Littérature scientifique sur le sujet « Medical policy – Social aspects – Germany »

AbstractSince 2010, Sweden has a Vision Zero policy on fire safety: no one should die or be seriously injured as a result of fire. Compared to the traffic safety model, however, the preconditions for successful implementation appear more immature and less convincing in the fire area. The purpose of this chapter is to illustrate, using the Vision Zero policy on fire safety as an example, how a Vision Zero initiative in a new area, where the conditions for governance may differ significantly from the area of inspiration, can be dealt with as a dynamic process to gradually establish credibility and effectiveness.Globally, fire is a significant cause of death and injury. The general trend is toward a slow decline, especially among middle-income and high-income countries. The decline may be due to successful fire safety efforts, but also to other conditions affecting it indirectly. Both risk-increasing and risk-reducing factors determine fire safety. Risk increasing factors include an ageing population, an increasing diversity of possible ignition sources, and a change in the composition and amount of combustible materials present in our homes. The risk-reducing factors include generally favorable socioeconomic and technological developments, including concrete societal actions directed against fire risks such as the promotion of smoke detectors and sprinkler systems.Fire safety is one of the oldest documented examples of societal risk management. City planning and construction were early influenced by fire safety considerations, while in contrast, the legal responsibility for residential fire safety has largely remained a private and individual matter. The situation is similar to the one that for long prevailed in the traffic sector, that is, the primary responsibility rests with the system’s users, not with its designers.The launch of the Vision Zero on fire safety in 2010 represented a clear boost in ambition. Along with the vision, a strategy intended to guide the work toward the visionary goal was also presented. The strategy included four items: information, technical solutions, local collaboration, and evaluation/research. Several actions were taken in line with the strategy, including a significant research effort and the development of a set of indicators to monitor progress.Ten years later, the research effort has brought new knowledge that puts previous perceptions into partly new light. The notion that survival depends on the individual’s personal capacities is strengthened. Adverse outcomes such as death and serious injury appear mainly linked to specific vulnerabilities of certain groups for medical and social reasons. Most fires are handled by the residents themselves without injuries and without assistance from Rescue Services; on the other hand, even minor fires can be fatal for vulnerable residents. This turns the problem framing toward social aspects rather than technical, since broad groups of residents lack the capacities needed, conflicting with the prevailing view that the individual should bear the primary responsibility.Other findings relate to the proven inefficiency of certain measures for groups at elevated risk and the need for re-thinking and innovations to meet the challenges ahead. This includes extended inter-sectoral collaboration on a broader spectrum of residential risks besides fire, threatening the same groups for similar social and medical reasons.This updated state of knowledge is now being used as a basis for renewing current national fire safety strategies. With reference to general principles of systems control, this chapter will discuss obstacles and challenges to establish a more robust and systematic national control of the fire problem in line with the Vision Zero policy. The appropriateness of launching Vision Zero policies in fields that are not yet ripe for systematic governance is also discussed. It is concluded that a Vision Zero initiative can still be meaningful and successfully pursued, provided that limitations in the ability to influence crucial elements in the system are openly identified and systematically addressed in a process in which strategical and policy developments interact with research and innovation.

