soziale stadt - bundestransferstelle
besonderem Entwicklungsbedarf - Soziale Stadt"
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5.7 Health Promotion
Poverty remains a serious health risk in Germany.(1) The reason for this is twofold. Worsening social conditions have led to a significant increase in health-related problems. This trend has been accompanied by a reduction in the personal, economic and social resources designed to help reduce these risks.(2) In addition, preventive medical services and health promotion primarily target the middle class and therefore rarely benefit the more disadvantaged sections of the population.(3) Unhealthy behavioural patterns – smoking, alcohol and drug abuse, poor eating habits, lack of exercise and very often aggressive tendencies – frequently aggravate the situation further.
Since the adoption of the World Health Organization's (WHO) Ottawa Charter for Health Promotion in 1986 and the founding of the German Healthy Cities Network (4) in 1989, the link between poverty and health problems has gradually received more attention in Germany . The national "Poverty and Health" congress, held in Berlin since 1995, reflects this interest. The connection between health promotion and social urban district development has been moving up the congress agenda in recent years.
In spite of this, health has been a very low priority in the programmes launched so far. The involvement of health authorities in the implementation of these programmes greatly increases the relevance of the issue at hand. For example, as a result of the participation of municipal health authorities in the drafting of integrated action plans (in 43 districts), the number of districts incorporating health-related measures into their programmes rose from just under 30 percent to about 60 percent.
The cross-sectional character of the health sector means that measures taken in other fields frequently have a bearing on health. This must be taken into consideration when evaluating findings.(5) A range of projects concerning the environment, transport, living conditions and public space are helping to reduce environment-related health problems. A number of sports initiatives are also promoting healthy living. Job creation programmes equally have a positive effect on health by improving the financial situation of district residents and boosting their self-esteem.(6)
Health-related problems and resources in districts
Relatively little attention is devoted to the issue of health when citing problems. There are several reasons for this. Firstly, it is not a topic which is deemed particularly important in traditional urban regeneration programmes.(7) A possible second reason is that most survey respondents came from urban planning backgrounds and therefore tended to attribute environmental health problems (8) to pollution and deficits in living conditions. For example, respondents refer to traffic and noise pollution, rather than the health risk posed by noise.(9) We must therefore assume that the actual proportion of health problems in the districts is considerably higher.
The same conclusion can be drawn from the findings in pilot districts. Health problems were reported in 14 of these areas. Children and young people appear to be hardest hit. Complaints include obesity, bad posture, respiratory diseases, tooth decay, allergies and motor and speech development disorders.(10) In some areas, such as the pilot district of Hamburg-Altona–Lurup, children's health is so neglected that they even display symptoms of deprivation. "According to employees of schools, childcare centres and youth clubs, many children are severely undernourished, especially when they return after the weekend.(11) In the pilot district of Berlin-Kreuzberg–Kottbusser Tor, this problem is even more pronounced. According to the neighbourhood management, "severe malnourishment is a common problem. Children of all nationalities scavenge alongside homeless adults for morsels of discarded food.(12) Furthermore, residents in about a third of the pilot areas are reported to have serious problems with drug addiction.
In addition to socially related health problems, nearly half of the pilot districts reported environmental health hazards. Road congestion and the accompanying noise pollution, noxious emissions and increased accident risk are the most commonly cited examples. Furthermore, these districts often have very few parks and open spaces, particularly in areas with pre-war housing. This has a detrimental effect on the living environment of district residents and leaves children and young people with little space for recreation, exercise and relaxation. Unlike the United States , Germany has done very little research into the extent to which these environmentally determined health risks reflect an unequal sociospatial distribution of ecological problems.(13)
In the nationwide survey, pilot districts also made very little reference to ways to develop health-related resources. Only seven percent of districts identified health promotion schemes as a way to combat health problems. The onsite programme support teams have also generally failed to highlight ways to promote health in pilot districts.
District strategies for preventive medicine and health promotion
Health sector projects and measures focus on providing preventive medicine and supporting health promotion services.(14) The living space and the day-to-day lifestyles of district residents are usually considered to be particularly important factors. The method of targeting particular districts is similar to the WHO's "Setting Approach", adopted in the mid-1980s to support preventive medicine and health promotion.(15)"Settings" are living environments and the specific social and organizational structures in which residents spend the majority of their time and develop lifestyles which have a bearing on their health. These structures include schools, workplaces, districts and neighbourhoods. District-specific approaches to preventive medicine and health promotion in programme areas aim to develop low-threshold services targeting hard-to-reach groups and encourage closer collaboration between health authorities by building networks.
The main impulse behind the development of low-threshold services for selected target groups was the observation that traditional preventive medical and health promotion services primarily target the middle class and often fail to reach the more disadvantaged sections of society whose health is particularly at risk. The new services are intended to take better account of the living conditions of the underprivileged which impact on their health and the personal and social resources available to this group. Experience has shown that the best results are achieved when – following the example of the Setting Approach – these services are provided in district buildings and facilities which are familiar to the target groups. Venues include schools, childcare centres, clubs, mosques and other social and religious institutions.
