Trends in incidence and mortality of early-onset cancer in Germany between 1999 and 2019.

Evidence on the recent temporal trend in the incidence and mortality of early-onset cancer, i.e., cancer diagnosed at ages of < 50 years, in Germany is scarce. To estimate the temporal trend in the incidence and mortality of early-onset cancer in Germany between 1999 and 2019. Input data were obtained from the Centre for Cancer Registry Data (Zentrum für Krebsregisterdaten, ZfKD). The analysis comprised all ages until 50 years and all types of cancer classified by the International Classification of Diseases (ICD-10)-codes C00-C97 (excl. C44). Temporal trends were estimated using negative binomial regression, differentiated by sex and cancer type. Between 1999 and 2019 in Germany, we observed stable or slightly increasing trends (0% and 1%) in the incidence of all early-onset cancers combined (C00-C97) for men and women, respectively, and strict declines in the mortality for both, men and women (-2% and - 3%). However, the trends differ largely with respect to sex and the individual cancer types. Early-onset cancer should be closely monitored to see whether stable and decreasing trends in the incidence and mortality continue. Knowing that despite decreasing incidence, the prevalence of a disease can rise due to their interplay with mortality, we recommend to maintain precise surveillance, efforts in prevention and early detection, as well as appropriate investments into healthcare resources, research and development.

Current methodologies of greenspace exposure and mental health research-a scoping review.

Introduction: Greenspaces can provide an important resource for human mental health. A growing body of literature investigates the interaction and the influence of diverse greenspace exposures. In order to gain a comprehensive understanding of the complex connection between greenspace and mental health, a variety of perspectives and methodological combinations are needed. The aim of this review is to assess the current methodologies researching greenspace and mental health. Methods: A scoping review was conducted. Four electronic databases (Pubmed, Embase, PsycInfo, Web of Science) were searched for relevant studies. A wide range of greenspace and mental health keywords were included to provide a comprehensive representation of the body of research. Relevant information on publication characteristics, types of greenspaces, mental health outcomes, and measurements of greenspace exposure and mental health was extracted and assessed. Results: 338 studies were included. The included studies encompassed a multitude of methods, as well as outcomes for both greenspace and mental health. 28 combinations were found between seven categories each for greenspace and mental health assessment. Some pairings such as geoinformation systems for greenspace assessment and questionnaires investigating mental health were used much more frequently than others, implying possible research gaps. Furthermore, we identified problems and inconsistences in reporting of greenspace types and mental health outcomes. Discussion: The identified methodological variety is a potential for researching the complex connections between greenspace and mental health. Commonly used combinations can provide important insights. However, future research needs to emphasize other perspectives in order to understand how to create living environments with mental health benefits. For this purpose, interdisciplinary research is necessary.

Climate change and health equity: A public health perspective on climate justice.

Background: The discourse on climate justice has developed from the theoretical approaches and discussions on environmental justice. A central tenet of the concept of environmental and climate justice is that environmental and climate issues cannot be seen in isolation from issues of social justice. Methods: A conceptual model was developed on the relationship between climate change impacts, social dimensions, adaptive capacities, biological sensitivity, and health equity in order to systematically analyse climate justice. Based on an exploratory literature review and the evaluation of the individual contributions of the status report on climate change and health, the evidence in Germany on social inequalities in exposure to climate change impacts and vulnerability to their direct and indirect health effects was summarised. Results: This paper provides an overview of the international debate and examples of evidence on climate justice in Germany. Climate justice in the sense of avoidable, unjust social inequalities in exposure, vulnerability, and the effects of climate mitigation and adaptation measures on health inequalities is still insufficiently addressed in Germany. Conclusions: A consistent integration of equity issues into climate policy is necessary. With reference to the international literature, options for action and research needs are identified.

[Research program "City of the Future - Healthy and Sustainable Metropolises"]. / Forschungsförderprogramm "Stadt der Zukunft ­ gesunde und nachhaltige Metropolen".