AbstractSince 2010, Sweden has a Vision Zero policy on fire safety: no one should die or be seriously injured as a result of fire. Compared to the traffic safety model, however, the preconditions for successful implementation appear more immature and less convincing in the fire area. The purpose of this chapter is to illustrate, using the Vision Zero policy on fire safety as an example, how a Vision Zero initiative in a new area, where the conditions for governance may differ significantly from the area of inspiration, can be dealt with as a dynamic process to gradually establish credibility and effectiveness.Globally, fire is a significant cause of death and injury. The general trend is toward a slow decline, especially among middle-income and high-income countries. The decline may be due to successful fire safety efforts, but also to other conditions affecting it indirectly. Both risk-increasing and risk-reducing factors determine fire safety. Risk increasing factors include an ageing population, an increasing diversity of possible ignition sources, and a change in the composition and amount of combustible materials present in our homes. The risk-reducing factors include generally favorable socioeconomic and technological developments, including concrete societal actions directed against fire risks such as the promotion of smoke detectors and sprinkler systems.Fire safety is one of the oldest documented examples of societal risk management. City planning and construction were early influenced by fire safety considerations, while in contrast, the legal responsibility for residential fire safety has largely remained a private and individual matter. The situation is similar to the one that for long prevailed in the traffic sector, that is, the primary responsibility rests with the system’s users, not with its designers.The launch of the Vision Zero on fire safety in 2010 represented a clear boost in ambition. Along with the vision, a strategy intended to guide the work toward the visionary goal was also presented. The strategy included four items: information, technical solutions, local collaboration, and evaluation/research. Several actions were taken in line with the strategy, including a significant research effort and the development of a set of indicators to monitor progress.Ten years later, the research effort has brought new knowledge that puts previous perceptions into partly new light. The notion that survival depends on the individual’s personal capacities is strengthened. Adverse outcomes such as death and serious injury appear mainly linked to specific vulnerabilities of certain groups for medical and social reasons. Most fires are handled by the residents themselves without injuries and without assistance from Rescue Services; on the other hand, even minor fires can be fatal for vulnerable residents. This turns the problem framing toward social aspects rather than technical, since broad groups of residents lack the capacities needed, conflicting with the prevailing view that the individual should bear the primary responsibility.Other findings relate to the proven inefficiency of certain measures for groups at elevated risk and the need for re-thinking and innovations to meet the challenges ahead. This includes extended inter-sectoral collaboration on a broader spectrum of residential risks besides fire, threatening the same groups for similar social and medical reasons.This updated state of knowledge is now being used as a basis for renewing current national fire safety strategies. With reference to general principles of systems control, this chapter will discuss obstacles and challenges to establish a more robust and systematic national control of the fire problem in line with the Vision Zero policy. The appropriateness of launching Vision Zero policies in fields that are not yet ripe for systematic governance is also discussed. It is concluded that a Vision Zero initiative can still be meaningful and successfully pursued, provided that limitations in the ability to influence crucial elements in the system are openly identified and systematically addressed in a process in which strategical and policy developments interact with research and innovation.

If We Turn to Other forms of Social Policy, how does the United States care for its old, its poor, its unemployed, and its disabled? Here, most outcomes place the United States in the lower half of the spectrum, but within European norms and standards. The primary weakness of American social policy is its reluctance to deal resolutely with poverty. If we measure outcomes before redistribution, the United States starts with an economy that produces less poverty than most European nations. According to one calculation, only Finland and the Netherlands have lower “natural” poverty rates. But after taxes, social benefits, and other mechanisms of redistribution have worked their magic, the American poverty rate (as measured relatively, i.e., as a fraction of median income) is higher than anywhere in Western Europe. We will come back in more detail to the question of poverty and inequality. In what one might call the middle-class entitlement aspects of the welfare state, however, America is less of an anomaly. As is widely known, the American state is more modest in size and scope than its European peers. Yet as an employer of civil servants, it ranks in the middle of the European scale (figure 50). France and Finland employ proportionately more civil servants, but at least five other countries, including Germany, hire fewer. Correspondingly, the percentage of America’s GDP spent on government employee salaries is higher than in six of the nations we are examining. The size of the American state, as measured by government expenditure as a percentage of GDP, also fits into the European span. Ireland and Switzerland spend less (figure 51). For most social policies and benefits— which together make up what is usually called the welfare state—the picture is analogous: the United States ranks low, but within the bottom half of the European spectrum. All figures given here and elsewhere (unless otherwise indicated) are phrased in internationally comparable terms. Sometimes this means benefits rates are measured as a percentage of median income, allowing a sense of what proportion of a standard of living is maintained. Sometimes they are calculated in Purchasing Power Parity (PPP) terms, which means that differences between the cost of living in poorer and richer nations have been factored in.

This chapter tests the book’s premises on a case of mixed-member proportional representation (MMP) representation, using the case of legislative committees in the Bundestag of Germany. Its results cover the two largest parties, the Christian Democratic Union and the Social Democratic Party. German parties should have a strong tendency to use the expertise model, because the MMP system means that votes cast anywhere in the country are of approximately equal value in maximizing seats. Thus, parties are able to emphasize their national reputation for policy, for which matching the expertise of their personnel to committee function is valuable. The MMP system also creates local single-seat districts in which nearly half of members are elected. Thus, aspects of the electoral–constituency model also should apply, as parties seek to develop connections to constituencies through local and personal vote of their legislators. The results offer strong support for the premises of the theory.

