The Federal Republic of Germany is a federal parliamentary republic in central Europe. With 81.8 million inhabitants, it is the most populous member state and the largest economy in the European Union. It has the world’s fourth largest economy by nominal GDP and the fifth largest by purchasing power parity. The country has developed a very high standard of living and a comprehensive system of social security. Germany has the oldest social health insurance system in the world. The country spends the highest proportion of its wealth on health in the EU and health expenditure per capita is the second highest.
At present the population is covered by a basic health insurance plan provided by statute. According to the World Health Organization, Germany’s health care system was 77% government-funded and 23% privately funded. Life expectancy at birth was 80.7 years in 2015 and slightly above the EU average of 80.6. Germany has a very low infant mortality rate. However, Obesity is a growing challenge in Germany. More adults in Germany are now obese than the EU average (16% vs 15% according to self-reported data), and the prevalence of obesity has increased by nearly one third since 2003.
The issue of health inequalities has been high on the political agenda in Germany for over a decade. Whilst there is no specific action plan in place, the issue has been mainstreamed into various policy responses since 2000 and increasingly inter-sectoral collaboration has become important. Health care legislation and the health insurance system are a national competency, whilst health promotion and public health actions aimed at tackling health inequalities take place on the regional level. Action has been taken on the national level and there is currently legislation being discussed in the Parliament based on the new structural developments in Germany in the field of prevention and health promotion.
The Preventive Health Care Act, introduced by the German Federal Ministry of Health in 2015, is innovative as it includes stakeholders from both within and outside the health sector. Together, they must agree on a joint national prevention strategy: the Federal Framework Recommendations (Bundesrahmenempfehlungen). The recommendations state that all initiatives implemented under the new law should contribute to reducing health inequalities, and that setting-based health promotion at municipal and local levels are the best way to implement action. Settings such as child day-care facilities, schools, local authorities, workplaces and long-term care facilities are therefore key.
The elements of the act include (i) a national prevention conference which includes health and social insurance bodies, the 16 states, and other relevant actors, (ii) A national prevention strategy and Federal Framework recommendations, and (iii) a prevention report which documents and evaluates results every four years. It requires health insurance funds to invest in and support health promotion initiatives, with a focus on health inequalities in settings at municipal level.
An overview of policy responses addressing health inequalities in can be found in our Policy Database.
An overview of projects and initiatives that are currently taking place or that have successfully been finalized, and that are addressing health inequality issues, can be found in our Project Database.
Please find below an overview of key actors in Germany working on health inequality issues:
- Bundesministerium für Familie, Senioren, Frauen und Jugend – The Federal Ministry of Family Affairs, Senior Citizens, Women and Youth
- Bundesministerium für Ernährung, Landwirtschaft und Verbraucherschutz – Federal Ministry of Food, Agriculture and Consumer Protection
Are you aware of any other key actors that should be added to this list?
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Please find below an overview of relevant documents addressing health inequality issues in Germany. Further publications can be found in our Publications Database.
- Strategien und Erfahrungen zur Verminderung gesundheitlicher Ungleichheit in Deutschland (2007) – Strategies and experiences to reduce health inequalities in Germany. Presentation by Prof. Dr. Elisabeth Pott, Dr. Frank Lehmann, MPH, Bundeszentrale für gesundheitliche Aufklärung (BZgA).
- APuZ: Gesundheit und Soziale Ungleichheit (42/2007) – Health and social inequalities. Publication by Aus Politik und Zeitgeschichte (From Politics to History – journal).
- Strategien zur Verminderung gesundheitlicher Ungleichheiten in Deutschland (2007) – Strategies for action to tackle health inequalities in Germany
Are you aware of any other key resources that should be added to this list?
Please let us know!