Cover_WHO_nr24_Mise en page 1 10/11/11 13:40 Page1 24 This book explores some of the key challenges facing Austria’s public health system. It PUBLIC HEALTH IN AUSTRIA PUBLIC HEALTH AN ANALYSIS OF THE STATUS OF PUBLIC HEALTH OF THE STATUS OF AN ANALYSIS examines how, over the last 50 years, the Austrian system has developed, and adapted and 24 how improved standards of living and education, and important advances in health care and Public Health medicine, have benefited the population. But the study also questions some of those developments and poses significant questions as to how the system needs to adapt to deal with the challenges presented by life in the 21st Century. The book sets Austria firmly within context by outlining the history of public health in in Austria developed countries, and examining the scope, functions and responsibilities of public Observatory health. The relevant structures and actors, and key sectors, are discussed and an up-to-date Studies Series overview of education, training and research in the field is presented. The Austrian public health system is then analysed in detail and the book draws on national An analysis of the status research and expert interviews to present a fully-rounded picture of the current situation of public health within the country. The resulting research finds that the public health system, which is still at a comparatively early stage of development, is struggling to maintain essential services and develop policies for improvement. The study suggests ways in which strategies and Edited by policies can be formulated to tackle these developments, and looks, in particular, at change within the fields of education, research and training. Joy Ladurner The book looks at such key areas as: Marlene Gerger • public health services (including health promotion and disease prevention, but also health Walter W. Holland care services) Elias Mossialos • information management and health reporting • health targets Sherry Merkur • public health training and research Susie Stewart • addressing disadvantaged and special needs groups. Rachel Irwin The final section provides recommendations for further improvement. Jürgen Soffried This book is essential reading for policy-makers, advisers and analysts interested in developing a public health strategy and competence in both developed and developing countries, as well as researchers interested in the Austrian health system. Jürgen Soffried Irwin and Rachel Susie Stewart, Merkur, Sherry Elias Mossialos, Holland, Walter W. Marlene Gerger, Ladurner, Joy by Edited The editors Joy Ladurner – Department of Social Policy, London School of Economics and Political Science, London. Marlene Gerger – Public Health Unit, Institute for Health Promotion and Prevention, Graz. Walter W. Holland – London School of Economics and Political Science, London. Elias Mossialos – LSE Health, London School of Economics and Political Science, London. Sherry Merkur – LSE Health, London School of Economics and Political Science, London. Susie Stewart – Faculty of Public Health, Royal Colleges of Physicians of the United Kingdom, London. Rachel Irwin – Department of Global Health and Development, London School of Hygiene & Tropical Medicine. Jürgen Soffried – Public Health Unit, Institute for Health Promotion and Prevention, Graz. Observatory Studies Series No. 24 Public health in Austria The European Observatory on Health Systems and Policies supports and promotes evidence- based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues. The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden and the Veneto Region of Italy, the European Commission, the European Investment Bank, the World Bank, UNCAM (French National Union of Health Insurance Funds), the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Public health in Austria An analysis of the status of public health Edited by Joy Ladurner, Marlene Gerger, Walter W. Holland, Elias Mossialos, Sherry Merkur, Susie Stewart, Rachel Irwin and Jürgen Soffried Keywords: PUBLIC HEALTH PUBLIC HEALTH PRACTICE – standards PUBLIC HEALTH ADMINISTRATION HEALTH POLICY PROGRAM EVALUATION AUSTRIA © World Health Organization 2011, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests about publications to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. 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The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies or any of its partners. ISBN 978 92 890 0249 3 Printed in the United Kingdom Cover design by M2M Contents Foreword ix Acknowledgements xi List of tables and figures xiii List of abbreviations xv About the authors xix Methodology xxi 1. Introduction 1 1.1 History 1 1.2 The German experience 2 1.3 The history of public health in developed countries 3 Late 19th century 3 Before the First World War 4 Between the wars 4 After the wars 5 Recent and current issues in public health 5 1.4 Scope, functions and responsibilities of public health 6 Addressing determinants of health 6 Scope and responsibilities 8 1.5 Structure of public health 9 National and local structures 9 Supranational and international structures 12 Other actors and sectors 13 Multidisciplinary public health 14 1.6 Education, training and research 15 1.7. Examples of public health in practice – selected issues 16 Coronary heart disease 16 Abortion and fertility 17 Violence 17 Reference to country examples 17 1.8 Conclusions 17 2. Analysis of the Austrian public health system 19 2.1 Introduction and definitions 19 Core functions of public health – a brief overview 19 Notions of public health in Austria 22 Experts’ opinions on the definition and understanding of public health 26 vi Public health in Austria 2.2 Legislation 30 2.3 Funding 36 Legislation 36 Research and literature 38 Funding of public health-related services – overview 38 Funding of selected public health services and activities 40 2.4 Organization, structures and stakeholders 42 2.5 Public health disciplines, training and research – key functions 55 Public health disciplines 55 Public health training and research structure 58 Functions of public health in Austria 60 2.6 Challenges and priority areas for public health in Austria 80 Health and disease in Austria 80 Challenges and priority areas for public health based on expert opinion 98 2.7 Conclusions 104 3. Information management and health reporting 107 3.1 Introduction 107 3.2 Legislation 110 3.3 Stakeholders 112 3.4 Health information systems 115 3.5 Data protection 115 3.6 Data surveillance and data analysis 116 3.7 Health reporting 118 Definitions and targets of health reporting 118 Development of health reporting in Austria 121 Infrastructure 122 Producers of health reports 123 Time spans between reporting 124 Contents of reports 124 Influence of international reporting activities 125 Follow-up measures, evaluation and sustainability 125 Success factors for health reporting 126 Ideal health reporting versus current practice in Austria 128 Trends 129 The role of social insurance in health reporting 132 3.8 Infectious diseases 133 Legislation on infectious diseases 134 Mandatory reporting of notifiable infectious diseases 135 Surveillance of infectious diseases 136 Early-warning systems 138 Outbreak control 139 Reporting and control of infectious diseases in practice 139