Healthy throughout life
Being and staying healthy – this is wellbeing, according to people who took part in the national dialogue. A strong healthcare system that provides everyone with good medical care, whether they live in the city or the country. Short waiting times for appointments with specialists, irrespective of whether they have public or private health insurance.
Being and staying healthy – this is wellbeing, according to people who took part in the national dialogue. A strong healthcare system that provides everyone with good medical care, whether they live in the city or the country. Short waiting times for appointments with specialists, irrespective of whether they have public or private health insurance.
“Health is the most important thing, of course – as well as sufficient possibilities for maintaining one’s health by means of an effective health care system that offers either affordable or free health care for everyone.”from an online response submitted on 23 June 2015
A long and healthy life
Medical advances make it is possible to treat diseases and age-related problems more and more effectively. This means that many people can stay healthy throughout their life.
Life expectancy at birth is a good measure for a population's general state of health. Life expectancy at birth indicates how long a newborn can expect to live on average. Life expectancy is calculated from current life tables that juxtapose registered deaths with current population figures. In 2015, the average life expectancy for women in Germany was about 83 years. For men the average was 78.
Since the late 1950s, life expectancy in Germany has been steadily increasing by almost three months each year. Compared to other OECD countries Germany’s life expectancy at birth lies slightly above the OECD average.
Large regional differences in life expectancy across Germany: Across the 395 districts and cities there were clear regional differences in life expectancy at birth between 2015 and 2017.1 The district of Starnberg came out top with 83.5 years. People in the city of Bremerhaven lived on average almost six years less with a life expectancy of 77.7.
In all districts and cities, women live much longer than men. Women in the district Starnberg had the highest average life expectancy at 85.5 years. Women in Pirmasens had the lowest life expectancy at birth with just below 80 years. Among men, it is also the residents of Starnberg that lived the longest, with an average of 81.5 years. Men in Bremerhaven lived on average to the age of just below 75 years.
Select your municipality or city:
The dots represent life expectancy at birth from 2015 to 2017 for 395 districts and cities in Germany – ordered from left to right, from the lowest to the highest life expectancy. Every interactive dot stands for a district or city.
The transparent dots show life expectancy in the districts and cities for the years 1995 to 1997. How many years of life have people gained since then?
Most years gained in Berlin: The longer the connecting line between two data points, the more years in life expectancy have been gained in the respective districts and cities in the last two decades. Residents of Berlin have gained almost six and half years, placing the capital at the top of the list. In the district of Erlangen life expectancy increased by 1.6 years. Throughout Germany, this was the lowest increase. Despite different rates of increase during the last decades, life expectancy was the same in Berlin and Erlangen with 80.7 years.
Largest gains in life expectancy in East Germany: 37 of the 40 districts and cities with the largest increases in life expectancy are in the eastern Federal States. But life expectancy in most eastern German districts and cities is still lower than in western Germany.
Highest life expectancy is found in Southern Germany: Of the 40 districts and cities with the highest life expectancy in the period 2015 to 2017, 32 are in Southern Germany – in Baden-Württemberg and Bavaria.
Lowest life expectancy is regionally shifting: Of the 40 districts and cities with the lowest life expectancy between 1995 and 1997, 39 were in eastern Germany. Between the period 2015 and 2017, this had fallen to 16 districts in the eastern German Federal States.
Nine of the 40 districts with the lowest life expectancy between 2015 and 2017 were in Lower Saxony and eight in North Rhine-Westphalia. Two were both in Rhineland-Palatinate and Schleswig-Holstein. But Bavaria, Bremen and Saarland also had one district with below-average life expectancy.
Discover the regional differences.
What Does the Government Do?
More has been done to improve the early detection of diseases and risks thanks to the Preventive Health Care Act of 2015 (Gesetz zur Stärkung der Gesundheitsförderung und Prävention) to strengthen health promotion and prevention. The national preventive strategy (Nationale Präventionsstrategie) coordinates measures for maintaining health. Health and long-term care insurance schemes in Germany spend over 500 million euros each year on preventative measures.
Staying fit, making the right choices
“[...] Right from the start, it is important to have access to good nutrition and enjoy exercising.”From the national dialogue event of the Federal Ministry of Health in Berlin on 28 July 2015
People know that a healthy life does not depend only on the quality of medical care, but also on their own behaviour and lifestyle. The dialogue covered a wide range of topics from regular exercise and movement to the significance of a healthy diet, responsible consumption of alcohol and the importance of keeping away from nicotine. The labelling of food ingredients was also discussed.
Adequate exercise and good nutrition are vital for individual health and the individual’s body weight. The body mass index (BMI) relates a person's weight to their height (kg/m²). According to the definition provided by the World Health Organisation (WHO), an adult with a BMI between 25 and under 30 is overweight. Those with a BMI of 30 and higher are considered to be obese.
