Correspondence (letter to the editor): Allow for Regional Requirements: Practices in Germany.

Abstract

The article portrays various issues which also apply to other countries, such as the USA. Within Mississippi, for example, the prevalence of type 2 diabetes in the Mississippi delta is 11%, which is much higher than in Jackson, Mississippi or than the national figure. The possible causes discussed in the MONICA study may also be important in Mississippi. These include socioeconomic conditions — the inhabitants of the delta region are often unemployed, destitute and poorly educated —, environmental factors, medical care — about 24% have no medical insurance, many others are underinsured; moreover transport or access to medical facilities is difficult, for example, because there is no public transport — and genetic factors — for example, Choctaw Indians (1). In contrast to the GEMCAS study and Germany, where about 92% of all adults have a GP, many Mississippi residents have no GP, especially in rural areas. It is striking in table 1 that almost twice as many people are unemployed in East Germany than in West Germany. Moreover, employed East Germans generally earn less than employed West Germans. It might be interesting to examine the state of health of East Germans who migrate to West Germany, and of West Germans who migrate to East Germany. The authors conclude that preventive measures should allow for regional requirements and should consider socioeconomic differences to a greater extent than in the past. I have to agree with this. The federally active Delta Health Alliance, the Diabetes Foundation of Mississippi and other institutions are attempting to address these differences in Mississippi (2). In addition, the American College of Endocrinology and the American Association of Clinical Endocrinologists have developed a power of prevention program (POP), with the main objective of preventing children from becoming fat (3).