April 26, 2023 | News | Interview

International Comparison: Life Expectancy in Germany is Underwhelming

In their recent paper published in the “European Journal of Epidemiology” MPIDR Researchers Domantas Jasilionis and Alyson van Raalte and Pavel Grigoriev and Sebastian Klüsener from the Federal Institute for Population Research (BiB) have a closer look on the development of life expectancy in Germany. In this interview Domantas and Alyson explain their findings.

Dr Jasilionis, what have you found in the analysis of the life expectancy in Germany compared to 15 other European countries, the USA and Japan?

DJ: Life expectancy in Germany is well below what we would expect for a wealthy, Western European country, and it has been for a long time. In 2019, the year before the start of the Covid-19 pandemic, Germany ranked 14 out of 15 "old" EU member states when comparing life expectancy of men, just ahead of Portugal. For the life expectancy of women, it ranked 13 out of 15, ahead of the UK and Denmark. Since reunification, the life expectancy gap to the worldwide longevity leaders like Japan or Switzerland has been stuck at around three to four years. This is surprising, because Germany has a high-performing economy, an equitable and advanced health care system, and a well-developed social security system.

Dr van Raalte, you tried to answer the puzzle why Germany has not managed to converge to other countries in life expectancy.

AvR: Yes, we looked at Germany because life expectancy trends in the USA and the UK have been in the spotlight for years. Rightly so because they are increasingly diverging from other high-income countries. But because of this, all of the attention has been on common factors specific to these two English-speaking and more liberal-oriented economies. No one has looked to the consistent laggards like Germany. And what we found is that the wider German context doesn’t neatly fit into these wider discussions on the social determinants of health. Germany is not experiencing an opioid-related mortality crisis. There haven’t been major austerity programs introduced in recent years. Regional mortality differences are low, at least compared to those found in other countries. Health care is equitable, well financed, and at the state of the art. Although German health-related behaviors are not exemplary by international standards, they are not far outside of the norm. Excess mortality from smoking, obesity, and excessive alcohol consumption here does not explain the life expectancy gap to other countries.

What are the reasons?

AvR: When it came to trying to get a deeper understanding for the underwhelming German life expectancy beyond causes of death, we found ourselves banging our heads against the wall. The data we would want to test our ideas just isn’t there. Take hypertension as an example. Do Germans test their blood pressure as often as their neighbors? When they have high blood pressure, do they control it with medication? Some have suggested that Germans are arriving at the hospital too late, in a poor state of health with multiple co-morbidities. But the data to make this argument is patchy, and often based on small surveys from a handful of cities, which is then extrapolated to give national estimates for international databases like the one of the OECD. We really need internationally comparative data on prescription drug usage, medical procedures, and health biomarkers aggregated over age and sex that are nationally representative and continuously collected.

How can policy makers in Germany ensure to improve the life expectancy of the German population?

DJ: This paper is not about the poor performance of Germany, but it is more about how this country could do much better considering numerous advantages in other socioeconomic and health care metrics. However, higher life expectancy levels in the vanguard countries show that there is a substantial room for Germany to further improve the health of its population. But it seems that although the well-resourced German health care system ensured better capacity in times of the Covid-19 pandemic, ensuring that life expectancy in Germany converges with that of the countries with the highest longevity levels, would require substantial additional efforts. It is evident that the primary areas of focus for Germany should include tackling the very high burden of premature morbidity and mortality due to cardiovascular diseases. This would require Germany to strengthen its health policies and prevention efforts, and to increase the overall efficiency of the primary care setting.

Original Publication

Jasilionis, D., van Raalte, A., Klüsener, S., Grigoriev, P.: The underwhelming German life expectancy. European Journal of Epidemiology (2023). DOI: 10.1007/s10654-023-00995-5