These services and schemes are of particular importance to children and young people – because they often suffer from serious health problems and have the potential to lead perfectly healthy lives, potential which should be activated and maintained. Youth work mainstays include onsite projects which serve nutritious meals and raise awareness of the relationship between wholesome food and good health, exercise programmes and schemes to prevent violence and addiction.(16)
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Fig. 53/54: |
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The Children's Canteen “The Best Way to Children's Minds is Through Their Stomachs“ in Wuppertal-Ostersbaum The neighbourhood children's canteen targets primary school children aged from six to twelve. Many children buy their lunch at fast food outlets and often fail to do their homework or do it badly. The canteen provides children with a hot meal and offers them support and guidance with their homework and a place for unstructured free time. The service provided by the canteen gives structure to the day-to-day lives of children neglected by their families and the chance to mix with children of the same age. The project is supported by various organizations in the district (see table to right of picture). |
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Other measures target women in the district and give them the opportunity to obtain information and advice on how to improve their health.(17) The primary aim is to encourage women to take responsibility for their own health, practise “healthy living” (with regard to nutrition and personal hygiene) on a day-to-day basis and take advantage of any additional medical services they might need. Many activities are also intended to make mothers more aware of the role they play in health promotion and its relevance to the well-being of their children. Women-only programmes often target immigrants. (18)Women from these groups are frequently ill-informed on health issues, since a poor grasp of the language and a traditional understanding of their cultural and social roles often prevent them from gaining access to the information they require and receiving the quality of healthcare they need. Besides publishing information in their native languages and organizing open courses and discussion groups, visiting women in their homes and giving them direct advice on health issues in their families have proved to be the most successful ways of combating this problem.
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Fig. 55/56: |
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Gelsenkirchen-Bismarck/Schalke-Nord Health Centre The health centre was founded in mid-1997. The project is supported by the Westfalen-Lippe pharmacy group (district of Gelsenkirchen), the Gelsenkirchen hospital association, the utility companies Emscher Lippe Energie GmbH and Gelsenwasser AG, the municipal authorities and the Volksbank eG Gelsenkirchen-Buer. The centre holds regular courses, talks and special events. These include exercise classes for women or for mother and child and "healthy living" days. Its programme focuses particularly on projects for children and young people (talks on AIDS, aggression management training, health promotion for pre-school children). Turkish women in the district are another of the centre's target groups. It offers them a weekly discussion group with childcare facilities as well as swimming and gymnastic courses in which the trainer wears a veil. |
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The aim of building networks to support district health promotion (19) is to establish cooperative neighbourhood alliances to improve health, backed jointly by health authorities and district health promoters. Possible partners for these alliances include the public health department, non-governmental health and community organizations, self-help groups, doctors, pharmacists, health insurance companies, sports clubs, schools and childcare centres. Experience has shown that cooperation such as this often provides the first opportunity for the various bodies and organizations to meet, exchange different points of view and ideas about health promotion and plan future joint projects for the district.
(1) Cf. e.g. Bundesministerium für Arbeit und Sozialordnung (Ed.), Lebenslagen in Deutschland. Der erste Armuts- und Reichtumsbericht der Bundesregierung, Berlin 2001; Andreas Mielck, Soziale Ungleichheit und Gesundheit. Empirische Ergebnisse, Erklärungsansätze, Interventionsmöglichkeiten,, Bern 2000. 
(2) Cf. e.g. Birgit Babitsch, Was macht arme Frauen krank?,, in: Raimund Geene and Carola Gold (Eds.), Gesundheit für Alle! Wie können arme Menschen von kurativer und präventiver Gesundheitsversorgung erreicht werden?, Berlin 2000, p. 130 ff (Materialien für Gesundheitsförderung, Volume 4).
(3) Rainer Grahlen and Sybille van Os-Fingsberg, Lernen mit, Herz, Hirn und Hand. Kommunikation auf dem Weg zur Gesundheit, in: Geene/Gold, p. 90.
(4) For more information, visit http://www.Gesunde-Staedte-Netzwerk.de.
(5) Interaction between policy areas was not covered in this survey, which had virtually no interdisciplinary component. The cross-sectional orientation of individual sectors often only became clear in the course of programme implementation.
(6) E.g. Ingeborg Junge-Reyer, Gesellschaftliche Strategien gegen Armut,, in: Geene/Gold, p. 32.
(7) A research project on "Health Promotion, Citizen Involvement and Urban Development", conducted by the Institute for Medicine and Sociology at the Hamburg-Eppendorf university clinic, investigated the importance of health issues in the Osterkirchenviertel district of Hamburg–Altona. The findings showed that health was a very low priority indeed. Cf. Alf Trojan, Brigitte Stumm, Waldemar Süß and Ines Zimmermann, Soziale Stadtentwicklung. Eine intersektorale Aufgabe für die Gesundheitsförderung,, in: Horst Heinemann (Ed.),Stadtentwicklung und Gesundheit, Frankfurt a. M. 1998, p. 23 f.
(8) Differentiating between socially and environment-related health problems is an integral component of a socioeconomic health model. This model is the theoretical foundation of the 1986 World Health Organization (WHO) Ottawa Charter's guiding principles of health promotion. Cf. Trojan/Stumm/Süß/Zimmermann, p. 15.
