Policies for disease prevention in Germany in the European context: a comparative analysis.

BACKGROUND In Europe important differences exist concerning policies for the prevention of common diseases. In most cases these cannot be explained by the underlying epidemiology. However, successful policies should have a measurable effect on disease epidemiology. There has been little research comparing the effect of national preventive policies on disease-specific mortality. OBJECTIVES To describe the mortality trends for three health problems representing the three levels of prevention in Germany and in selected European countries, which are of interest for the disease under question. To relate epidemiological trends to preventive policies at the national level and at the level of the European Union (EU). METHODS Comparison of age-standardized mortality rates for road traffic accidents, cervical cancer and diabetes mellitus in the period 1970-2002, using routine data. Analysis of disease-specific prevention policies in countries that deviate from the general trend in the EU, with a special focus on developments in Germany. RESULTS The development of mortality rates during the last 30 years for road traffic accidents, cervical cancer and diabetes mellitus varied substantially across Europe. Although the evidence linking specific public policies to epidemiological trends is sparse and often limited to ecological studies, a number of epidemiological changes can be plausibly linked to specific policies in the countries concerned. CONCLUSION Successful preventive policies exist for all health problems reviewed. The current status of implementation of these policies can only be interpreted in the historical and political context of the countries concerned. The role of epidemiology to guide health policy decisions is under-utilized, as is the regulatory framework for disease and injury prevention at the level of the EU. Less formal policy measures such as European clinical guidelines are equally scarce. More rigorous comparative health services research is needed to formulate evidence-based policies for disease prevention.