Urbanization is advancing worldwide and thus, cities are increasingly living spaces for people. Therefore, it is essential to place the health and well-being of city dwellers at the center of urban planning. The research funding program "City of the Future - Healthy and Sustainable Metropolises" from the Fritz and Hildegard Berg Foundation at the German Stiftungszentrum has been providing important inter- and transdisciplinary research impulses on this topic since 2010. Junior research groups at the interfaces of health sciences and other disciplines in the natural and social sciences were funded. One focus of the research program is to enable intensive cooperation with practitioners, in order to reflect upon and work on problems and issues from practice using the best possible scientific methods and to catalyze the transfer of knowledge. The research consortia are accompanied by annual conferences on a wide variety of urban health topics at various venues in Germany. In addition, transdisciplinary networks have been established and further initiatives (e. g., founding of an institute) have been launched. In this paper, the development of the multifaceted research funding program "City of the Future - Healthy and Sustainable Metropolises" is presented, including an outlook into its future development.

[Sustainable Urban Health as a conceptual and action approach]. / Nachhaltige StadtGesundheit als Denk- und Handlungsansatz.

The field of urban health, i.e., the application of public health for people in the city, is oriented towards both scientific knowledge and practical action. In the international arena, a scientific infrastructure exists for this purpose. Despite the common roots of public health and urban planning in Germany, the connection between these fields of work was not very apparent for a long time. Legal requirements for the participation of public health service in (urban) planning processes have had little impact so far. The aim of this study was to connect to international urban health developments in order to make the topic more visible, to support professional exchange and to give impulses for research and practice. To express the close links between human health, ecological stability and social justice, the approach was conceived as sustainable urban health. With this in mind, the program "City of the Future - Healthy, Sustainable Metropolises" was initiated in 2011.This article characterizes the basic approach as integrating and describes the underlying guiding principles, i.e., "View field expansion" as an epistemological principle and "Bridge building" as an action-guiding principle, and outlines the details. The spectrum of topics ranges from medical and nursing care over "classical" prevention and health promotion to health in all policies. Within this approach, "smaller" tasks can be pursued, e.g., an overview of local health actions and actors, networking promotion, or preserving significant developments in collective memory. At the same time, it is about contributions to the solution of "big" tasks, e.g., the derivation of conclusions from the Corona learning experience, a more consistent implementation of health in all policies, or transformation steps towards an ecologically sustainable development of society. Legal norms, public health services, health reporting, and urban planning come up as leitmotifs. The article also outlines the genesis of the position papers in this supplementary volume and concludes with an outlook.

[COVID-19 vaccination - motivation and stress factors: A cross-sectional survey of physicians and medical assistants in Germany]. / COVID-19-Impfung: Motivations- und Belastungsfaktoren ­ Eine Querschnittserhebung bei Ärzt*innen und Medizinischen Fachangestellten in Deutschland.

AIM: The aim of the study was to investigate motivation and stress factors related to the COVID-19 vaccination campaign among outpatient physicians and medical assistants in Germany. METHODS: In a quantitative, non-representative online survey, a total of 514 physicians and MFAs from different or the same practice were asked about reasons for and barriers to participation in the vaccination campaign, organizational conditions - including vaccine supply and availability - and workload. RESULTS: 70.3% of the respondents were physicians and 28.8% were medical assistants. In both occupational groups, the majority were from North Rhine-Westphalia (73.7% in total). The main motivations for participating in the vaccination campaign were to contribute to the fight against the pandemic (92.3%) and to advance the vaccination campaign (90.1%). For 94.6% of respondents, workload had increased since the vaccination campaign began in April 2021. Key stress factors were increased bureaucratic workload (92.5%), scheduling appointments for vaccinations (91%), patient inquiries (90.3%), and extra work/overtime (83%). Too much bureaucracy (69.6%) was the most frequently cited reason for not participating in the vaccination campaign. CONCLUSION: A large number of practices are making a key contribution to combating the pandemic by participating in the COVID-19 vaccination campaign, but this is also associated with a high workload situation. This is exacerbated by the dynamics of the infectious event and frequently changing demands and policy requirements on vaccinating practices. There is a strong desire for a uniform and less bureaucratic approach.

Environmental Burden of Disease due to Emissions of Hard Coal- and Lignite-Fired Power Plants in Germany.

