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My Germany in 2017: a resilient country that is taking responsibility
Comment
My Germany in 2017: a resilient country that is taking responsibility the first paper in this Series explains.2 I remember the friendly general practitioner, always the same one, who visited me at home through all my childhood illnesses: measles, mumps, rubella, whooping cough, chickenpox, scarlet fever—vaccines didn’t exist yet then. For my frequent sports injuries in my time as active volleyball player in a regional league, I had immediate access to either an accident and emergency department or a sports injury specialist in an office-based practice. However, medical school was very different to what it is now. Yet the German system has been slow to catch up with other countries to go beyond rote learning of medical facts. Global health did not feature at all in my course and even public health was a somewhat neglected topic. I had to escape to Vienna, Austria, for my first clinical year to get some practical and patientcentred experience. Working as a doctor, which I did for 6 months in Berlin when the wall was still dividing the city, was characterised by a strong adherence to hierarchy with not always the best people in charge. I remember vividly being told to do as asked “because I say so”, when questioning a decision. Softening professional hierarchies and giving women equal chances in high-ranking positions while making family life possible is only slowly changing in Germany, and was
Published Online July 3, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)31658-6 See Online/Comment http://dx.doi.org/10.1016/ S0140-6736(17)31617-3 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(17)31280-1 and http://dx.doi.org/10.1016/ S0140-6736(17)31460-5
Adam Berry/Stringer/Getty
2017 is a good year to put a spotlight on Germany and health. Germany is leading the forthcoming G20 meeting and has a general election on Sept 24. The political landscape is shifting palpably given President Donald Trump in the White House, the UK’s decision to leave the European Union, and a newly hopeful and energised France under President Emmanuel Macron. After a frustrating G7 meeting in Taormina, Italy, on May 26 and 27, Germany’s Federal Chancellor Angela Merkel stated in an unusually blunt speech that as Europeans “we should really take our fate into our own hands…the times in which we could rely fully on others are somewhat over”.1 Germany clearly is in a new leadership role that it has been reluctant to take in the past. The two papers in this Lancet Series look at the German health system and its remarkable resilience through a very turbulent time over the past 135 years and Germany’s expanding role in global health.2,3 Leading the G20 Summit in Hamburg on July 7 and 8, Germany has taken important and more assertive steps to show leadership in global health by putting health firmly on the G20 agenda and holding the first ever meeting of G20 Health Ministers in Berlin on May 19 and 20. The declaration by the G20 Health Ministers has a strong focus not only on combating antimicrobial resistance, but also on health systems strengthening for universal health coverage, data systems strengthening for health policy, and building and maintaining a skilled and motivated health workforce as an integral part of functioning and resilient health systems.4 My Germany has changed beyond recognition from the place where I grew up in the 1960s, 1970s, and 1980s. It’s a good change, one that I am proud of, especially now that my chosen country frequently refers to me as a non-UK born European migrant and I am still awaiting news on what will happen to me in the future 1 year after the Brexit referendum. I have now lived nearly as long in the UK, working first as a medical doctor in paediatrics and then as a medical editor at The Lancet, as I have in my home country Germany, where I grew up and went to medical school. What has not changed much is the way the German health system works as
German Federal Chancellor Angela Merkel and German Family Affairs Minister Katarina Barley with participants of the Youth 20 Dialogue, in Berlin, June 7, 2017
www.thelancet.com Published online July 3, 2017 http://dx.doi.org/10.1016/S0140-6736(17)31658-6
1
Comment
one of the main reasons that I decided against Germany as the country for my professional career. I also remember walking through East Berlin where everything seemed grey, subdued, and at an eerie standstill compared with the western part where I lived. Looking at the Gendarmenmarkt area—the heart of former East Berlin—now, this feels like a dream. Surely a city cannot change so quickly? But Berlin did. The whole country did. I remember the day when the Berlin Wall came down, and I think every German remembers that exact moment. I was working as a House Officer in a London neonatal intensive care unit and the nurse in charge excitedly called me to the television screen. It was an amazing and unbelievably moving moment. A country that managed to have a strong resilient health system through two world wars, a division, and reunification, is in an excellent position to talk about resilience—one of the three pillars of Germany’s G20 presidency. Germany’s chosen motto is “shaping an interconnected world” with the three main pillars of resilience, sustainability, and responsibility.5 The latter was perhaps the most difficult aspect for a country that still prefers to talk about partnerships not leadership. Arguably, the refugee crisis in 2015 and 2016, in which Germany has welcomed a large number of people and taken a clear leadership against the prevailing mood of the moment, has been a turning point for Germany. Angela Merkel, often criticised for being too timid and conventional, has shown strength and resolve to do the right thing: “wir schaffen das” (we will succeed).
