[Urban Health (StadtGesundheit): The Wider Perspective Exemplified by the City State of Hamburg]

Public health and city planning have common roots, and in many places they are now reuniting under the heading of urban health. To organize this field adequately requires a broad, integrative view of medical care, health promotion, and health in all urban policies. Given current crises and developments including climate change and globalization, such a wider perspective should also be useful for Germany. Using the City State of Hamburg as an example and combining historic and systematic approaches, we explore the preconditions for in-depth analyses. Our results show that health is a significant topic of Hamburg urban policy, featuring a broad range of structures, processes and actors, both within the health sector and far beyond. Health promotion over the last 30 years evolved notably from a niche topic into an established field with remarkable cooperative structures. The tradition of comprehensive reporting on urban health in Hamburg that was initiated more than 200 years ago is no longer alive today. However, local health reporting keeps integrating a wide range of diverse topics. Communication among the Hamburg health actors - beyond straightforward medical quality assurance - does not seem to focus on critical evaluations, e. g. concerning social and ecologic sustainability. A prerequisite for in-depth analyses including external comparisons is to secure permanent access to relevant sources. Robust approaches to this end, however, seem to be lacking.

[Memorandum on sustainable reinforcement of prevention and health promotion: challenges at the federal, state and local level]

Research-based evidence and practice-based experience are core requirements for the effective implementation of preventive interventions. The knowledge gained in the Prevention Research Funding Initiative of the German Federal Ministry of Education and Research (2004-2013) was therefore amalgamated, reflected and consolidated in the Cooperation for Sustainable Prevention Research (KNP) meta-project. In annual strategy meetings, researchers and practitioners from the field and other experts developed 3 memoranda providing recommendations for the further development of research and practice in the field of prevention and health promotion. Memorandum III is primarily aimed at decision-makers in politics and administration at the federal, state and local level, in civil society and in the workplace. Its recommendations show that structuring efforts are urgently needed to achieve sustainable policy, particularly in the fields of health, education, employment and social affairs. Memorandum III brings together the knowledge extracted and problems identified in research projects. More so than its 2 predecessors, Memorandum III abstracts knowledge from the individual projects and attempts to derive guidance for action and decision-making, as shown by the 7 recommendations that appear to useful for consensus-building in practice and research. Value judgments are inevitable. Prevention and health promotion are an investment in the future: of social health, social capital and social peace. Improvement of the framework conditions is needed to achieve the harmonized awareness and the sustained effectiveness of these structure-building efforts in different policy areas, spheres of life, fields of action, and groups of actors. This includes the implementation of an overall national strategy as well as the expansion of sources of funding, extension of the legal framework, overarching coordination, and the establishment of a National Center of Excellence to develop and safeguard prevention and health promotion. The memorandum is intended to stimulate a discourse resulting in structure-building and stabilizing measures designed to ensure the sustainability of prevention and health promotion.