A tale of two Germanys

Editor—The fall of the Berlin Wall in 1989 marked the beginning of the end of communism in eastern Europe and in eastern Germany. As McKee and Fister point out, certain constellations of epidemiological and demographic variables characterise the resultant process of political and economic transition: low or even decreasing life expectancy (especially for men) and higher prevalences of alcoholism and obesity. This has happened in the postcommunist Länder (federal states) of eastern Germany. East Germany is different from other east European countries in that its healthcare sector was not deconstructed, with periods of severe dysfunction: it simply adopted the healthcare system of West Germany. Despite this, life expectancy at birth is still lower in eastern Germany than in western Germany, although the difference had diminished at the end of the 1990s. Alcoholic disease is a feature of the typical transition process. The number of people discharged from hospital with alcoholic disease was higher in eastern Germany in 1994 and 1999 than in western Germany. Obesity is another transition related problem and a risk factor for many diseases. The proportion of the population with obesity (body mass index > 29.9) is higher in eastern Germany than in western Germany. This difference has remained for over 10 years after the fall of the Berlin Wall. In the medium term, the situation is set to even out. But it is remarkable that in spite of the same, well equipped (curative) health system, health care does not strongly modify mainly lifestyle linked health effects in a population that is exposed to transition after communism. For eastern Germany, the end of this transition process is in sight.