The social determinants of health are crucial

Health collectives on healthcare "The social factors of health are crucial"

Two collectives from Berlin and Munich want to change the healthcare system.

Doctor Kirsten Schubert has experience, Sami M. and Katia S. are just getting started.

By Nina Gessner

taz: Kirsten, Katia and Sami, you want to change the future of the healthcare system. Where are you on this path right now?

Kirsten Schubert: We have managed to set up an innovative outpatient healthcare project in Berlin. At the moment, we offer outpatient medical care as well as neighbourhood work, counselling, self-help groups, a café, sports activities and public relations work. All under one roof.

Katia S.: We haven't got that far yet. Our aim is to set up a district health centre in Munich at some point. But we are still in the networking phase, building up our infrastructure and offering workshops and lectures.

taz: Can you as a health collective in Munich learn from Berlin?

Sami M.: Berlin is a beacon of the future for us. That's why we're looking at what we want to adopt. Of course, Berlin is a role model both for us and, we think, for nationwide outpatient care.

taz: Kirsten, do you also see your project as a beacon?

Kirsten: I would certainly see it as a lighthouse project. When you work on it every day, you sometimes forget that it's not a matter of course for a GP to work as part of a team with social workers, psychological counsellors and nurses.

taz: Was the project accepted directly in the neighbourhood?

Kirsten: The most difficult thing is actually to be accepted in the neighbourhood and to work with the people to improve their living conditions. That is much more difficult than setting up a doctor's surgery or writing applications to get money.

taz: What's it like in Munich right now? Are you also looking for a connection in a particular neighbourhood?

Sami: We are currently planning a needs analysis to get a better overview. That's why I wouldn't name a neighbourhood. We don't see ourselves as a fire brigade that comes to a "problem neighbourhood" and then puts it out. It's about establishing a new form of healthcare and neighbourhood work.

taz: So one focus is also on the neighbourhood work itself. You already have a café in Berlin for networking in the neighbourhood.

Kirsten: Yes, that is part of our community work. We offer mobile health counselling and sports with young people and support tenant exchanges. Everything is based on the idea that the social factors of health are the decisive factor that needs to be changed.

taz: How do you view the criticism that you do the work on a voluntary basis that should be done by the healthcare system?

Sami: That is certainly a danger. Of course, you have to be careful not to simply compensate for the shortcomings of a sick system through voluntary work, but rather, as Kirsten says, to create the basis for people to connect collectively.

Kirsten: We want to grow, be taken seriously - and fundamentally change healthcare. That's precisely why we're writing applications. At the moment, there is no legal form for our approach, so we have to finance ourselves as a patchwork construct from third-party funds and the regular financing of medical practices.

taz: Politicians want to link social and health counselling through health kiosks. Is this a similar approach?

Kirsten: Health kiosks do not offer medical care and are not integrated into ongoing treatments. This means that the actual medical care remains largely untouched, without integrated prevention.

taz: If you look 20 years into the future, where will your work be?

Sami: Ideally, our project will be integrated in 20 years' time. Our utopian wish would clearly be for the care approach to prevail, which collectively combats systemic causes - without the private sector and profit-orientation.

Kirsten: I hope that this will also help to change society in the coming years. We want people to say: diversity makes you healthy, marginalisation makes you ill.

taz: What do you need at the moment to get closer to this goal?

Katia: We are currently looking very hard for further sponsoring memberships and donations - for the health collective and for our umbrella organisation, the Poliklinik Syndikat. Unfortunately, this is the reality of our work. But it is also important that we move towards multi-professional work on an equal footing.

taz: The Poliklinik Syndikat also writes: "There is no healthy life in a sick system." Do you want to heal the system or treat people's symptoms?

Kirsten: Of course, it would be nice if we could simply cure the system. But I think that this capitalist system makes people ill. It promotes the pursuit of profit, social division and also a fragmented healthcare system characterised by competition. Fundamental changes are needed.