[Salomon Neumann (1819-1908) and the Right to Health]. / Salomon Neumann (1819­1908) und das Recht auf Gesundheit.

The "Universal Declaration of Human Rights (UDHR)" of the United Nations (UN) of 1948 sets out a right to health as a common ideal and aspiration. In his writings on the reform of the Prussian Medical Charter "Public Health and property" 100 years before the UDHR was set out, the Jewish physician Salomon Neumann had defined health as a right for every citizen, a right that should to be protected by a public system of health care. His reasoning went beyond contemporaneous critical social discussion. Right of humans to health has been acknowledged nationally and internationally; in the Federal Republic of Germany, the question as to whether there is a basic right to health is still open.

[Design of a Curriculum Clinical Social Medicine]. / Entwurf eines Curriculums Klinische Sozialmedizin.

The economic transformation of health care systems, which is supported by both the economic and the political sector, is in demand of constant humane correction. Legal regulations of social systems securing health corresponding to the code of social law are guard rails for a responsible use of limited resources and are subject to constant development. All doctors caring for patients should be in a position to reflect the real life context of their patients as both causal and modifying influence for health and disease from a social medical perspective, apart from their specific medical field of expertise.Accordingly 3 parts of sub-specialization training are suggested: clinical tasks of social medicine as detailed in the code of social law, clinical social medicine in health care according to the 5(th) book of the code of social law and social medicine in clinical social medicine/participation. Higher level-of-care hospitals, as well as rehabilitation clinics, should offer sub-specialization in social medicine without interruption of employment contracts. Corresponding criteria for the regulation on further education should be formulated by the German Society of Social Medicine and Prevention (DGSMP) as the competent scientific association and presented to the committee on further education of the Federal Medical Association. This aims at strengthening social medicine in clinical care.

[Plea for a strengthening of clinical social medicine]. / Plädoyer für eine Stärkung der klinischen Sozialmedizin.

Social medicine is concerned--in the midst of a constantly changing society--with the social and economic conditions that influence health, disease and medical care. A comprehensive medical care therefore requires medical doctors who, beyond the biomedical issues, realize diseases in the context of the social needs of the individual person and systematically include these in their prevention, treatment and rehabilitation concepts.The system of social security, particularly the health care system, depends on medical doctors' expertise in helping patients for the appropriate use of services from the system of social security. According to the German professional education regulations for doctors the additional specialization in "social medicine" also includes the competence for "assessment of the nature and extent of health disorders and their classification in the framework of social security systems". This judgment is one part of the tasks of the Medical Services belonging to the various branches of the social security system. It is also provided in practice by medical doctors with competence in social medicine working in acute care facilities.

Smoking habits and attitude to smoking in the study population of the MONICA Project Augsburg.

Data concerning smoking habits were derived from the first MONICA-Augsburg survey 1984/85 based on a random two stage cluster sample of the 25-64 year old population of the city of Augsburg and the two surrounding rural districts (n = 5312). Data were gathered by a standardized interview. Response was 79%. Overall, about 36% of men and 18% of women are regular cigarette smokers (i.e. smoking more than one cigarette per day). In both sexes smoking decreases with increasing age. In men 43% of the 25-34 year old participants are regular smokers and 29% in the age group 55-64. In women 29% of the youngest age group but only 9% aged 55-64 are current regular smokers. In male regular cigarette smokers the mean amount of cigarettes consumed per day is 21, in women 14 cigarettes. The mean amount of nicotine and tar consumed per day is 17 mg and 277 mg in men, 10 mg and 159 mg in women. On the average men start smoking at the age of 18 and women at the age of 21. In both sexes the percentage of regular smokers, who are willing to change their smoking habits, is very high. In each age and sex group about 60% of all regular smokers affirmed their willingness to quit smoking in the future. It is hoped, that this willingness of the population to change their smoking behavior will be supported by suitable education and intervention programs.

[Providing educational goals in social medicine for the practicing physician in basic medical education]. / Vermittlung sozialmedizinischer Ausbildungsziele für den berufsfähigen Arzt in der grundständigen Arztausbildung.

Social Medicine has a long and successful tradition in providing public medical care, but it does not have a long-standing academic tradition. To this very date, some medical faculties have neither a representative of the discipline nor a corresponding institute. Although the topics of Social Medicine are manifold, there is a discrepancy in the time allotted for teaching within the medical curriculum. Social Medicine must offer practical and orientational knowledge. In the medical faculties, Social Medicine also represents the health sciences, and in the Schools of Public Health it has the function of a bridge discipline and is the most prominent representative of medicine.

[Drug-assisted treatment of substance dependence (Drug and Alcohol Symposium, Basel 1992)]. / Medikamentengestützte Behandlung bei Drogensucht (Drogen- und Alkoholsymposium, Basel 1992).

The report on the symposium is an interim account of the treatment of drug addiction in Switzerland. The spread of drugs could not be halted by prohibition. The ideal of a drug-free society does not seem to be translatable into reality. Hence, it is unrealistic to set up continence or sobriety as a goal in the treatment of all addicts, for a proportion of drug dependents or addicts is bypassed or not addressed at all. New approaches based on pharmaceuticals an assisting medication, combined with a diversified allocation of drugs, are under discussion.

[Reality and social interpretation of health]. / Realität und gesellschaftliche Interpretation von Gesundheit.

The health profile of a human society depends upon its social development and in particular upon current social and cultural conditions. Health can be defined in many ways; both the pathogenetic and the salutogenetic approaches have their merits. Partial aspects of reality are offered for example by attempts to describe health conditions quantitatively by means of health indicators such als life expectancy, mortality, morbidity, incapacity to work, use made of medical services, and the like. The description of health must encompass the entire range of its objective and subjective experience in its somatic, mental and social dimensions. Epidemiological data must always be supplemented by the results of phenomenological observations to obtain a true picture of the experience of reality and the acceptance of the results by the group under observation.