(9) The research project, conducted by the Institute for Medicine and Sociology at the Hamburg–Eppendorf university clinic, (cf. footnote 13) (Trojan/Stumm/Süß/Zimmermann, p. 23 ff.) also established that, although traffic and environmental pollution were identified as problems in the renewal projects investigated, their potentially detrimental affect to health was not acknowledged.
(10) For general information on disadvantaged children and young people's state of health: B. Hock, G. Holz and R. Simmedinger, Gute Kindheit – Schlechte Kindheit? Armut und Zukunftschancen von Kindern und Jugendlichen in Deutschland, Abschlußbericht zur Studie im Auftrag des Bundesverbandes der Arbeiterwohlfahrt, Institut für Sozialarbeit und Sozialpädagogik,, Frankfurt 2000; Bezirksamt Mitte von Berlin, Abteilung Gesundheit und Soziales, (Ed.), Gesundheitliche und soziale Lage der Schulanfänger in Berlin-Mitte,, Berlin, November 2001, p. 34 ff.; Bundesamt für Strahlenschutz (Ed.), Dokumentation: Forum Kinder-Umwelt und Gesundheit. Eine Veranstaltung im Rahmen des Aktionsprogramms Umwelt und Gesundheit am 23. und 24. November in München, s.l, n.d.
(11) Breckner/Herrmann/Gonzales/Läpple, p. 41.
(12) Beer/Musch, “Stadtteile ...“, p. 46.
(13) Werner Maschewsky, Umweltgerechtigkeit herstellen. Neue Strategien an der Schnittstelle von Umwelt, Gesundheit und Sozialpolitik, in WechselWirkung, H. 6 (2002), p. 38 f.
(14) While preventive medicine provides targeted protection from illnesses and medical complaints by reducing the chance of damage and risk to health, the main goal of health promotion is to build up resources which support the improvement of people's health. These resources target individuals and also, more generally, all social classes. Cf. Ulla Walter, Friedrich Wilhelm Schwartz and Friederike Hoepner-Stamos, Zielorientiertes Qualitätsmanagement und aktuelle Entwicklungen in Gesundhetsförderung und Prävention, in: Bundeszentrale für Gesundheitliche Aufklärung (Ed.), Qualitätsmanagement in Gesundheitsförderung und Prävention. Grundsätze, Methoden und Anforderungen, Köln 2001, p. 23 (Forschung und Praxis der Gesundheitsförderung), Volume 15.
(15) Cf. Eberhard Göpel, Gesundheit fördern durch bürgerschaftliches Engagement. Aktuelle Ziele und Voraussetzungen für eine Neuordnung öffentlicher Gesundheitspolitik,, in: WechselWirkung, H. 6 (2002), p. 16.
(16) Cf. e.g. the following projects in the database: School Meals in Bremen-Schwachhausen, Restructuring of the Mümmelmannsberg Education Centre Cafeteria in Hamburg-Mitte–Mümmelmannsberg, Affordable Meals in Lüneburg-Alenmoor, Gelsenkirchen-Bismarck/Schalke-Nord Health Centre and The Best Way to Children’s Minds is Through Their Stomachs – The Children's Canteen in Wuppertal-Ostersbaum.
(17) Cf. e.g. the following projects in the database: Luruper Women's Oasis in Hamburg-Altona–Lurup, Gelsenkirchen-Bismarck/Schalke-Nord Health Centre, Mother and Child Exercise Group in Recklinghausen-Hochlarmark and Guardian Angels Club – Health and Social Support for Expectant Mothers and Young Families in the District in Flensburg-Neustadt.
(18) Cf. e.g. the following projects in the database: the Bayoumahaus Intercultural Centre Health Project in Berlin-Friedrichshain–Boxhagener Platz and Gelsenkirchen-Bismarck/Schalke-Nord Health Centre.
(19) E.g. Dorothea Stappert and Marianne Leßmann, Aktionsbündnis Gesundheit. Kooperative Gesundheitsförderung in einem benachteiligten Stadtquartier. Knappenviertel Oberhausen,, in: Ministerium für Arbeit, Soziales und Stadtentwicklung, Kultur und Sport des Landes Nordrhein-Westfalen (Ed.), Quergedacht – Selbstgemacht. Integrierte Handlungsansätze in Stadtteilen mit besonderem Erneuerungsbedarf. Dokumentation zur Veranstaltung am 21 October 1999 in Köln-Kalk, Düsseldorf 2000, p. 40–43, as well as the following projects in the database: Working Towards a Healthy Heimfeld – Network for Neighbourhood Health Promotion in Hamburg-Harburg–Heimfeld-Nord.
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Translated from: Soziale Stadt - Strategien für die Soziale Stadt, Erfahrungen und Perspektiven – Umsetzung des Bund-Länder-Programms „Stadtteile mit besonderem Entwicklungsbedarf – die soziale Stadt", Deutsches Institut für Urbanistik 2003 |
Im Auftrag des BMVBS vertreten durch das BBR. Zuletzt geändert am 01.11.2006