How does good health care increase life expectancy

Healthy through life

"Of course, the most important thing is health - and sufficient opportunities to maintain it, in other words a sustainable health system that offers affordable or free services for everyone."from an online response dated June 23, 2015

A long, healthy life

Medical progress makes it possible: diseases and age-related weaknesses can be treated better and better. So many people can go through life healthy.

The Life expectancy at birth works well as a measure of the general health of a society. Life expectancy at birth is the average expected lifespan of a newborn child at. The current life tables and population figures are the basis for calculating life expectancy. In 2017, the average life expectancy of women in Germany was 83.3 years. Men lived on average just under 79 years old.

Life expectancy in Germany has been increasing since the late 1950s, by almost three months every year. A data comparison of the total German population with other OECD countries shows: Germany has an average life expectancy in the middle field - above the OECD average.

Development of life expectancy at birth

Regional life expectancy - big differences in a Germany-wide comparison: In the 395 rural districts and independent cities in Germany, life expectancy at birth differed significantly from region to region between 2015 and 20171: the Starnberg region was the frontrunner with more than 83.5 years. At 77.7 years of age, the people in Bremerhaven lived almost six years shorter on average.

In all counties and urban districts women live significantly longer than men. Women in the Starnberg district reached the highest average age at 85.5 years. The women in the Pirmasens district had the lowest life expectancy at birth at just under 80 years of age. In the case of men, it is also the residents of the Starnberg district who were the oldest at 81.5 years. Men in Bremerhaven lived an average of just under 75 years.

The dots arrange life expectancy at birth in the years 2015 to 2017 for 395 rural districts and urban districts in Germany - from left to right, from the lowest to the highest life expectancy. Each interactive point stands for a district or an independent city.

The transparent points show the life expectancy in the counties and urban districts for the years 1995 to 1997. How many years of life have people gained in the last 20 years?

Biggest gain in years of life in Berlin: The longer the connecting line between the data points, the more years the residents in the counties and urban districts have gained in the last 20 years. In Berlin that was almost six and a half years. The capital was the front runner. Although the number of years gained in the district of Erlangen was the lowest in Germany at 1.6 years, with 80.7 years, Berlin and the district of Erlangen were on par in terms of life expectancy at birth between 2015 and 2017.

Strongest increases, especially in eastern Germany: Of the 40 urban districts with the greatest increase in life expectancy, 37 come from eastern Germany. Nevertheless, life expectancy in most eastern German districts and cities is still below the average life expectancy in western Germany.

Regional highest life expectancy mainly in southern Germany: Of the 40 districts and urban districts with the highest life expectancy in the years 2015 to 2017, 32 are in southern Germany - in Baden-Württemberg or Bavaria.

Low life expectancy - regional focuses are shifting: Of the 40 districts with the lowest life expectancy between 1995 and 1997, 39 were in eastern Germany. Between 2015 and 2017 there were only 16 districts.

Nine of the 40 districts and urban districts with the lowest life expectancy in the years 2015 to 2017 were in Lower Saxony and eight in North Rhine-Westphalia. Rhineland-Palatinate and Schleswig-Holstein each had two of the districts with the lowest life expectancy. But also in Bavaria, Saarland and Bremen there was a district with a below-average life expectancy.

Explore the regional differences.

Source: Calculations by the Federal Institute for Population Research based on figures from the federal statistical offices and the state level.

What is the federal government doing?

For example, the 2015 Act to Strengthen Health Promotion and Prevention does more to identify diseases and disease risks at an early stage. The national prevention strategy coordinates measures to maintain health. The health and long-term care insurance funds in Germany spend more than 500 million euros annually on preventive measures.

Stay fit, live consciously

"[...] Access to good nutrition and having fun exercise right from the start is important."Participants in the dialogue organized by the Federal Ministry of Health on July 28, 2015 in Berlin

People know that a healthy life depends not only on the quality of medical care, but also on it own behavior. The range of topics in the dialogue was correspondingly broad: from regular exercise and healthy nutrition to responsible use of alcohol and nicotine. The labeling of ingredients in food was also discussed.

Sufficient exercise and good nutrition are important building blocks for maintaining individual health and, last but not least, for your own body weight. The Body Mass Index (BMI) sets a person's weight in relation to their height (kg / m²). According to the definition of the World Health Organization (WHO), an adult with a BMI between 25 and under 30 is considered overweight. As obese apply to people with a BMI of 30 and above.

