Ethische Reflexion in der Gesundheitsförderung: Partizipation und Partizipative Gesundheitsforschung

The author traces the development of the concept of health promotion from 1980s policies of the World Health Organization. Two approaches that signify the modernization of public health are outlined in detail: the European Health for All targets and the settings approach. Both aim to reorient health policy priorities from a risk factor approach to strategies that address the determinants of health and empower people to participate in improving the health of their communities. These approaches combine classic public health dictums with "new" strategies, some setting explicit goals to integrate public health with general welfare policy. Health for All, health promotion, and population health have contributed to this reorientation in thinking and strategy, but the focus of health policy remains expenditure rather than investment.

Background Teaching ethics in public health programmes is not routine everywhere – at least not in most schools of public health in the European region. Yet empirical evidence shows that schools of public health are more and more interested in the integration of ethics in their curricula, since public health professionals often have to face difficult ethical decisions. Discussion The authors have developed and practiced an approach to how ethics can be taught even in crowded curricula, requiring five to eight hours of teaching and learning contact time. In this way, if programme curricula do not allow more time for ethics, students of public health can at least be sensitised to ethics and ethical argumentation. This approach – focusing on the application of seven mid-level principles to cases (non-maleficence, beneficence, health maximisation, efficiency, respect for autonomy, justice, proportionality) – is presented in this paper. Easy to use ‘tools’ applying ethics to public health are presented. Summary The crowded nature of the public health curriculum, and the nature of students participating in it, required us to devise and develop a short course, and to use techniques that were likely to provide a relatively efficient introduction to the processes, content and methods involved in the field of ethics.

Enabling is a concept central to health promotion. It is perceived as a mechanism that can help people gain control over determinants of health. Little is known, however, about enabling among policy-makers and professionals. This case study investigates enabling among policy-makers and professionals who engaged in a specific participatory approach, cooperative planning. We define 'enabling' as creating action situations that allow policy-makers and professionals to (i) build individual capacities for health promotion and to (ii) apply these capacities to concrete organizational and political action at the institutional level. This case study followed policy-makers and professionals as they participated in a local physical activity promotion action research project in Germany. We conducted a secondary analysis of qualitative data gathered in that project (2005-2011). Methods included participant observation, document analysis, focus groups and qualitative interviews. All data were revisited for the case study and analyzed using qualitative content analysis. Findings include examples of enabling among policy-makers and professionals related to the cooperative planning process. Individual capacities were developed in perceived project roles, interactions with target groups and decision-making procedures. Findings also demonstrated municipal policy changes. Access to physical activity infrastructures improved, and an intersectoral job position was funded to support physical activity promotion among target group participants. Findings were analyzed using a model that links cooperative planning with a framework on policy change from a political science perspective. We conclude that cooperative planning might be a pathway to negotiated agreements that foster systematic enabling and health-promoting policy change.