Geffert Karin, Voss Stephan, Rehfuess Eva, Rechel Bernd
Chair of Public Health and Health Services Research, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany.
Pettenkofer School of Public Health, Munich, Germany.
Health Res Policy Syst. 2024 Dec 5;22(1):161. doi: 10.1186/s12961-024-01231-6.
In response to climate change-induced increases in heat periods, the WHO recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are implemented neither comprehensively nor nationwide. Several recommendations have identified the public health service (PHS) at municipal and federal state levels as a key actor regarding to heat and health. Therefore, this study aimed at assessing the role of the PHS in implementing HHAPs at municipal and federal state levels in Germany.
We conducted a policy document analysis to assess the legal basis for the work of the PHS in the 16 federal states in Germany. Furthermore, we conducted semi-structured interviews with 16 experts from within and outside the PHS to explore their perceptions of the PHS in the implementation of HHAPs. The interviews were analysed using reflective thematic analysis.
The policy document analysis revealed that heat is not mentioned in any of the federal states' regulatory frameworks for the PHS, while tasks related to environment and health are addressed, but tend to remain vague. The interviews confirmed that there is currently no clearly defined role for the PHS in implementing HHAPs in Germany and that the actual role primarily depends on the local setting. Main barriers and facilitators could be assigned to three levels (individual, organizational and political), and two overarching contextual factors (awareness of the need for adaptation and existence of other public health emergencies) influenced the implementation of HHAPs across all levels. At the individual level, motivation, knowledge and competencies, and previous experience were possible barriers or enablers. At the organizational level, administrative structures, financial and human resources, leadership and networks were barriers or facilitators, while at the political level they included legislation and political decisions.
The PHS could and should be a relevant actor for implementing measures addressing health and climate change locally, in particular because of its focus on vulnerable populations. However, our findings suggest that the legal basis in the federal states of Germany is insufficient. Tailored approaches are needed to overcome barriers such as rigid, non-agile administrative structures and competing priorities, while taking advantage of facilitators such as awareness of relevant actors.
为应对气候变化导致的炎热期增加，世界卫生组织建议实施热健康行动计划（HHAPs）。在德国，热健康行动计划既未全面实施，也未在全国范围内推行。多项建议已将市和联邦州层面的公共卫生服务（PHS）确定为应对炎热与健康问题的关键行为主体。因此，本研究旨在评估公共卫生服务在德国市和联邦州层面实施热健康行动计划中的作用。
我们开展了一项政策文件分析，以评估德国16个联邦州公共卫生服务工作的法律依据。此外，我们对公共卫生服务机构内外的16名专家进行了半结构化访谈，以探讨他们对公共卫生服务在实施热健康行动计划中的看法。访谈采用反思性主题分析法进行分析。
政策文件分析表明，德国任何一个联邦州针对公共卫生服务的监管框架中均未提及炎热问题，尽管涉及环境与健康的任务有所提及，但往往仍较为模糊。访谈证实，目前德国公共卫生服务在实施热健康行动计划方面没有明确界定的角色，其实际作用主要取决于当地情况。主要障碍和促进因素可归为三个层面（个人、组织和政治），两个总体背景因素（适应需求意识和其他突发公共卫生事件的存在）影响了热健康行动计划在各级的实施。在个人层面，动机、知识和能力以及以往经验可能是障碍或促进因素。在组织层面，行政结构、财政和人力资源、领导力和网络是障碍或促进因素，而在政治层面，它们包括立法和政治决策。
公共卫生服务可以而且应该成为在当地实施应对健康与气候变化措施的相关行为主体，特别是因为其关注弱势群体。然而，我们的研究结果表明，德国联邦州的法律依据不足。需要采取量身定制的方法来克服诸如僵化、不灵活的行政结构和相互竞争的优先事项等障碍，同时利用相关行为主体意识等促进因素。