Obese people have a higher risk of getting sick. These include type II diabetes, strokes and cardiovascular diseases. The BMI is therefore an indicator for that individual health care. The focus is on Development of the proportion of people with a body mass index of 30 and above.

Over a period of 18 years, the proportion of obese people in Germany rose by almost 35 percent. In 1999 just under twelve out of 100 people in Germany were obese, in 2017 more than 16 out of 100 people. Men were more likely to be obese than women.

Development of the proportion of obese people by age group in 1999 and 2017

In an OECD comparison, Germany is in the upper midfield. Countries like Switzerland or Italy have ten obese people per 100 people. Conversely, in Mexico or New Zealand, more than 30 out of 100 adults are obese. In the United States of America, this affects 38 out of 100 adults

The The risk of obesity increases with age. Between 1999 and 2017, the risk of becoming obese increased significantly in all age groups. In the age group of 55 to 64 year olds the proportion of obese men was highest. Almost every fourth man in this age group was obese. The age group 65 and over was the most affected among women. In 2017, almost every fifth woman in this age group was obese.

At young adults only 5 out of 100 people were obese. But the trend is increasing: they are in this age group largest percentage increases to observe. Between 1999 and 2017, the proportion of 18 to 24-year-old men doubled.

The proportion of people with a BMI of 30 and higher is between 1999 and 2017 increased in all federal states. Regional differences were found in the height and development of the BMI. The eastern German states of Mecklenburg-Western Pomerania, Saxony-Anhalt, Thuringia and Brandenburg are particularly affected by obesity. One reason for this is the age structure in these federal states: the population here was older on average.

Development of the proportion of obese people by federal state in 1999 and 2017

The BMI is an indicator of health that varies greatly with the person personal lifestyle of the individual is connected. A high consumption of meat and sausage as well as foods with a high fat and sugar content are not in line with the recommendations of the German Nutrition Society. However, eating habits are personal decisions that are influenced - positively and negatively - by what is actually on offer and individual preferences. They are already shaped in early childhood. In this respect, nutrition education is of great importance.

What is the federal government doing?

The Federal Center for Health Education explains the consequences of unhealthy nutrition. With the National Reduction and Innovation Strategy, sugar, fat and salt contents in finished products are to be sustainably reduced by 2025. And the citizens' portal “In Form” also offers helpful nutrition and fitness tips.

Medical care in Germany

Good medical care for all citizens is essential for quality of life. The German health insurance system was discussed in a lively dialogue. It was important to the people that a doctor is on site who takes enough time for patients and listens to them. Good accessibility and availability was an issue above all for the participants in rural areas.

"I would like medical care close to the location to be guaranteed."from the citizens' dialogue of the Emmaus Diakonissenanstalt in Niesky on October 20, 2015

The indicator for Supply of general practitioners and specialists measures how many inhabitants a doctor cares for on average in a district region3.

Number of residents who are cared for by a family doctor per district region in 2010 and 2018

A family doctor cared for an average of 1,599 residents in Germany in 2018. However, there were major regional differences. In the Garmisch-Partenkirchen district, a general practitioner looked after around 1,190 residents, while in the Herford district it looked after 2,033 residents. Compared to 2010, a family doctor cared for an average of 59 residents more than eight years earlier in 2018.

Better planning ensures4 good nationwide coverage. No further doctors can settle in areas with many general practitioners. Incentives are set in underserved areas to encourage more doctors to settle there. In supposedly underserved areas, the proximity to the big city also helps; General practitioners there take care of the surrounding area.

Residents in all districts of Germany can reach the nearest family doctor on average in less than six minutes. For some residents, however, the way to the nearest family doctor can also take significantly more time.

The shortest journeys are made by residents of large cities. Residents in large rural districts have the longest journey to the nearest family doctor. This means that residents of Munich can reach the nearest family doctor in an average of 2.1 minutes. The residents in the Eifelkreis Bitburg-Prüm in Rhineland-Palatinate are on the road almost five times as long - that is, over ten minutes.

Average travel time by car to the nearest family doctor in a district region in minutes 2018
Shortest and longest journeys to the nearest family doctor in minutes 2018

The principle of free choice of doctor means: Every insured person in Germany can freely choose his or her family doctor. The indicator can show the general availability of general practitioners, but not other important aspects of medical care.