This chapter introduces the books and the individual chapters, which were written by both academics and practitioners in the field in Germany and the UK. The book reflects an interest in democracy and, more pointedly, in how to express and practice citizenship, particularly in relation to helping others and generating a physical and social space for individual belonging. The book builds a narrative of how policy has failed to account for social belonging and, likewise, provide a framework for social solidarity in welfare reform though in practice the experience of belonging seems critical for instigating changes in individual behaviour and self-confidence. Part I: The Social Consequences of Welfare Policy examines policy attempts to address related aspects of poverty and consolidate a social role for the state through specified responsibilities, whether through providing health services, unemployment insurance, or other benefits. Part II: The Practice of Social Good is comprised of practitioner case studies. The section shows how grassroots activism translates abstract notions of a just society fashioned by policymakers. Part III: Social Change and Neoliberalism returns to the presentation of academic research and Part IV: Situating Solidarity in Perspective continues providing a critical platform to discuss the meaning of citizenship.

This chapter examines the origins and consequences of Medicare's peculiar bifurcated structure, focusing on the role played by former House Ways and Means Committee chair Wilbur D. Mills. It shows that fiscal conservatism has been no less central to Medicare than the commitment to social insurance principles. The chapter first reviews the scholarly literature on Medicare finance and welfare state before discussing the logic of Mills's financing design. Three aspects of Medicare's legislative design are analyzed: the financing scheme chosen for Hospital Insurance; the financing scheme chosen for Supplementary Medical Insurance; and why Medicare's financing came to be divided in the first place. The chapter concludes with an assessment of recent Medicare reform proposals that featured competing financing approaches.

In the period before the Covid-19 pandemic, it seemed that the health and insurance sys- tems of developed countries were extremely stable, functional and largely humanely organized. Constant investments in the field of health, the progress of medical research gave the impres- sion of certainty and faith that health would be one of the most valuable categories of human- ity in the future. The importance of health even reached the point that the election results, for example, in the USA in the second half of the 21st century, depended to a large extent on the health program policy. However, the Covid-19 pandemic has completely refuted these views and pointed to significant omissions, inflexibility, and even corruption when it comes to health insurance and the organization of health systems. Namely, the crisis has shown that in the EU there is no satisfactory cooperation between health systems and insurance of EU members, sufficient information of citizens about the rights and possibilities of cross-border health care, as well as clear legal form of using medical services outside the territory of the domicile state. The members of the EU, as well as those outside of it in Europe, each became well-fortified bastions where common European values almost did not exist. Everyone fought individually as he knew and was able. The situation was no better in the USA either, where the values of the famous “Obamacare” (entered into force in 2014 and introduced mandatory health insur- ance for the majority of US residents) were completely destroyed. Small and medium-sized companies began to suffer the greatest pressure, which, due to insolvency, were late in paying their employees’ health insurance, and in the middle of 2021, as many as 64% of employers in the USA reduced their health insurance coverage. As for the situation in the Republic of Ser- bia, the pandemic has shown that our health system is not as weak as we are ready to assess it. Although there is no connection between the state and private health sectors, the pandemic has shown all the flexibility and, under the circumstances, good organization. The credit goes mostly to the medical staff, who showed incredible sacrifice to keep the health system function- ing. All this shows the absence of a global defense strategy against challenges that can threaten health and the human population. The world is completely unprepared to adequately resist the challenges that pandemics like Covid-19 can bring.

The main principle of sustainability means being able to meet the needs of today’s society without compromising the ability of future generations to meet their own needs. Sustainable development implies the interdependence of its main components: society, economy, and ecology. The prosperity of a society depends on economic progress and the development of new technologies, but in a way that the natural environment is protected and preserved. This concept is inextricably linked to the concept of ecology and, consequently, to all types of transport, given that transport is considered one of the

In the past 40 years, China has experienced the largest and fastest urbanization development in the world. The infrastructure, urban environment and medical services of cities have been improved significantly. The health impacts are manifested in the decrease of the incidence of infectious diseases and the significant increase of the life span of residents. However, the development of urbanization in China has also created many problems, including the increasing pollution of urban environment such as air, water and soil, the disorderly spread of urban construction land, the fragmentation of na

Germany is a parliamentary democracy (The Federal Government, 2021) with two politically independent levels of 1) Federal (Bund) and 2) State (Länder or Bundesländer), and has a highly differentiated decentralized system of Government and administration (Deutsche Gesellschaft für Internationale Zusammenarbeit, 2021). The 16 states in Germany have their own government and legislations which means the federal authority has the responsibility of formulating policy, and the states are responsible for implementation (Franzke, 2020). The Federal Government supports the states in dealing with extraor