"From Crisis to Health in All Policies"

Discussion paper for the Poverty and Health Congress 2021

(version: 25. November 2020)

Organisational framework

The Poverty and Health Congress in 2020 had to be cancelled at very short notice due to the SARS-CoV2 pandemic. To ensure the next congress on Poverty and Health can be implemented, a significant reduction in size of the congress 2021 is necessary, in order to be able to implement as a virtual event and to provide financial security. For this reason, the Poverty and Health Congress 2021 will be planned for and implemented on three days and with a maximum of 80 events. A "satellite event" the day prior to the congress covering a major topic should be possible and is currently being examined in liaison with central partners of the congress.

Due to the dynamic developments of the SARS-CoV2 pandemic as well as providing security in the event planning and guaranteeing the implementation of the congress, it will be implemented in a virtual venue only.

The spread of the SARS-CoV2 pandemic and the resulting containment measures are now having a massive impact on all areas of our society (Leopoldina, 2020; United Nations, 2020; Zukunftsforum Public Health, 2020). At all levels, links between the social situation of people and their chances of coming through the current crisis in good health can be demonstrated (Deutsche Gesellschaft für Medizinische Soziologie, 2020). The risks and consequences of the pandemic are clearly socially unequally distributed - both in terms of exposure and vulnerability as well as in terms of care (Kompetenznetzwerk Public Health COVID-19, 2020; Dragano et al., 2020b). In the history of the Federal Republic of Germany no health problem has ever had such a significant impact on the entire society (Saboga-Nunes et al., 2020). The pandemic and its consequences will therefore remain a central focus for public health (Deutsche Gesellschaft für Sozialmedizin und Prävention, 2020).

The crisis clearly shows the necessity of an overarching approach. The complex challenges can only be overcome by joint action in all areas of politics and society. (Zukunftsforum Public Health, 2020). Findings show that disadvantages accumulate and interactions between the influencing factors (currently particularly visible in the case of gender and/or ethnicity) must be considered (Kompetenznetzwerk Public Health COVID-19, 2020). This results in numerous links to be connected for the programme of the 2021 Congress.

Health promotion is more important than ever in this time of crisis! Especially in the current situation, health-promoting and preventive measures in living environments such as companies, schools, day-care centres and nursing care are essential components in overcoming direct and, above all, indirect consequences of the current pandemic (Deutsche Gesellschaft für Public Health, 2020). Health promotion also has a leading role to play when it comes to advocating for sustainable investment in the public health system (Saboga-Nunes et al., 2020) and, for example, identifying and countering financial cuts in public health services (Zukunftsforum Public Health, 2020) and other maladministration, such as the temporary suspension of funds for prevention (Deutscher Bundestag, 2020). Based on studies, the medical sociologist Nico Dragano points out that during the last financial crisis in 2008, those countries that did not cut expenditure in the social system emerged better from it. Where, for example, prevention programmes and information campaigns were discontinued in order to realise savings, it had serious consequences (Dragano, 2020a). 

"Health is created and lived by people within the settings of their everyday life; where they play, learn, work and love" (Weltgesundheitsorganisation, 1986). In the current crisis, these framework conditions on the ground, which are shaped by politics, administration and civil society, are being put to the test. It is to be expected that where resilient and at the same time flexible, cross-sectoral structures of cooperation and collaboration have been established and expanded, it will be possible to respond better and faster to a crisis in order to provide good support and care for the population in such times and to respond to the health consequences of containment measures. On the one hand, to maintain the status quo of health care and health promotion support as best as possible, and on the other hand, to mitigate the consequences and impacts of the crisis on all areas of life (work, education, health, housing, etc.). The recent crisis clearly reveals the gaps and failures in the development and expansion of cross-sectoral strategies and structures for health promotion and prevention, e.g. in the education sector, in environmental and climate policy, in the provision and support of vulnerable target groups, such as refugees, homeless people, (single parent) workers* in the low-wage sector, or older people with health impairments.

