is still surprising that it has taken this long for the country to identify its gaps. German academia and government must now step out of the shadows and build strong foundations for public health and global health. The new statement is an invaluable road map towards these goals. The Lancet
John Stanmeyer/VII/Corbis
Mental health in China: what will be achieved by 2020?
For China’s national work plan for mental health 2015–20 see http://news.xinhuanet.com/ english/201506/18/c_134338552.htm
2548
This month, in a rural village in China, four siblings aged 5–13 years died by suicide after consuming pesticide. This sad case brought to light several major health concerns in China: the wellbeing of so-called left-behind children, whose parents are mostly migrant workers; the terrible toll, and the need for effective control, of suicide; and the broader issues of mental health in a changing society. An estimated 173 million adults in China have mental health disorders, of whom 4·3 million are registered as having severe mental health problems. Recognising the seriousness of the challenges, China released its National Mental Health Working plan (2015–20) on June 18. This plan represents a collective effort of all relevant government bodies. Prevention and treatment of depression, autism, and dementia were defined as key targets. The plan set specific goals for the next 5 years— such as more than 80% of registered patients with severe mental illnesses in “management”, with treatment reaching at least 80% of people with schizophrenia. Eligible, severely affected patients living with economic
difficulties will also receive financial support. Furthermore, the number of registered psychiatrists will be doubled to 40 000 by 2020 to provide more qualified and accessible mental health services. However, given that no explicit budget has been allocated for the plan, whether these aspirational goals are achievable remains doubtful. Importantly, the plan identifies a need to strengthen information systems, to gather evidence, to do more research in mental health, and to create an assessment system for measuring progress during the next 5 years. Worryingly, suicide prevention as well as strategies to tackle stigma and discrimination against people with mental illness were absent from the government’s plan. China’s mental health system needs to be fully integrated into all aspects of China’s national health and social policy and budget plan, health-system reform, and delivery of primary and secondary health care. Mental health is everyone’s business; and good mental health planning is the bedrock of a better future for the whole of Chinese society. The Lancet www.thelancet.com Vol 385 June 27, 2015
Ulrich Baumgarten
Reforming public and global health in Germany
For the public health statement see http://www.leopoldina.org/ uploads/tx_leopublication/2015_ Public_Health_LF_EN.pdf
Germany is not fulfilling its full potential in public and global health, according to a new statement from three of the country’s leading scientific academies. Their report— Public health in Germany: structures, developments and global challenges—was produced by an international working group of scientists who assessed what is needed to better the health of the population from the perspectives of academic public health, global health research, supporting institutions and structures, and the translation of science. Germany has had notable successes in public health in recent decades, including reductions in infectious diseases and the protection of non-smokers, but, like other countries, it faces new challenges from communicable and non-communicable diseases, an ageing population, health inequalities, and pressures on health-care systems. However, addressing these challenges is hampered by a lack of coherent structure for public health education and research in Germany, declining resources, and absence of political commitment to health policy recommendations, states the report. Furthermore, Germany has the experience
to increase its contribution to global health challenges, especially in areas such as universal health coverage and social protection, but it has not seized this opportunity. The statement makes several recommendations, including the coherent national provision of education programmes in public and global health, an emphasis on interdisciplinary research in public health, development of an innovative global health research agenda, and a commitment from academia to not only generate knowledge but also to identify ways in which it can be implemented through policy development, public dialogue, and international collaboration. That Germany lags behind in public health should be viewed in a historical context of past, as the report states, “disastrous approaches” in this area that have taken decades to recover from. However, it is still surprising that it has taken this long for the country to identify its gaps. German academia and government must now step out of the shadows and build strong foundations for public health and global health. The new statement is an invaluable road map towards these goals. The Lancet
John Stanmeyer/VII/Corbis
Mental health in China: what will be achieved by 2020?
For China’s national work plan for mental health 2015–20 see http://news.xinhuanet.com/ english/201506/18/c_134338552.htm
2548
This month, in a rural village in China, four siblings aged 5–13 years died by suicide after consuming pesticide. This sad case brought to light several major health concerns in China: the wellbeing of so-called left-behind children, whose parents are mostly migrant workers; the terrible toll, and the need for effective control, of suicide; and the broader issues of mental health in a changing society. An estimated 173 million adults in China have mental health disorders, of whom 4·3 million are registered as having severe mental health problems. Recognising the seriousness of the challenges, China released its National Mental Health Working plan (2015–20) on June 18. This plan represents a collective effort of all relevant government bodies. Prevention and treatment of depression, autism, and dementia were defined as key targets. The plan set specific goals for the next 5 years— such as more than 80% of registered patients with severe mental illnesses in “management”, with treatment reaching at least 80% of people with schizophrenia. Eligible, severely affected patients living with economic
difficulties will also receive financial support. Furthermore, the number of registered psychiatrists will be doubled to 40 000 by 2020 to provide more qualified and accessible mental health services. However, given that no explicit budget has been allocated for the plan, whether these aspirational goals are achievable remains doubtful. Importantly, the plan identifies a need to strengthen information systems, to gather evidence, to do more research in mental health, and to create an assessment system for measuring progress during the next 5 years. Worryingly, suicide prevention as well as strategies to tackle stigma and discrimination against people with mental illness were absent from the government’s plan. China’s mental health system needs to be fully integrated into all aspects of China’s national health and social policy and budget plan, health-system reform, and delivery of primary and secondary health care. Mental health is everyone’s business; and good mental health planning is the bedrock of a better future for the whole of Chinese society. The Lancet www.thelancet.com Vol 385 June 27, 2015