Within a period of 18 years the share of obese people in Germany increased by 35 per cent. In 1999, just under 12 in every 100 people in Germany were obese, by 2017 this had risen to more than 16 in every 100. Men were more likely to be obese than women.
Compared to other OECD countries Germany comes around above average. In countries such as Switzerland around ten out of 100 people are obese. In contrast, in Mexico and New Zealand more than 30 out of 100 adults are obese. In the United States of America this holds true for nearly 38 out of 100 adults.2
The risk of obesity increases with age. Between 1999 and 2017, the risk of becoming obese increased significantly in all age groups. The proportion of obese men in Germany was highest in the 55 to 64 age group. One in 4 men in this age group were obese. The age group 65 years and older was most prone to become obese. One in 5 women in this age group were obese.
Only around 7 in 100 young adults were obese. But the trend is alarming: this age group displays the highest percentage increase. Between 1999 and 2017 the share of obese young adults doubled.
The number of people with a BMI of 30 and above increased in all regions of Germany between 1999 and 2017. The comparison of German states revealed differences in terms of level and the rate of increase in BMI. Obesity was particularly prevalent in the eastern German states of Mecklenburg-Vorpommern, Saxony-Anhalt, Thuringia and Brandenburg. One of the reasons for this is the age structure in these regions, where the average age of the population is higher.
The BMI is an indicator of health that is strongly linked to an individual's personal life choices. High consumption of meat and cold meat as well as foods high in fat and sugar do not correspond with the recommendations of the German Nutrition Society for a balanced healthy diet. However, dietary habits are personal choices that are influenced positively or negatively by what is actually available to individuals and their personal preferences. These habits are set at a very young age, so it is vital that people are educated about nutrition.
What Does the Government Do?
The Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung) provides information about the consequences of unhealthy nutrition. With a National Strategy the Federal Government aims to reduce salt, fat and sugar in processed foods until 2025. The "In Form" initiative offers useful tips on nutrition and fitness.
Medical care in Germany
Good provision of medical care for all citizens is a vital element of wellbeing. The national dialogue provided scope for a lively debate on the German health insurance system. People found it important to have a doctor on hand who spends enough time with patients and listens to them. Participants from rural areas were particularly concerned about the availability of doctors close to where they work or live.
“I would like medical care to remain easy accessible in all parts of the country.”from the national dialogue event at Diakonissenanstalt Emmaus in Niesky on 20 October 2015
The indicator number of residents covered by a general practitioner or general specialist measures how many residents a doctor cares for within a county.3
In 2018, a general practitioner (GP) in Germany looked after an average of 1,599 residents. But there were marked regional differences. In Garmisch-Patenkirchen one GP looked after 1,190 residents, while in Herford district the figure was 2,033 residents. Compared to 2010, in 2018 one GP on average looked after 59 more residents than eight years before.
Needs planning for contracted practitioners ensures4 a balanced provision of care across Germany. Areas with a surplus of GPs should prevent a further increase in the number of physicians. Areas with a shortage of doctors should provide incentives to encourage doctors to practice there. However, areas with fewer doctors often benefit from being close to a major city as physicians there also look after patients in the surrounding area.
In every county in Germany, the nearest GP is on average less than six minutes away by car. However, for some residents it can take much more time to get to their nearest GP.
Residents of larger cities have the shortest distance to travel, whereas residents of sprawled-out rural districts have to travel the furthest to visit their nearest GP. In Munich, people on average have to drive 2.1 minutes to get to their nearest GP. Meanwhile, for residents of the Eifelkreis Bitburg-Prüm in Rhineland-Palatinate travel takes almost five times longer – more than 10 minutes.
The principle of free choice of doctor means that every person with health insurance coverage in Germany has the right to choose their general practitioner. The indicator reflects the general accessibility of GPs, but not other aspects of medical care that are otherwise important to people.
On average, one general specialist looks after 1,443 residents. In 2018, this ranged from 499 residents per general specialist in Heidelberg to 2,334 residents in the district of Sömmerda in Thuringia. General specialists are much more concentrated in cities and they also look after patients in the surrounding region.
The regional differences are much stronger when it comes to general specialists. General specialists include eye specialists, surgeons, gynaecologists, dermatologists, ear, nose and throat specialists, neurologists, orthopaedists, psychotherapists, urologists and paediatricians. Internists, such as cardiologists or gastroenterologists do not belong to the group of general specialists. The figures for internists are not shown here.
What Does the Government Do?
With the Appointment Service and Care Provision Act (Terminservice- und Versorgungsgesetz), we want to further improve medical care. Patients ought to get doctor's appointments faster. We achieve this by e.g. doctors who offer more consultation hours. The appointment service points are supposed to become central contact points for patients and be available 24 hours a day, 7 days a week. In addition, the scope of services offered by the statutory health insurance will be expanded to include additional services. The health insurance funds will be obliged to offer their insured persons electronic patient files by 2021 at the latest.
