Healthy throughout life

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 six months above the OECD average

Life expectancy at birth

Large regional differences in life expectancy across Germany: Across the almost 400 districts and cities there were clear regional differences in life expectancy at birth between 2013 and 2015.1 The district of Starnberg came out top with 83.3 years. People in the city of Bremerhaven lived on average almost six years less with a life expectancy of 77.6.

In all districts and cities, women live much longer than men. Women in the district Breisgau-Hochschwarzwald had the highest average life expectancy at almost 85 years. Women in Pirmasens had the lowest life expectancy at birth at 80 years. Among men, residents of Starnberg lived the longest, with an average of 81.5 years. Men in Bremerhaven lived on average to the age of 74.3.

Select your municipality or city:

The dots represent life expectancy at birth from 2013 to 2015 for almost 400 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. Residents of Berlin have gained more than six years, placing the capital at the top of the list. In the district of Emden life expectancy increased by 1.5 years. Between 2013 and 2015, the life expectancy was two years higher in Berlin (80.5 years) than it was in the district of Emden (78.5 years).

Largest gains in life expectancy in East Germany: 38 of the 40 districts and cities with the largest increases in life expectancy are in the eastern Federal States. But life expectancy in most western German districts and cities is still higher than in eastern Germany.

Highest life expectancy is found in Southern Germany: Of the 40 districts and cities with the highest life expectancy in the period 2013 to 2015, 33 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 2013 and 2015, this had fallen to 19 districts in the eastern German Federal States.

Eight of the 40 districts with the lowest life expectancy between 2013 and 2015 were in North Rhine-Westphalia and eight in Lower Saxony. Three were in Bavaria and three in Schleswig-Holstein. But Bremen, Rhineland-Palatinate, and Saarland also had one or two districts 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.

Obesity increases the risk of health problems such as type II diabetes, strokes and heart problems. So the BMI is an indicator for individual healthcare. The focus is on people with a body mass index of 30 and above.

Within a period of 15 years the share of obese people in Germany increased by 36 per cent. In 1999, just under 12 in every 100 people in Germany were obese, by 2013 this had risen to 15 in every 100. Men were more likely to be obese than women.

Obesity prevalence among adults by age group

Compared to other OECD countries Germany comes around halfway. In countries such as Switzerland around ten out of 100 people are obese. In contrast, in Mexico and New Zealand more than 33 out of 100 adults are obese. In the United States of America this holds true for nearly 40 out of 100 adults.

The risk of obesity increases with age. Between 1999 and 2013, the risk of becoming obese increased in all age groups. The proportion of obese men and women in Germany was highest in the 55 to 64 age group. One in 4 men and 1 in 5 women in this age group were obese.

Only around 1 in 20 young adults were obese. But the trend is alarming: this age group displays the highest percentage increase.

The number of people with a BMI of 30 and above increased in all regions of Germany between 1999 and 2013. 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.

Obesity prevalence among adults by federal states

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. To protect consumers, the government is keen to see more transparency and information, such as on drug leaflets and food labels. With its Equity in Health cooperation network (Kooperationsverbund Gesundheitliche Chancengleichheit), the federal government is promoting quality using the example of obesity prevention in kindergartens and day care facilities, and 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.2

Number of persons per county looked after by one GP 2010 and 2016

In 2016, a general practitioner (GP) in Germany looked after an average of 1,572 residents. But there were marked regional differences. In Garmisch-Patenkirchen one GP looked after 1,100 residents, while in Gütersloh the figure was 2,037 residents. Compared to 2010, in 2016 one GP on average looked after 33 more residents than five years before.

Needs planning for contracted practitioners ensures3 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 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 2.4 minutes to get to their nearest GP. Meanwhile, for residents of the Eifelkreis Bitburg-Prüm in Rhineland-Palatinate travel takes almost four times longer – more than 10 minutes.

Travel time by car to the nearest GP within a county 2016
Shortest and longest journey to nearest GP 2016

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 1,438 residents. In 2016, this ranged from 440 residents per general specialist in Heidelberg to 2,270 residents in Gifhorn. 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.

Number of persons per county looked after by one general specialist 2016

What Does the Government Do?

With its Care Provision Strengthening Act (Versorgungsstärkungsgesetz) of 2015, the federal government guaranteed high-quality, accessible medical care for cities and rural districts alike. The new appointment service points set up by the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) help patients who have referrals to get an appointment with a specialist within four weeks. The Hospital Structures Act (Krankenhausstrukturgesetz) guarantees comprehensive in-patient care.

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 2015, around 2.9 million people in Germany were in need of long-term care. The majority of those needing care are looked after at home, mainly by their relatives. Some 700,000 people in need of care are supported by relatives together with assistance care services. One third of all people in need of care live permanently in a retirement or nursing home.

Number of persons in need of care by type of care provision by end of year 2015

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?

The German Federal Government has introduced three Long Term Care Strengthening Acts (Pflegestärkungsgesetze) during the current legislative period. These involve expanding home care services for those who need them and their families, and making these services more flexible. On 1 January 2017, the federal government will be introducing a new system for assessing the support needs that are due to cognitive and psychological impairments, specifically those related to dementia. These people will be given easier access to services provided by long-term care insurance. In order to ensure better standards, the quality assessment of long-term care in nursing and retirement homes will be reformed (Pflege-TÜV).

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.4

Proportion of persons assessing their health to be "bad" or "poor" vs. "good" or "very good" by income groups 2014

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 - 45 per cent of people on low incomes 5 and around 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. This means that people on low incomes and the chronically ill are not generally required to make co-payments. The federal government is also keen to directly promote good health in the places where people live, study and work.

Footnotes

  1. 1

    Death counts have been pooled for the years 2013 to 2015 and 1995 to 1997 to make life expectancy across districts comparable.

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  2. 2

    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.

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  3. 3

    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

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  4. 4

    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.

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  5. 5

    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.

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