[Social medicine as a paradigm for innovative developments in public health]. / Sozialmedizin als Paradigma für innovative Entwicklungen im öffentlichen Gesundheitsdienst.

The integration of national health authorities into the regional administrative departments in Bavaria at January 1st 1997 offers the chance to a further, demand-oriented development of the tasks of public health service, according to the situation of requirements of state and communes. Each layer of action educes a separate view on problems. National concern of public health care is above all health protection, medical supervision and the composition of special medical estimates. Public health care developed in communal responsibility first and foremost serves provisions for existence of citizens. Looking after national concerns of public health in a figurative sphere of activity, public health care has ist main focus in the fields of health and social issues (health education and assistance, social-compensatory tasks), prevention and health promotion. Today in research and teaching at universities these tasks are represented by social medicine and the public health research associations. They are elaborating the specialized and the orientation-related knowledge. The public health assistance institutions as well as prevention and health promotion obtaining increasing importance in our health service, developments are necessary that enable the public health service in Bavaria to fulfill these communal tasks in the future.

[Long-term use of narcotics in pain therapy]. / Langzeitanwendung von Betäubungsmitteln bei der Schmerztherapie.

From 1. 1. 1976 to 30. 6. 1987, a total of 25,611 prescriptions for narcotics were obtained from pharmacies by 4131 persons living in a town of 250,000 inhabitants in the Federal Republic of Germany. 2412 patients (58.4%) had been prescribed narcotics on only one occasion, 3178 patients (76.9%) over a limited period of six months, presumably for acute pain. Only 520 patients (12.6%) received, over a period of at least six months, five or more narcotic prescriptions per six months. Reasons for the latter prescriptions were malignant tumours in 273 (6.6%) and chronic pain due to benign diseases in 144 (3.5%). In 21 patients (0.5%) the narcotic dosage had risen over two years, presumably because of the development of tolerance. 19 patients had been on narcotics for at least eight years, without their doctor diagnosing addiction. The data suggest that, in prescribing narcotics for patients with incurable disease, the risk of addiction should play no role.

[Prescribing strong opioids for pain therapy and for substitution therapy by established physicians]. / Verschreibung von Betäubungsmitteln zur Schmerztherapie und zur Substitution durch niedergelassene Arzte.

The prescription of strong opioid by general practitioners was studied, particularly for the treatment of chronic pain. In a medium-sized town (around 250 000 inhabitants) 17,839 prescriptions of strong opioids were issued by 455 doctors over 5 years (1 January 1990 until 31 December 1994) to 1,939 patients. Of these patients 37.8-48.3 % of them received only one prescription for 6 months, 60.5-75.8 % received between 1 and 4 prescriptions for 6 months, and only 20.9-35.7 % of all patients received 5 or more prescriptions for 6 months. The amount of strong opioids prescribed for cancer pain relief seems to be almost the same in 1992 as 10 years ago. The consumption of oral morphine has steadily increased compared to 1982 and constitutes almost one-half of all narcotics prescribed for pain treatment by general practitioners. For pain treatment the value of strong opioids is recognized by both patients and physicians in contrast to the prescription of levomethadone as substitution therapy for drug-addicted patients. The 6.7 % of the physicians who participated in methadone substitution therapy prescribed more strong opioids (52.4 % of prescriptions) than all other physicians together prescribe for pain treatment. In order to safeguard the quality of medical care for pain treatment by strong opioid analgesics, unbiased training of physicians and a clear definition of narcotics is required. It is suggested that the expression "narcotic prescription" be changed related to the legislative terminology in the pharmacology-related expression "analgesic prescription". The prescribing regulations should not constrain medical treatment, but create a basic rule for the prescription of strong opioids.

[The present and future of social medicine]. / Gegenwart und Zukunft der Sozialmedizin.

There have been far-reaching structural changes in medicine in recent years, prompting us to review the social medicine from the time it was first officially included in the medical curriculum of instruction and examination of licensed physicians (1970) to the present day. This subdiscipline focuses on the specific interactions between medicine and society on the one hand and on the structures and functions of public health services in an ever-changing society on the other. Diseases and their sequels are considered to occur on a somatopsychosocial plane. Analysis of the close interaction between health and social factors affords a view on the problem of social inequality and disease or its sequels and the way they are attacked or overcome in our society, from the legal claim for assistance to the complementary help offered by a socially oriented structure of medicine. This is the range of operations of sociomedicine, concentrating mainly on prevention and rehabilitation. Epidemiological analysis is one aspect, individual social medical expertising another, both of them being important instruments in affording help within the framework of statutory health insurance allowances (sickness insurance, pension fund, medical care insurance, unemployment insurance and the like). In the future, increasing importance will be attached by reflecting the social consequences of developments in medicine and vice versa. This, in turn, will have an influence on the scientific and social approaches practised by social medicine.

[HIV tests as preventive responsibility of public health offices]. / HIV-Tests als präventive Aufgabe der Gesundheitsämter.

4,382 blood samples were examined for HIV antibodies between August 1985 and the end of December 1988 at the Public Health office of the city of Augsburg. The prevalence of positive tests was 0.57% (n = 25). The rate at which various consultation offers were made use of was calculated for 1988. From 1985 to 1988 approximately 200 registered female prostitutes were regularly tested for HIV. It was only in 1985 that the HIV antibody test was positive in two women. Compared with 1984-1986 as basis there was a marked drop in the incidence of gonorrhoea to 71.7% and in 1988 to 6.5%.