Contextual factors in the surveillance of non-communicable diseases (NCD) in Germany: political, social and environmental indicators

Background: The health of the population is shaped by political, social and environmental conditions – referred to as contextual factors in this paper – which influence the risk of type 2 diabetes and other non-communicable diseases (NCD). The article provides an overview of selected indicators for this topic. Method: The indicators were developed based on a literature review and a multi-stage selection process, considering their relevance for the prevention of diabetes and other NCD as well as the availability of data. Available nationwide data were used for operationalisation. Results: Six indicators were agreed upon: tobacco control, the consumer price index, food taxation and prevention expenditure in the area of health policy measures, the at-risk-of-poverty rate in the area of employment and social affairs, and use of means of transport in the area of built and physical environment. The time trends for these indicators are integrated into the NCD Surveillance of the Robert Koch Institute (RKI) and are presented on the web portal of the federal health reporting. The results for all indicators point to inadequate prevention measures. Conclusions: Context indicators help to track changes over time in environmental determinants of health. As part of NCD Surveillance at the RKI, this topic will be continuously developed.