>> While the central question in medicine is: What makes people sick? The central question of public health is: What keeps people healthy? Both perspectives on health and illness are essential for successful pandemic management. Both the pathogenetic, disease and risk-oriented view of medicine and the salutogenic, health and resource-oriented public health view.
The multidiscipline of public health combines all sciences that deal with health and disease. The German translation is therefore health sciences and includes medicine, nursing, sports and nutritional sciences, psychology, pedagogy, but also systems, social and communication sciences, epidemiology and biostatistics, management, health economics, ethics and a few more.
The activities of public health aim to minimize health and social inequalities and to enable as many people as possible to live as long as possible with good health and a high quality of life. The determinants of health are crucial, i.e. those factors that have a positive or negative influence on our health. In addition to our genome, age and gender, these include health behavior, our living and working environments, social networks, but also education, the labor market, the environment, housing, the rule of law, the social and health system and much more.
From a public health perspective, a pandemic is a society-wide and social event that affects all members of a society. It not only records the direct effects of the new coronavirus SARS-CoV-2, the number of people suffering from Covid-19, the hospital burden and the number of deaths, but also the countless desired and undesirable health, psychosocial and economic effects of all measures. While a purely medical-virological perspective only focuses on one virus and one disease, a public health perspective always looks at the big picture, all determinants of health, existing inequalities, but also the care of other diseases. Why this overall social perspective could not prevail in Germany and Austria is one of the many open questions.
At the treatment level, an intervention without reliable knowledge and without prior information about the effects and possible side effects would not only be unscientific and unethical, but in certain cases would also be punishable. The same applies to interventions at the societal level. As in medicine, the principle of proportionality also applies in politics: “Measures should only be taken if the desired effects occur with sufficient certainty and clearly exceed possible undesirable effects.”1 Instead of the principles of evidence-based medicine, those of evidence-based health policy apply ( “Evidence-Based Public Health”): “For this purpose, the available knowledge of the medical, economic, ethical, socio-cultural and legal aspects of diseases and measures is assessed systematically, transparently and in a targeted manner and incorporated into the decision-making processes. All steps – from problem definition to implementation of measures and programs – should be explicit, transparent and justified.”2
Both principles have been criminally neglected. In the last three years, health policy decisions have all too often been opaque, poorly justified, unscientific, unethical and disproportionate. This policy, which was perceived as arbitrary, cost a lot of trust, significantly weakened the effectiveness of pandemic management and social cohesion, and increased the collateral damage.
A good database is the basic requirement for precise risk assessment, correct risk communication and any successful risk management. It is comparable to a cockpit, in which all the necessary instruments are not only present, but also provide correct data. If instruments don't work or show incorrect values, it may still be possible to fly by sight in good weather, but at night or in fog, wrong decisions quickly occur with corresponding undesirable consequences. Germany and Austria, two of the richest countries in the world, did not have a fully equipped cockpit with precise instruments at any point during the pandemic and were flying blind far too often.
Without good data, risk management cannot be successful. But not without appropriate strategies and measures. The most serious consequence is the combination of unsuitable strategies and measures based on poor data. Better data, consideration of proportionality and assessment of the desired and undesirable effects of all measures, compliance with ethical principles, protection of fundamental rights and much more would have been possible. The thesis papers prepared by German health scientists have provided good suggestions since spring 2020,3 but were ignored by the dominant medical-virological tunnel vision.
Fighting a single health risk “at all costs” and neglecting all other determinants of health is a social derailment that must never be repeated. There is therefore no way around a comprehensive, interdisciplinary assessment of the pandemic - https://pandemieaufarbeitung.net/ -; However, this is not only a political and scientific task, but above all a task for society as a whole, in which the citizenry must also be involved. Appreciative and on an equal footing. This process will take years, requires sufficient resources and must be well moderated. Sponge about it is definitely not an option! <<