At general specialists the regional differences are much more pronounced: On average, a general specialist cares for 1,443 residents. In 2018, the range ranged from 499 residents per general practitioner in Heidelberg to 2,334 residents in the Sömmerda district. In the case of general specialists, care is much more concentrated in the cities. You have to supply the surrounding area accordingly.

General specialists include ophthalmologists, surgeons, gynecologists, dermatologists, ear, nose and throat specialists, neurologists, orthopedists, psychotherapists, urologists and paediatricians. Internal specialists, such as cardiologists or gastroenterologists, do not count as general specialists, but as specialized specialists. This group is not shown here.

Number of residents who are cared for by a general specialist per district region in 2010 and 2018

What is the federal government doing?

With the Appointment Service and Supply Act, we want to further improve supply. Patients should get medical appointments faster, e.g. by offering more consultation hours. The appointment service points are intended to be central contact points for patients. You can be reached 24 hours a day, 7 days a week. In addition, the scope of services of statutory health insurance is being expanded to include additional offers. The health insurance companies are obliged to offer electronic patient files for their insured persons by 2021 at the latest.

Care and attention

Being dependent on care is one of the life situations that can affect anyone in the course of their lives. The topic occupied the dialogue participants and will gain in importance in the future.

“Should I have to go to a nursing home [...] I would like to be cared for humanely - not after minutes. But according to mental and physical needs. "from an online answer dated September 12, 2015

In total, more than 3.4 million people in Germany were in need of care at the end of 2017.5 The majority of those in need of care are cared for at home and mostly by their relatives. Around 830,000 relatives are supported by a care service. A little more than a quarter of all those in need of care live permanently in a nursing home or old people's home.

Number of people in need of care by type of care at the end of 2017

The data on the quality of care is not sufficient at this point in time. Therefore, there is no indicator for Measurement of quality in nursing care recorded. Instead, a placeholder is inserted. This indicates additional data requirements. The aim of the federal government is to close this gap by the next report.

What is the federal government doing?

More financed positions, more staff, more trainees, more wages, more responsibility and better training - all of this will make the situation of the nursing staff and thus also the people in need of care better. These measures were decided in the so-called Concerted Care Action. In order to make care attractive again, the federal government has secured the financing of new positions, 13,000 positions in geriatric care. In the hospitals, every new job is even financed. The working and general conditions in nursing should also be improved by paying appropriate wages across the board. We are also providing more junior nurses. We will increase the number of apprentices by 10 percent by 2023. And we are stepping up efforts to recruit nurses from abroad.

Health care for everyone

Open and fair access to health services was important for the citizens in the dialogue. The wish was expressed several times to be well cared for regardless of income and place of residence. Many people felt that the separation of private and statutory health insurance was unfair. Specifically, it was about differences in medical care or waiting times for specialist appointments.

"An appointment with the doctor has to depend on how urgent the case is and not on who pays better."from the ver.di citizens' dialogue in Cologne on June 19, 2015

One approach to pointing out possible gaps in health is to look at the relationship between health and income. Relationships between health and socio-economic factors are very complex. Whether one's own health is assessed as good or bad is due not just to one factor, but to many different ones: income level, level of education, occupation of a person or age.

The indicator Relationship between subjectively assessed health and income measures the subjectively assessed health for different income groups. 6

Proportion of people who rate their health as “less good” or “bad” or “good” or “very good”, differentiated according to income class in 2016

The lower the income, the more common is your own health than "Less good" or "bad" classified. In the lowest income group, one in four assesses their state of health as “less good” or “bad”. At the top of the income distribution, on the other hand, it is a good one in ten. However, most people value their health as "Good" or "very good" a. For people with low incomes7 that is 47 percent. For people with particularly high incomes, it is just under 58 percent.Causal conclusions are only possible to a limited extent: poor health can impair income opportunities. At the same time, low income can result in poor health.

Ensuring universal health care for all people - that is the goal of the welfare state. That is why almost everyone in Germany has health insurance. Health restrictions should not lead to income poverty and vice versa.

What is the federal government doing?

The solidarity principle ensures that all insured persons have the same entitlement to benefits. Regardless of whether they earn little or a lot, or whether they are sick or healthy. Individual co-payments are limited to income. With the Insurance Relief Act, the contributions to the statutory health insurance are again paid equally, i.e. in equal parts by employees and employers or pensioners and pension insurance. The self-employed with low incomes are relieved considerably and contribution debts are reduced.