At the Poverty and Health Congress 2017, Richard Wilkinson presented how and to what extent the costs of inequality in today's societies can be estimated. For example, in (income) more unequal societies, mental health problems, drug use, obesity, violent behaviour and imprisonment, as well as teenage pregnancies increase. Child well-being, on the other hand, decreases, as do school achievement and social mobility (Waldhauer et al., 2018). Therefore, a central question from the public health perspective will be whether we succeed in preventing inequalities in our society from growing further despite the crisis, or - even better - whether we can reduce it.

We know that this pandemic, too, is neither spreading nor behaving democratically. People in socially disadvantaged structures are affected more often and to a greater extent. Existing differences increase and new inequalities emerge. One can speak of a "hierarchy of need" (Sell, 2020). Efforts need to be made by society as a whole and across all departments to cushion the effects of this crisis in the short, medium and long term in order to prevent the social gap from growing bigger and to ensure social participation for all groups in the long term. In this context solidarity and social participation are essential and not something that happens by itself. This is imperative both at the institutional and statutory level (e.g. pay-as-you-go social insurance schemes, ...) and at the level of social production (neighbourhoods, ...).

The social trend towards "individualisation" has led to the dismantling of the welfare state and the economisation of the health care system (Prainsack, 2010). This is also linked to the norm of acting independently and making decisions for one's own health. With the spread of the pandemic a change in public discourse is taking place: "All together feel how vulnerable they are" (Bude, 2020). This should be built on; since it is different with non-communicable diseases, which were already responsible for 86% of deaths and 77% of the disease burden before the pandemic, at least in the World Health Organization European Region (Weltgesundheitsorganisation, 2012). For these diseases, the risk or the responsibility is still highly individualized. 

If we take a closer look at the history of the origin of this pandemic, we can also see that climate protection and health are inseparably linked. The lung disease Covid-19 caused by the virus is a zoonosis; by definition, these are diseases that are transmitted from animals to humans (Deutsches Zentrum für Infektionsforschung, 2020). For example, rising temperatures allow the spread of vectors of certain infectious diseases (Deutsche Allianz Klimawandel und Gesundheit, 2020). These arise from an interplay between pathogens, infected organisms and the natural and social environment. The progress of humans into unspoiled habitats will further promote outbreaks of zoonotic diseases (Zukunftsforum Public Health, 2020). However, even beyond the zoonotic history of the pandemic, climate change is a central challenge for the well-being of our societies and the elements that shape it (mobility, consumption, etc.).

The medium and long-term management of the pandemic and its consequences requires not only virology and epidemiology but also expertise from public health, ethics, law, psychology and other disciplines, in research and (applied) practice alike (Zukunftsforum Public Health, 2020). Next years´s Poverty and Health Congress will be restructured following the Ottawa Charta (WHO, 1986), whose relevance is evident in the current pandemic situation. The fields of action developed therein, structure the upcoming congress into five thematic areas: Built healthy public policy; Create supportive environments; Strengthen community action; Develop personal skills; Reorient health services. 

The pandemic also prompts us to readjust the central challenges for public health: Solidarity (social closeness despite physical distance) and social participation are urgently needed in this crisis; health communication and sustainable relational behavioural prevention are at the heart of the acute measures for coping with the crisis; prevention, curative care and nursing must be geared to communicable as well as non-communicable diseases.

The Poverty and Health Congress would like to contribute to the current development of a public health strategy for Germany, currently led by the Future Forum Public Health. The aim is to develop solution strategies for how we, as a public health community, can make a stronger contribution to reducing socially induced inequalities in health opportunities. The discussion paper serves as a framework to identify key questions and fields of action for the link between poverty and health, which also arise from the containment and consequences of the coronavirus pandemic.

The current crisis offers the opportunity to initiate and accompany long-term change processes! Once again, we provide the platform and we cordially invite you to participate! 

Fotos: André Wagenzik & Icons: Do Ra / fotolia.com