Politics in the Preventative State

Headed by:
Dr. Kathrin Loer
Project Status:
since 2015

Type of project: Habilitation project

Project Outline

“Measles are edging closer” reports the Frankfurter Allgemeine Zeitung on December 4, 2015 [in German], citing outbreaks of measles in several regions in Germany already. When such headlines are published, health politicians regularly discuss vaccination. In Germany, it is up to every citizen to decide whether or not to get vaccinated, and parents are under no obligation to have their children vaccinated (yet). This is where information campaigns come in, aimed at influencing the corresponding – preventative – behavior, e.g., the “Germany is looking for the vaccination record” campaign (German: “Deutschland sucht den Impfpass”) by the BZgA (a public agency promoting health education). By contrast, vaccination is mandatory for instance in the United Kingdom (UK) to prevent certain diseases from spreading. Though health risks are at a comparable level in both countries, policy measures differ significantly.

Similar discrepancies can be found in regulations on gambling, which is associated with addiction as a health risk: Regulation on the range of gambling varies not only between the UK and Germany, but also within Germany regarding different types of gambling, which are discussed in the context of “health protection” (Loer 2014). Political measures also diverge where health risks of certain practices and fashions, e.g., body decoration (piercings, tattoos), are concerned: damage resulting from such practices is explicitly excluded from insured healthcare services in Germany (§ 52 (2) SGB V), while the National Health Service in the UK strictly regulates the execution of piercings and tattoos (registration systems, local government acts etc.) but offers healthcare services in case of damage.

In many OECD countries, avoiding health risks is increasingly debated under the rubric of “preventative policy”; however, the resulting political measures vary widely. Though some risks seem to have “newly” arisen, often established products and practices come to be regarded as health risks in need of regulation from a certain point in time. This is demonstrated by measures taken to protect non-smokers as well as initial campaigns to reduce the consumption of sugar (e.g., in the US, Australia, and Mexico).

Protecting individual citizens is one of the noblest of state functions – it encompasses protection from health risks, even if it is not made explicit but rather included (so far) in occupational and consumer safety or environmental protection. A new perspective on health protection is brought to the fore where diseases are concerned that result from individual behavior, i.e., when the goal is to “protect citizens from themselves”. Such a change in the direction of health policy in the “preventative state” might be connected to structural problems many industrialized nations are trying to solve: Demographic change and technological progress push the organizational capacities of systems to their limits, affect economic and social coexistence and increase cost pressure within the systems.

This habilitation project analyzes under which preconditions policy measures on the prevention of health risks are passed on the national level. The phenomenon to be explained (the dependent variable) consists of political measures taken by the nation state to prevent individual health risks. Therefore, the central question is whether and how policies intervene in those everyday decisions that could carry health risks or increase the risk of disease. Put differently: Why are political decisions to intervene in individual life practices made in a nation state and which preconditions are they contingent on?