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Similarly, her positive pre-G20 initiative to give young people from more than 30 countries a chance to present their recommendations at a Youth 20 gathering in Berlin on June 1–8 has shown that she is ahead of many leaders with a much needed change in attitudes.6 Listening to the live broadcast when young people presented their urgent topics for the G20 meeting and proposed solutions to Angela Merkel on June 7 inspired hope and optimism for an interconnected world. Looking backwards and inwards and isolating itself from the world is not Germany’s approach. Sabine Kleinert The Lancet, London EC2Y 5AS, UK [email protected] I declare no competing interests. 1
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Süddeutsche Zeitung. Wir Europäer müssen unser Schicksal in unsere eigene Hand nehmen. Süddeutsche Zeitung, May 28, 2017. http://www. sueddeutsche.de/politik/g-krise-wir-europaeer-muessen-unser-schicksalin-unsere-eigene-hand-nehmen-1.3524718 (accessed June 5, 2017). Busse R, Blümel M, Knieps F, Bärnighausen T. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. Lancet 2017; published online July 3. http://dx.doi.org/10.1016/S0140-6736(17)31280-1. Kickbusch I, Franz C, Holzscheiter A, et al. Germany’s expanding role in global health. Lancet 2017; published online July 3. http://dx.doi. org/10.1016/S0140-6736(17)31460-5. G20 Germany 2017. The Berlin Declaration of the G20 Health Ministers Together Today for a Healthy Tomorrow. 2017. https://www. bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/G/ G20-Gesundheitsministertreffen/G20_Health_Ministers_Declaration_ engl.pdf (accessed June 6, 2017). Federal Government of Germany. Germany’s G20 Presidency begins. 2017. https://www.g20.org/Content/EN/Artikel/2016/11_en/2016-11-30-g20kernbotschaften-im-kabinett_en.html (accessed June 6, 2017). Federal Ministry for Family Affairs, Senior Citizens, Women and Youth. About Y20. 2017. https://y20-germany.org/abouty20/ (accessed June 8, 2017).
www.thelancet.com Published online July 3, 2017 http://dx.doi.org/10.1016/S0140-6736(17)31658-6
My Germany in 2017: a resilient country that is taking responsibility the first paper in this Series explains.2 I remember the friendly general practitioner, always the same one, who visited me at home through all my childhood illnesses: measles, mumps, rubella, whooping cough, chickenpox, scarlet fever—vaccines didn’t exist yet then. For my frequent sports injuries in my time as active volleyball player in a regional league, I had immediate access to either an accident and emergency department or a sports injury specialist in an office-based practice. However, medical school was very different to what it is now. Yet the German system has been slow to catch up with other countries to go beyond rote learning of medical facts. Global health did not feature at all in my course and even public health was a somewhat neglected topic. I had to escape to Vienna, Austria, for my first clinical year to get some practical and patientcentred experience. Working as a doctor, which I did for 6 months in Berlin when the wall was still dividing the city, was characterised by a strong adherence to hierarchy with not always the best people in charge. I remember vividly being told to do as asked “because I say so”, when questioning a decision. Softening professional hierarchies and giving women equal chances in high-ranking positions while making family life possible is only slowly changing in Germany, and was
Published Online July 3, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)31658-6 See Online/Comment http://dx.doi.org/10.1016/ S0140-6736(17)31617-3 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(17)31280-1 and http://dx.doi.org/10.1016/ S0140-6736(17)31460-5
Adam Berry/Stringer/Getty
2017 is a good year to put a spotlight on Germany and health. Germany is leading the forthcoming G20 meeting and has a general election on Sept 24. The political landscape is shifting palpably given President Donald Trump in the White House, the UK’s decision to leave the European Union, and a newly hopeful and energised France under President Emmanuel Macron. After a frustrating G7 meeting in Taormina, Italy, on May 26 and 27, Germany’s Federal Chancellor Angela Merkel stated in an unusually blunt speech that as Europeans “we should really take our fate into our own hands…the times in which we could rely fully on others are somewhat over”.1 Germany clearly is in a new leadership role that it has been reluctant to take in the past. The two papers in this Lancet Series look at the German health system and its remarkable resilience through a very turbulent time over the past 135 years and Germany’s expanding role in global health.2,3 Leading the G20 Summit in Hamburg on July 7 and 8, Germany has taken important and more assertive steps to show leadership in global health by putting health firmly on the G20 agenda and