Objectives: The study estimated the environmental burden of disease (EBD) attributable to a long-term exposure of the population to nitrogen dioxide (NO2) and fine particulate matter (PM2.5) emissions from hard coal- and lignite-fired power plants in Germany for the year 2015. Methods: The contribution of coal-fired power plants to the total air pollutant concentration was modelled using a chemical transport model and then combined with population data to assess the corresponding population exposure. We calculated years of life lost (YLL), years of life with disability, or disability-adjusted life years for different health outcomes with a strong evidence for an association with the exposure. Results: The burden of disease from PM2.5 emissions from lignite is 1.2 times higher than that from hard coal emissions (7,866 YLL compared to 6,412 YLL). NO2 emissions from lignite, cause a burden of disease 2.3 times higher than hard coal NO2-emission (13,537 YLL compared to 5,906 YLL). The EBD for both pollutants is dominated by diseases of the cardiovascular system. Conclusion: Abandoning energy generation by coal-fired power plants would lower the burden of disease in Germany.

[Health protection and climate change require ambitious limit values for air pollutants in Europe : Opinion on the revision of the Directive on Air Quality and Clean Air for Europe of the Environmental Public Health commission of the Robert Koch Institute and the Federal Environment Agency]. / Gesundheitsschutz und Klimawandel erfordern ambitionierte Grenzwerte für Luftschadstoffe in Europa : Stellungnahme zur Revision der Richtlinie über Luftqualität und saubere Luft für Europa der Kommission Environmental Public Health des Robert Koch-Instituts und des Umweltbundesamtes.

Based on scientific findings, the World Health Organization (WHO) has recommended stricter guideline values for air quality in 2021. Significant reductions in the annual mean values of particulate matter (particle size 2.5 µm or smaller, PM2.5) and long-term exposure to nitrogen dioxide (NO2) and ozone (O3) were put forward. The risk of mortality already increases above the WHO guideline values, as shown in studies investigating low concentrations of air pollutants. In Germany, the 2021 WHO guideline values for PM2.5 and NO2 were clearly exceeded in 2022.In this position paper we give the following recommendations for the European Air Quality Directive: (1) set binding limit values according to WHO 2021, (2) apply the limit values to the whole of Europe, (3) continue and expand the established country-based monitoring networks, (4) expand air quality measurements for ultrafine particles and soot particles, and (5) link air pollution control and climate protection measures.Stricter limits for air pollutants require societal and political changes in areas such as mobility, energy use and generation, and urban and spatial planning. Implementation according to WHO 2021 would lead to a net economic benefit of 38 billion euros per year.Ambitious limit values for air pollutants also have an impact on climate change mitigation and its health impacts. The Environmental Public Health commission concludes that more ambitious limit values are crucial to enable effective health protection in Germany and calls for air pollutant limit values in line with the 2021 WHO recommendations to become binding in Europe.

Exploring the Significance of Legal Status on Refugees' and Asylum Seekers' Access to Health Care in Germany-A Mixed-Method Study.

Objectives: The study aims to investigate the significance of legal status for well-being and access to and use of needs-based health care by asylum seekers and refugees in Germany. Methods: Using a mixed-method-design, we first conducted a cross-sectional study to explore access to health care and unmet needs of refugees and asylum seekers and legal status. Data were analysed using descriptive statistics. For the qualitative study a heterogeneous sample was recruited from the quantitative data. Interviews were analysed using a deductive-inductive approach. Results: Quantitative results showed that health care utilisation was associated with an unsecure legal status but not with unmet care needs. The in-depth qualitative study revealed that the legal status determines experiences of structural violence that can negatively affect well-being and associated access to health care. Conclusion: An insecure legal status can affect access to health care for refugees and asylum seekers. In order to improve health, changes in living conditions and the removal of access barriers are necessary.

Risk Perception of the SARS-CoV-2 Pandemic: Influencing Factors and Implications for Environmental Health Crises.

