[The role of local health departments in reducing inequalities in health in Switzerland].

Examples from Switzerland: In Switzerland, as in other countries, several studies have demonstrated social inequality in health. The aim of this study is to demonstrate practical approaches to reducing these differences, as they offer themselves on the local level, and to analyse the implications for the functioning of local departments of Public Health. Case studies, mainly from the health department of the city of Bern, are used to demonstrate measures taken 1. to identify and correct unmet needs of the socially disadvantaged disabled elderly; 2. to find children from marginal groups who failed to be immunised before entering school age, and to arrange for them to be immunised; and 3. to include psychosocial measures when routine school health examinations have led to observations of a biomedical nature. Recent difficulties are pointed out which developed in this connection as a consequence of the privatisation of traditional Public Health functions. The examples show that considerable effort is needed if local health departments attempting to correct social inequalities try to solve individual problem cases. The task is often multidisciplinary. It involves other administrative sectors such as education, social services and housing construction, and is greatly influenced by measures taken on the Federal or Cantonal (Federal Provincial) level. Whereas demonstrating social inequalities through periodic health reporting can be seen as belonging to the traditional activities of health departments, eliminating or reducing the inequalities not only requires a far-reaching re-orientation of local Public Health services, but also a re-definition of the job description and training of Public Health physicians; and as this process continues, it appears that health departments in Continental Europe will increasingly be led to adopt approaches developed previously by Public Health departments in Anglo-Saxon countries.