holding the first ever meeting of G20 Health Ministers in Berlin on May 19 and 20. The declaration by the G20 Health Ministers has a strong focus not only on combating antimicrobial resistance, but also on health systems strengthening for universal health coverage, data systems strengthening for health policy, and building and maintaining a skilled and motivated health workforce as an integral part of functioning and resilient health systems.4 My Germany has changed beyond recognition from the place where I grew up in the 1960s, 1970s, and 1980s. It’s a good change, one that I am proud of, especially now that my chosen country frequently refers to me as a non-UK born European migrant and I am still awaiting news on what will happen to me in the future 1 year after the Brexit referendum. I have now lived nearly as long in the UK, working first as a medical doctor in paediatrics and then as a medical editor at The Lancet, as I have in my home country Germany, where I grew up and went to medical school. What has not changed much is the way the German health system works as
German Federal Chancellor Angela Merkel and German Family Affairs Minister Katarina Barley with participants of the Youth 20 Dialogue, in Berlin, June 7, 2017
www.thelancet.com Published online July 3, 2017 http://dx.doi.org/10.1016/S0140-6736(17)31658-6
1
Comment
one of the main reasons that I decided against Germany as the country for my professional career. I also remember walking through East Berlin where everything seemed grey, subdued, and at an eerie standstill compared with the western part where I lived. Looking at the Gendarmenmarkt area—the heart of former East Berlin—now, this feels like a dream. Surely a city cannot change so quickly? But Berlin did. The whole country did. I remember the day when the Berlin Wall came down, and I think every German remembers that exact moment. I was working as a House Officer in a London neonatal intensive care unit and the nurse in charge excitedly called me to the television screen. It was an amazing and unbelievably moving moment. A country that managed to have a strong resilient health system through two world wars, a division, and reunification, is in an excellent position to talk about resilience—one of the three pillars of Germany’s G20 presidency. Germany’s chosen motto is “shaping an interconnected world” with the three main pillars of resilience, sustainability, and responsibility.5 The latter was perhaps the most difficult aspect for a country that still prefers to talk about partnerships not leadership. Arguably, the refugee crisis in 2015 and 2016, in which Germany has welcomed a large number of people and taken a clear leadership against the prevailing mood of the moment, has been a turning point for Germany. Angela Merkel, often criticised for being too timid and conventional, has shown strength and resolve to do the right thing: “wir schaffen das” (we will succeed).
2
Similarly, her positive pre-G20 initiative to give young people from more than 30 countries a chance to present their recommendations at a Youth 20 gathering in Berlin on June 1–8 has shown that she is ahead of many leaders with a much needed change in attitudes.6 Listening to the live broadcast when young people presented their urgent topics for the G20 meeting and proposed solutions to Angela Merkel on June 7 inspired hope and optimism for an interconnected world. Looking backwards and inwards and isolating itself from the world is not Germany’s approach. Sabine Kleinert The Lancet, London EC2Y 5AS, UK [email protected] I declare no competing interests. 1
2
3 4
5 6
Süddeutsche Zeitung. Wir Europäer müssen unser Schicksal in unsere eigene Hand nehmen. Süddeutsche Zeitung, May 28, 2017. http://www. sueddeutsche.de/politik/g-krise-wir-europaeer-muessen-unser-schicksalin-unsere-eigene-hand-nehmen-1.3524718 (accessed June 5, 2017). Busse R, Blümel M, Knieps F, Bärnighausen T. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. Lancet 2017; published online July 3. http://dx.doi.org/10.1016/S0140-6736(17)31280-1. Kickbusch I, Franz C, Holzscheiter A, et al. Germany’s expanding role in global health. Lancet 2017; published online July 3. http://dx.doi. org/10.1016/S0140-6736(17)31460-5. G20 Germany 2017. The Berlin Declaration of the G20 Health Ministers Together Today for a Healthy Tomorrow. 2017. https://www. bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/G/ G20-Gesundheitsministertreffen/G20_Health_Ministers_Declaration_ engl.pdf (accessed June 6, 2017). Federal Government of Germany. Germany’s G20 Presidency begins. 2017. https://www.g20.org/Content/EN/Artikel/2016/11_en/2016-11-30-g20kernbotschaften-im-kabinett_en.html (accessed June 6, 2017). Federal Ministry for Family Affairs, Senior Citizens, Women and Youth. About Y20. 2017. https://y20-germany.org/abouty20/ (accessed June 8, 2017).
www.thelancet.com Published online July 3, 2017 http://dx.doi.org/10.1016/S0140-6736(17)31658-6