BACKGROUND: The SARS-CoV-2 pandemic and climate change are two simultaneously occurring large scale environmental health crises. This provides an opportunity to compare the risk perception of both crises in the population. In particular, whether experiencing the acute pandemic sensitizes people to the risks of ongoing climate change. METHODS: Panel participants answered a web-based questionnaire. The risk perception of SARS-CoV-2 and influencing factors were assessed. Differences of risk perception dimensions regarding SARS-CoV-2 and climate change were analyzed as well as associations between dimensions. RESULTS: The results show that an economic impact by the pandemic is associated with more dimensions of SARS-CoV-2 risk perception than an experienced health impact. Moreover, dimensions of risk perception of the pandemic and climate change are perceived differently. Furthermore, the affective dimension of pandemic risk perception is significantly associated with all dimensions of climate change risk perception. CONCLUSIONS: Emotional-based coping with the risks of SARS-CoV-2 is associated with risk perception of climate change as well as various factors that shape the individuals' risk perception. It is currently necessary and will be increasingly necessary in the future to solve coexisting crises, not selectively, but in a common context within the framework of a social-ecological and economic transformation.

[Experiences of people with refugee backgrounds in utilising healthcare in Germany-findings from a qualitative study]. / Erfahrungen von Menschen mit Fluchtgeschichte bei der Inanspruchnahme der Gesundheitsversorgung in Deutschland ­ Erkenntnisse einer qualitativen Studie.

BACKGROUND: Refugees and asylum seekers face a variety of legal, structural, administrative, cultural and linguistic barriers in accessing healthcare. However, there is currently a lack of available data on the health needs of refugees and asylum seekers. In particular, their subjective experience in accessing healthcare has not been considered sufficiently. AIM OF THE STUDY: This paper explores the subjective experiences of refugees and asylum seekers in accessing and using healthcare. Strategies for dealing with potential challenges are presented. METHODS: The recruitment of interview partners was based on a quantitative cross-sectional study collected as part of a study on the health of refugees (FlüGe health study). Persons who agreed to be contacted again were contacted by telephone. A heterogeneous sub-sample (n = 18) with regard to age, gender, nationality, health status and utilisation behaviour was interviewed using interpreter-supported problem-centred interviews. Data were analysed using a deductive-inductive approach. RESULTS AND DISCUSSION: The migration-insensitive healthcare for refugees and asylum seekers is characterised by language barriers, disorientation, experiences of rejection, mistreatment and structural barriers. Experiences of foreignness in the healthcare system can lead to delayed care seeking or underusage of healthcare systems. At the same time, individual strategies by refugees, asylum seekers and healthcare providers are used in order to meet these challenges.

COVID-19 after the first wave of the pandemic among employees from a German university hospital: prevalence and questionnaire data.

The SARS-CoV-2 pandemic has changed lives around the world. In particular, healthcare workers faced significant challenges as a result of the pandemic. This study investigates the seroprevalence of SARS-CoV-2 in March-April 2020 in Germany among healthcare workers and relates it to questionnaire data. In June 2020, all employees of the reporting hospital were offered a free SARS-CoV-2 antibody test. The first 2,550 test results were sent along with study documents. The response rate was 15.1%. The COVID-19 PCR test prevalence amongst health care workers in this study was 1.04% (95% CI 0.41-2.65%), higher by a factor of 5 than in the general population (p=0.01). The ratio of seroprevalence to PCR prevalence was 1.5. COVID-19-associated symptoms were also prevalent in the non-COVID-19-positive population. Only two symptoms showed statistically significant odds ratios, loss of smell and loss of taste. Health care workers largely supported non-pharmaceutical interventions during the initial lockdown (93%). Individual behavior correlated significantly with attitudes toward policy interventions and perceived individual risk factors. Our data suggest that healthcare workers may be at higher risk of infection. Therefore, a discussion about prioritizing vaccination makes sense. They also support offering increased SARS-CoV-2 testing to hospital workers. It is concluded that easier access to SARS-CoV-2 testing reduces the number of unreported cases. Furthermore, individual attitudes toward rules and regulations on COVID-19 critically influence compliance. Thus, one goal of public policy should be to maintain high levels of support for non-pharmaceutical interventions to keep actual compliance high.

[Pneumology in the Model Degree Program of the Medical Faculty Ostwestfalen Lippe, Germany]. / Das Fach Pneumologie im Modellstudiengang der Medizinischen Fakultät Ostwestfalen-Lippe (OWL).

