[Psychiatry without coercion-Exclude the coercion or the patients?] / Psychiatrie ohne Zwang ­ den Zwang ausschließen oder Patient:innen?

BACKGROUND: With reference to the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), a fundamental change in psychiatric care in Germany was proposed in 2019 by Zinkler and von Peter, supported by a legal perspective from Kammeier, which has since led to controversial debates. Essentially, the aim is not only to reduce coercion in psychiatry to a minimum, but also to fundamentally exclude it in a psychiatry that only provides care. The function as an agent of social control is to be returned from psychiatry to state institutions. Psychiatric hospitals will only admit patients with their consent; patients who refuse therapy will not be admitted regardless of their capacity for self-determination and will remain untreated or, if they have committed a criminal offence or threaten to commit a criminal offence, they will be taken into custody or imprisoned in accordance with the legal regulations applicable to all people. There they will receive psychiatric care if they so wish. AIM OF THE PAPER: The paper outlines the background of this concept, including international sources, traces the discussion in German specialist literature and takes a critical look at it. RESULTS: The criticism is primarily directed against the fact that responsibility for a relevant proportion of psychiatric patients would be handed over to the police and judiciary and that, as a result, two realities of care would be established that would considerably differ in terms of quality. CONCLUSION: Arguments are put forward in favor of retaining the function of social control and considerations are suggested as to how caring coercion can be largely minimized.

[Health and investment: How are the 237 billion euro of the German professional pension funds invested?] / Gesundheit und Kapitalanlagen - wie sind die € 237 Mrd. der berufsständigen Versorgungswerke angelegt?

BACKGROUND: Exceeding ecological limits through climate crisis, loss of biodiversity, altered biogeochemical cycles and novel substances is dangerous and leads to increased morbidity. Hence, financial assets should be divested from hazardous industries and re-allocated to support the transformation to an economy that keeps activities within ecological limits. The present study investigates how sustainability criteria are applied to the assets of German pension funds. METHODS: A survey containing 26 items on 1) business practice, 2) implementation of sustainability strategies, 3) application of ESG criteria to investment decisions, and 4) projects and goals was sent to each and every of 93 German professional pension funds. Furthermore, their annual business reports and publications were analyzed for information on sustainability efforts. RESULTS: 37 of 93 pension funds responded to our survey, 8 of them returned the query. All agreed that ESG criteria are part of their business culture. Predominantly, they adhere to common standards for sustainable investments (UNPRI [United Nations Principles for Responsible Investment], 75% approval); yet, they do not exclude the production of goods that are potentially harmful to health (e.g., tobacco and alcohol). DISCUSSION: A minority of the participating pension funds agrees that ESG criteria are part of their business culture. However, only few of them provide information about their actual application. Nevertheless, there are pension funds that do not respect sustainability criteria in an appropriate way, and thus take unnecessary financial risks and invest in harmful industries.

[Climate change and its significance in the healthcare community: history, landmarks, and major players]. / Das Thema Klimawandel und seine Bedeutung im Gesundheitssektor: Entwicklung, Akteure, Meilensteine.

Since the early 1990s, science has addressed anthropogenic climate change as a health issue. From about 2000 onwards, the scientific literature and evidence on the health effects of climate change has been rapidly increasing. Global warming is now considered an "existential threat to humankind," and leading health organizations call climate change "the defining issue for public health in the 21 century" or a "public health emergency."In recent years, climate change as a health issue has become more and more prominent in health communities on the national and international level.The growing importance of this issue in the international health community and the stages, milestones, and topics of this development are described and what health professionals and health organizations can do to protect health from climate change is demonstrated. The decisive role of The Lancet and the reports of its international commissions, the British Medical Journal (BMJ), and the World Health Organisation (WHO) in setting the agenda is underlined. Important actors, organizations, initiatives as well as new concepts like "planetary health" and "planetary boundaries" are introduced. In the German health sector, however, climate change - apart from niches - has not been much of an issue so far. Neither in the health sector, climate policies, nor climate movement the connections between climate change and health are sufficiently understood, considered, or implemented. A look beyond borders shows what might be possible and necessary in view of the possibly "greatest crisis we have ever faced."The article is based on the author's experience, cooperation, and exchange with parties that are engaged with the issue and on years of literature research. He initiated the campaign of German doctors calling on their pension funds to divest from fossil fuels and is a founding and present board member of the "German Alliance on Health and Climate Change," which was founded 2017.