In the current healthcare system, health is viewed as an individual resource. So-called ‘social determinants of health’ are either not taken into account at all or only inadequately, even though the negative link between health and social inequality is well documented (e.g. Marmot, 2005).

“Social determinants” encompass the conditions in which people live. Examples include educational attainment and working conditions, socio-economic status, housing situation and experiences of discrimination.

The ongoing economisation of the healthcare system is exacerbating this situation. Flat-rate payments and investor involvement in medical care centres or hospitals are just two of many examples that demonstrate that the healthcare system is part of the capitalist economic system and that the people who depend on it are not the priority. The result is falling wages for staff, massive staff cuts, high workloads and, consequently, poorer care.

In our view, truly sustainable and equitable healthcare is incompatible with the capitalist system. Nevertheless, it is our aim to identify the ‘social determinants’ that influence our patients’ health and to take them into account in our work. It is essential that we take a critical look at our own role as carers and service providers. For this reason, we also consider it absolutely essential to work in a spirit of solidarity and on a non-profit basis, both internally and externally.

A community-based health centre is a place dedicated to creating as much space and as many services as possible to ensure a sustainable, healthy life for people in the neighbourhood. This should encompass both primary medical care (e.g. general practice) and advisory services (e.g. psychological/psychosocial support, advice on tenancy law or residency, nutrition or exercise) . Furthermore, the neighbourhood health centre should serve as a drop-in centre for local residents and provide a space for networking and exchange, e.g. in the form of a café or as a venue for events.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (WHO, 1995)

The neighbourhood health centre operates on a self-managed and collective basis. Among other things, this means that there is no management or similar structure, and we interact with one another with as little hierarchy as possible. Furthermore, we aim to operate as independently as possible from funders, political parties or other potential influencers, refuse to be exploited by them, and always prioritise the interests of the people with whom we work at the centre.

We work together on an interprofessional basis. This means that people with different areas of expertise work together towards the common goal of ensuring the best possible healthcare and actively participating in social change. These may include, for example, social workers, people with a particularly good knowledge of the neighbourhood, healthcare workers, people who have experienced specific forms of discrimination, lawyers, psychologists and activists.

We work together on a grassroots democratic basis, which means that we aim to reach decisions by consensus wherever possible, and that important decisions must not be made by individual representatives, but must always be referred back and discussed collectively.

Health policy and healthcare must therefore not be limited to the individualised medical treatment of individuals, but must aim to bring about fundamental changes to social conditions: for example, an equitable distribution of wealth and a social policy that promotes equality, fair housing and working conditions, sustainable environmental policy, the fight against racism, and gender equality.

To this end, it is important for us not only to focus on what people can do personally to contribute to their own well-being (behavioural prevention), but also to consciously bear in mind the social and structural factors that influence the health status of a person or group of people (environmental prevention) and to attempt to change these conditions individually or, where possible, structurally.

One way to achieve this is to create a space where people can come together to share experiences and build connections. An open space, such as a café, where people are welcome to simply be themselves, without any obligations or expectations placed upon them.

There is also the option of finding a space or a community where people can organise themselves collectively. To meet people who face similar everyday struggles. It can be a place for exchange, mutual support and collective organisation.

We also believe it makes sense to open up a space where people can, at times, pursue various self-organised preventive approaches, such as cooking together, sporting activities or self-help groups.

Prejudices have a significant influence on how we interact with people and how we treat them. This applies to every encounter, not only in a professional context but also in a personal one, although the implications are particularly far-reaching in a healthcare setting and therefore require special attention.

Despite their structural nature, experiences of discrimination manifest themselves individually and therefore also have varying effects on health and experiences within the healthcare system. Discrimination can make people ill (e.g. German Centre for Integration and Migration Research (DeZIM), 2023).

We are committed to eliminating discrimination in our work, both internally and in our interactions with our patients, neighbours, fellow practitioners and all other people we encounter.

In doing so, we wish to acknowledge and take into account the overlap and co-occurrence of various forms of discrimination—for example, based on origin, gender, class, disability or educational background—that a person faces in social reality.

To make access to our healthcare services as accessible as possible for everyone, it is important to us, for example, that patients are able to choose the language in which they communicate with us; in other words, the lowest common denominator should not be sufficient. Nor should patients have to worry about being understood. To ensure this, working with professional interpreters is of particular importance to us.

Overall, with the help of everyone who works there, as well as users and visitors, the Poliklinik should be designed as an open space that is as free as possible from exclusion and discriminatory behaviour.

Healthcare in Germany is characterised by hierarchies and power imbalances.

For example, there is a strict separation between healthcare providers and patients. We aim to challenge this separation and, where appropriate, break it down. The principle of ‘shared decision-making’ can serve as a basis for this. This is a concept of the doctor-patient relationship in which, as the name suggests, a joint decision is made regarding the patient’s treatment. It is important to move away from paternalistic assumptions and to recognise patients as experts when it comes to the physical and mental stresses they face as a result of their life circumstances.

Furthermore, the people receiving care know the strengths and weaknesses of their neighbourhood and are key contacts when it comes to identifying ways to bring about improvements.

We want to actively seek feedback through various channels and provide space so that the Poliklinik is shaped by patients and visitors themselves, in accordance with their needs. We advocate for the self-organisation of visitors, for example in the form of a patient representative body that represents patients’ interests vis-à-vis the collective.

Furthermore, hierarchies and power dynamics also emerge within a collegial environment. We strive for a team ethos in which all staff members interact as equals. We must not lose sight of those who may be working at the Poliklinik through other service providers.

The aim is to break down the socially established hierarchies that exist between different professions and areas of expertise.

The question remains as to what extent the term ‘patient’ allows for a hierarchy-free or low-hierarchy way of working and does justice to the different people who visit the Poliklinik with a variety of concerns.

As a Poliklinik, we operate on a multi-professional basis both within our collective and externally. In practical terms, this means that healthcare workers and other experts from a variety of fields work together as equals. For example, we aim to offer legal advice, particularly in the areas of tenancy, employment and asylum law. Where we are unable to provide these or other services ourselves, we refer people to existing external agencies or experts. We also aim to work closely with these organisations, always with the aim of ensuring the best possible care.

This collaboration is to be facilitated and further developed through training, supervision, intervision and case discussions. Detailed medical history forms for patients and precise documentation also contribute to the comprehensive recording of (health-related) data.

We see ourselves as a primary care provider within the healthcare system and operate in accordance with best practice. In doing so, we always base our work on the latest research and available evidence, without losing sight of the individual.

For us, this also means not neglecting under-researched or unexplored areas (e.g. gender medicine) or existing biases due to prejudice (e.g. in psychotherapy research) when making individual treatment decisions. However, it is particularly important to us not to leave any room for conspiracy theories.

Where possible, a negotiation must take place should the treatment approaches of healthcare professionals conflict with the patient’s wishes.

An example of this fundamental stance is that we do not issue homeopathic prescriptions, as there are currently no reputable scientific studies proving their direct efficacy.

Current medical research has a major influence on the way we think about illness and health. It often fails to address patients’ needs, living conditions and perceptions, as it is heavily driven by capitalist profit-making logic.

Our own research, in the form of evaluation and the further development of our work, is therefore a central premise of the project. It is important to us to record data, knowledge and experiences within this framework and, where appropriate, to make them accessible. All participation in surveys or evaluations must be voluntary and free from pressure. Health also means feeling well.