Making long-term care quantifiable and transparent
Everyone may need long-term care at some point in his or her life. This issue was addressed by participants in the national dialogue and will become increasingly important.
“If I should ever have to go to a nursing home […], I would like to be treated humanely – not on the basis of a schedule but instead as needed on the basis of my physical and mental condition.”from an online response submitted on 12 September 2015
At the end of 2017, more than 3.4 million people in Germany were in need of long-term care.5 The majority of those needing care are looked after at home, mainly by their relatives. Some 830,000 people in need of care are supported by relatives together with assistance care services. More than a quarter of all people in need of care live permanently in a retirement or nursing home.
The available data on the quality of long-term care is currently inadequate, therefore no indicator has been set for measuring the quality of care, but a placeholder has been used. This shows that better data is needed. The federal government aims to close this gap by the time of the next report.
What Does the Government Do?
More funded jobs, more staff, more apprentices, more pay, more responsibility and better training - all this will make the situation of caregivers and persons in need of care tangibly better. All this was decided in the so-called Concerted Action on Nursing (Konzertierte Aktion Pflege). In order to finally make nursing attractive again, the Federal Government has acted and secured the financing of new jobs, 13,000 jobs in care for the elderly. In hospitals, also every new job is financed. The working and general conditions in nursing are also to be improved by comprehensively paying adequate wages. We are also ensuring more junior nursing staff. By 2023 we will increase the number of trainees by 10 percent. And we are stepping up our efforts to attract nursing staff from abroad.
Health care for all citizens
People who took part in the national dialogue stressed the importance of open and fair access to healthcare services. Many mentioned the need for good healthcare provision regardless of income or place of residence. Many people perceived the separation of private and public health insurance as being unfair, particularly differences in the quality of medical care and waiting times for appointments with specialists.
“Doctor appointments should be issued on the basis of urgency rather than according to who can pay the most.”from the national dialogue event of ver.di in Cologne on 19 June 2015
The relationship between income and health provides one approach to identifying potential equity gaps with regard to health. However, the relationship between health and socio-economic factors are very complex. Whether people assess their own health as being good or bad does not depend on a single factor, but on a range of factors, such as income level, education level, occupation and age.
The indicator ratio of self-reported health and income measures the subjective assessment of health across different levels of income.6
The lower someone's income, the more likely they are to assess their health as poor or bad. In the lowest income groups, one in four people describe their state of health as "poor" or "bad", while this is only the case for one in ten people in the highest income group. However, irrespective of their personal income, most people assess their health as good or very good - 47 per cent of people on low incomes 7 and just below 58 per cent of people with very high incomes. The causal conclusions that can be drawn from this evidence are quite limited and the direction of the relationship remains open: poor health can compromise people's ability to earn higher incomes. At the same time, low incomes can lead to poor health.
Universal health care is a goal of the welfare state. Therefore, almost everyone in Germany has health insurance. Health problems should not lead to low incomes, and vice versa.
What Does the Government Do?
The principle of solidarity in the national health insurance system ensures that everyone with health insurance can access the same services, regardless of whether they are high or low earners, sick or healthy. Co-payments are based on income. The federal government is also keen to directly promote good health in the places where people live, study and work. With the Relief for Insured Persons Act (Versichertenentlastungsgesetz), which came into force at the beginning of 2019, statutory health insurance contributions will again be paid equally by employees and employers or pensioners and pension insurance. The burden on self-employed persons with low incomes will be considerably reduced and contribution debts will be diminished.
Footnotes
- 1
Death counts have been pooled for the years 2013 to 2015 and 1995 to 1997 to make life expectancy across districts comparable.
- 2
For further readings see OECD (2019). The Heavy Burden of Obesity: The Economics of Prevention. OECD Health Policy Studies, OECD Publishing Paris.
- 3
Counties include county towns and their surrounding district (in German Kreisregion). This regional breakdown is appropriate for measuring the density of medical care, as doctors in towns often also care for patients in the surrounding districts. Germany has 361 counties and 402 districts and cities.
- 4
The needs planning for contracted practitioners defines how many residents one general practitioner or specialist has to look after, broken down for the whole of Germany
- 5
The sharp increase in the number of people in need of long-term care is due to the introduction of the new and broader definition of long-term care needs on January 1, 2017. As a consequence, more people are defined as being in need of care and therefore receive benefits of the long-term-care insurance.
- 6
The figures represent a statistical estimate. The upper and lower limits of the 95 per cent confidence interval reflect the statistical uncertainty, as data come from a randomly selected sample.
- 7
The incomes of German people between the ages of 20 and 64 are shown from the lowest to the highest. Income is divided into five equally large bands, so called quintiles. The first quintile contains those 20 per cent of households with the lowest income. The highest quintile contains those 20 per cent of households with the highest income.