The specialist field of "pneumology" is still underrepresented in university clinics in Germany, but this is not the case at the newly founded medical faculty Ostwestfalen-Lippe (OWL) in Bielefeld. This is linked to representing pneumology and internal intensive care medicine in patient care, teaching and research across the board and the opportunity to actively help shape the development of the human medicine faculty in an exciting environment.The early anchoring of the subject "Pneumology" in the model degree program of medical school in OWL (begin winter semester 2021/22) contributes to further visibility and a university medical orientation. In this overview various issues of Pneumology in the Model Degree Program are explored by basic scientists, clinical teachers, members of the medical faculty and a student.In today's Evangelisches Klinikum Bethel (EvKB), pulmonary medicine has a long tradition. The hospital's first lung and infection center was opened in 1927. The EvKB's department for internal medicine, pneumology and intensive care medicine, which has been independent since 2009, is becoming a university clinic for pneumology within the medical faculty OWL. Relevant translational and interdisciplinary research can be intensified.There are 30 "Pneumology" teaching units in the model degree program, which are divided into two study sections using different formats, such as lectures, seminars, hands on courses and skills lab. It is represented in particular in the module complex "Circulation and Respiration". The content of the first phase of teaching was carried out by a module commission, with members representing the subjects involved in the module.Knowledge of the basics from, for example, physiology, pathophysiology, anatomy and pathology are taught to the students in the run-up to the pneumology course. Using the example of physiology, the presentation of the learning content of a basic subject is elaborated in this article.Half of all teaching units on pneumology of the entire course took place in the 2nd semester (in March and April 2022), so that students experienced the clinical relevance of the content at an early stage. There was a particular focus on obstructive airway and restrictive lung diseases. After imparting the basic knowledge of the physical examination of the lungs in the Skills Lab, the most important pathological findings in the above-mentioned diseases on inspection, palpation, auscultation and percussion are demonstrated and practised in patients as part of bedside teaching under supervision.Communication training is also longitudinally integrated into the modular teaching, with a total of more than 200 teaching hours and is performed interdisciplinary. In the "Circulation and Breathing" module eight hours are devoted to this with simulated patients, the anamnesis and therapy advice on classic cardiopulmonary diseases. For the students, integrating the teaching of basic theory and its clinical application for each organ systems represents a challenge in the model degree program, the advantages outweigh from today's perspective.

Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis.

The environment in healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The concept of therapeutic landscapes seems to be a promising approach in this context. The aim of this qualitative meta-analysis is to review the effects of therapeutic landscapes for different stakeholders in psychiatric care facilities. A systematic literature search was conducted in the four data bases PubMed, PsycInfo, CINAHL, and Web of Science. Thirteen predominately qualitative studies were included in this qualitative meta-analysis. The methodological quality of these qualitative studies was assessed, using an adapted version of the Journal Article Reporting Standards for Qualitative Research, and a thematic analysis was conducted. The results were categorised into the three main themes of the physical (built and natural), social, and symbolic dimensions of the therapeutic landscape. Given the heterogeneity of the summarised data and an overall methodological quality of the included studies that can be rated as medium, the results should be interpreted with caution. Current findings are based almost exclusively on qualitative studies. Therefore, there is a need for quantitative study designs that investigate the relationship between specific environmental elements and mental health outcomes for different stakeholders in psychiatric facilities.

Health Care for Refugees in Europe: A Scoping Review.

BACKGROUND: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. METHODS: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. RESULTS: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. CONCLUSIONS: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.

[The COVID-19 Pandemic as an Opportunity for Teletherapy? - A Survey of non-medical therapy professionals in the health sector]. / Die COVID-19-Pandemie als Chance für Teletherapie? ­ Eine Umfrage bei Vertreter*innen von Gesundheitsfachberufen.

OBJECTIVE: The aim of the study was to investigate the use of teletherapy during the corona pandemic by three non-medical therapy professionals in the health sector. METHOD: As part of a questionnaire-based online survey, 282 participants from the field of ergotherapy, physiotherapy and speech therapy were asked about usage behavior, challenges, potentials, and general conditions of teletherapy. RESULTS: Especially ergo and speech therapists used teletherapy during the corona pandemic. From their point of view, teletherapy also had a potential to be used as an alternative form of therapy, regardless of the coronavirus pandemic, adding that there was a great need for further assistance and training in the field of teletherapy. CONCLUSION: To implement this form of therapy on a long-term basis, in addition to technical requirements and training opportunities, accounting formalities need to be clarified.

