Foreign empirical studies identify almost equal two factors with regard to primary care in remote areas: the recruitment of students from rural areas combined with special educational programs with a rural primary care orientation both in under- and postgraduate medical education. These programs should include several and longer practical working periods in primary care units and be well coordinated between the medical school and the local teaching physicians. As for the state public health sector, comparable initiatives are still lacking.

The discussion on the development of public health affairs was invigorated anew by the report on public health in Germany of Leopoldina/Acatech/Union of the German Academies of Sciences and Humanities of the year 2015. The report urges strengthening of public health and global health in Germany and addresses explicitly the Public Health Service (PHS). This indispensable inclusion of the PHS in further strategic planning offers for the first time an opportunity for a comprehensive and sustainable practice/policy transfer on the federal, state and community level, and also a chance for a sustainable network with modern academic public health institutions together with representation of medical specialization in public health at universities, that has been absent so far. A Johann-Peter Frank model for cooperation and stepwise modelling of this transition with the inclusion of the Academies for Public Health Service is presented.

Zusammenfassung Der bev?lkerungs- bzw. systembezogene Ansatz von Public Health ist ein kritisches Element f?r die nachhaltige Weiterentwicklung eines Gesundheitswesens und zur Verminderung gesundheitlicher Ungleichheiten. Er ist angesichts der globalen gesundheitlichen Herausforderungen unverzichtbar. Die Bedeutung von Public Health f?r die Gesundheit der Menschen wird in Deutschland jedoch institutionell nur unzureichend widergespiegelt. Dies gilt f?r Forschung und Lehre, den ?ffentlichen Gesundheitsdienst und auch f?r Querschnittsbereiche, in denen Public Health nicht ausreichend repr?sentiert ist. In der Vergangenheit gab es verschiedene Initiativen, um die historisch bedingten strukturellen Defizite in Deutschland aufzuarbeiten und die Rolle von Public Health zu st?rken. Das hier vorgelegte White Paper soll eine Diskussion ?ber zuk?nftige gesundheitspolitische Handlungsoptionen anregen. Die Autorinnen und Autoren sind in Praxis, Forschung und Lehre von Public Health in Deutschland aktiv.

Zusammenfassung Im Zuge eines Konjunkturpaketes haben sich Bund und Länder auf einen 4 Milliarden Euro schweren Pakt für den Öffentlichen Gesundheitsdienst (ÖGD) verständigt, um den ÖGD personell wie infrastrukturell zu stärken. Eine zentrale Rolle spielt die nachhaltige Stärkung des ÖGD zur Sicherstellung gesundheitlicher Schutzaufgaben zur Krisenbewältigung. Damit der ÖGD die ihm obliegende komplexe Aufgabe der gesundheitlichen Daseinsfürsorge vor Ort langfristig und qualitativ hochwertig ausfüllen kann, wird es notwendig sein, bestehende Strukturen zu optimieren, so dass akute Bedrohungssituationen ebenso wie eher langfristig und strategisch ausgerichtete Planungsaufgaben souverän gemeistert werden können.

Refugees continue seeking sanctuary in Germany and it can reasonably be expected that their health will be affected by the conditions they lived in before and during flight. Ensuring nationwide care for refugees should be demand oriented, effective and efficient, which requires tackling mostly similar challenges a community level in a consistent manner. The aim must be providing adequate medical care based on the principle of respect for human dignity and ensuring public health standards. Within the currently situation, this basic expectations are often not sufficiently met. Generally accepted national standards, longer-term strategies and sustainable care are not yet achieved noticeably by public health services in Germany.To warrant permanent and sustainable high-quality medical care for refugees, local networks of involved institutions should be established with a longer-term perspective. Moreover, the financially eroded and personnel thinned public health service will only be able to fulfil statutory requirements and expectations of the local, state and federal policy makers for a limited amount of time only. Safeguarding that services are coping with the size of challenges over longer periods of time and anchoring the acquired expertise of medical care for refugees within the public health services, requires immediately better financial and personnel resources. Then the public health services will be a reliable partner supporting all people in Germany, particularly those that require subsidiary and socially-compensatory supply.