Health as a Public Concern: Revitalizing Civic Engagement in the German Health System Through Civic-Minded Movements

This chapter delves into the interplay between the state and citizens within the context of the German health system which has been characterized by a bulwark of bureaucratic state institution and corporatist stakeholders. However, over the years, it has evolved to embrace a more civic-minded approach. Nowadays, user organizations rooted in civil society are actively involved in health governance bodies. Nevertheless, this process of civic engagement has somewhat been constrained and domesticated, leading to a status quo where citizen participation has become merely a component for the functioning of the health system rather than a resource to foster renewal and change. To illustrate the historical development of civic engagement and state-citizen intermediation within the German health system, a four-phase framework is used. Based on this framework, three contemporary health topics, i.e. health kiosks, hospital carer strikes, and health data cooperatives, which raise public concern will be investigated. These examples demonstrate the potential to revitalize civic engagement by employing underutilized forms of intermediation, such as co-creation, protest, and social innovation. In order to achieve this goal, civic-minded health movements are essential, as they can act as amplifiers and vehicles to reinvigorate civic engagement in the German health system.