[Organizational Health Literacy of German Public Health Departments (OHL-PH): Development of a Conceptual Model Employing Expert Interviews]. / Organisationale Gesundheitskompetenz deutscher Gesundheitsämter (OGK-GA): Entwicklung eines theoretischen Modells mit Hilfe von ExpertInneninterviews.

OBJECTIVE: In addition to the users' individual health literacy (HL), the organizational health literacy (OHL) of health care organizations plays an important role as well in assuring the health of the poipulation. In Germany, public health departments are responsible for public health at population level. They should help their users to access, understand and navigate and use information and services in their health-related decisions. This study addresses the question of the best conceptual model of OHL of the German public health departments for the first time. METHODS: In this explorative study, eleven guideline-oriented interviews with experts from public health departments were conducted in three German federal states. Subsequently, the transcripts underwent qualitative content analysis. RESULTS: A new conceptual model consisting of twelve attributes was identified for OHL of public health departments in Germany. These twelve characteristics can be assigned to the aspects "leadership and organizational culture", "employees" and "development and implementation of information and services". CONCLUSIONS: This model for the OHL-PH lays the foundation for future research in this area. It enables the development of a self-assessment tool and therefore the measurement of the level of OHL as well as the identification of barriers. Increasing the OHL of German public health departments by overcoming these obstacles can make a significant contribution to improving public health.

Urbanicity-Perspectives from Neuroscience and Public Health: A Scoping Review.

Urban residency is associated with exposure to environmental factors, which can influence health in many ways. Neuroscientific research, as well as Public Health research, aim towards broadening evidence in the field of Urban Health. However, it is unclear whether the association between urban living and mental illnesses is causal rather than explainable by other selective effects. This review seeks to gather information on the current evidence regarding urban living and neurological outcomes to demonstrate how Public Health and Neuroscience could complement each other in the field of Urban Health. A scoping review was conducted in four electronic databases according to the PRISMA-statement guidelines. 25 empirical studies were included. Outcomes such as schizophrenia and psychotic disorders, social and cognitive functioning were scrutinised. Evidence was found for alteration of brain functioning and brain structure. Most studies researching cognitive functioning or cognitive decline displayed possible protective effects of urban living compared to rural living. The different study designs in Public Health and Neuroscience could profit from each other. Although the comparability of studies is limited by the inconsistent assessments of urbanity. Synergies and potentials to combine aspects of Public Health and Neuroscience in the field of Urban Health to improve population health became apparent.

Barriers to Organizational Health Literacy at Public Health Departments in Germany.

BACKGROUND: Strengthening individual health literacy and knowledge about health challenges are important preventive approaches in public health to improve health equality. Health care organizations have come into focus in this regard. They need to raise their organizational health literacy (OHL) to help users to access and navigate information and services. OBJECTIVE: In Germany, public health departments (PHDs) are responsible for public and environmental health at the population level. This study breaks new ground as it is the first to investigate the OHL of these health care organizations. The study attempts to answer what barriers keep them from raising their OHL and how can these be overcome? METHODS: In this explorative study, 10 guideline-oriented interviews with experts from PHDs were conducted in two states in Germany. Qualitative content analysis was used to extract the results from the experts´ statements. KEY RESULTS: Eleven barriers to raising OHL were identified. Obstacles were found in leadership and organizational culture, design and implementation of information, and in human resources. False expectations due to negative preconceptions about public service were identified as a new barrier that had not been elucidated in prior literature. The same applies to lack of cooperation on cross-sectoral topics as well as lack of accessibility. Clear communication of tasks and clear jurisdictional authority are some of the recommendations for lowering these barriers. Other examples include identifying and using synergies and involvement of target groups. CONCLUSIONS: Overcoming these obstacles could improve the OHL of German PHDs. This, in turn, could improve the health of the general population and thus contribute significantly to overall public health. Extrapolating to the whole of Germany and other countries could further strengthen research on OHL. [HLRP: Health Literacy Research and Practice. 2021;5(3):e264-e271.] Plain Language Summary: Public health departments (PHDs) must be able to help their users access, understand, and use health information and services. This competence is called organizational health literacy (OHL). Ten experts from German PHDs were interviewed about barriers to raising OHL. This article reports the barriers identified and recommendations for lowering them, as well as three previously unknown obstacles.