Social Epidemiology after the German Reunification: East vs. West or Poor vs. Rich?

Summary

Objective:

Social epidemiology has consistently demonstrated an association between socio-economic disadvantage and ill health. Seventeen years after reunification, economic disparities persist between former “East” and “West” Germany. We examine whether there are according health disparities and how they developed over time.

Methods:

Secondary analysis of socio-economic and health data for Germany.

Results:

Health disparities, for example in life expectancy, are decreasing between East and West. Throughout Germany, however, differences in living conditions and demographic trends are widening at city and county level. This development is easily missed when only East and West are compared.

Conclusion:

Small-area analyses are required to disentangle the association between socio-economic inequalities and health in Germany. In such analyses, not only individual but also contextual (e.g. area level) characteristics need to be included. Contextual variables can be used to group smaller areas such as counties into clusters with similar properties. Thus, individual survey data can be linked with contextual characteristics while maintaining data protection and at the same time achieving sufficiently large case numbers. Concurrently, theoretical models explaining health inequalities need to be further developed so that they embrace contextual characteristics.