Abstract
The sizeable mortality gap between the German Democratic Republic (East Germany) and the pre-unified Federal Republic of Germany (West Germany) narrowed rapidly after the two states were unified. Despite extensive research, the mechanisms underlying the convergence process are still not fully understood. Significant changes to coding practices and the system of data collection introduced in East Germany shortly after reunification have further complicated the ability of researchers to interpret mortality trends. Our aim is to assess the role of German reunification in the convergence process in light of the evolution of long-term mortality trends by causes of death. Compared to previous studies, we rely on much more detailed mortality data, which we first adjust for notable distortions. We propose an upward correction of cancer mortality, as well as corrections that account for obvious changes in the items selected within the ICD chapter of circulatory diseases. We identify three distinct processes that took place in East Germany around the time of reunification: (1) a sustained reduction in mortality that started before reunification; (2) a temporary increase in mortality in 1990–1991 that was related to the abrupt social transition, as reflected by socially sensitive causes such as accidents, alcohol-related diseases, and acute myocardial infarction; and (3) a reunification-driven process of convergence that was mostly caused by the accelerated decline in mortality from cerebrovascular and chronic heart diseases. Mortality improvements observed in the GDR starting in the 1980s might be interpreted as the first signs of a cardiovascular revolution. Shifts in individual behaviour likely started before reunification, whereas the real progress in medical care occurred later with the implementation of the Western system of health care. We therefore conclude that German reunification per se did not initiate the convergence process, but rather reinforced and accelerated trends that were already apparent.
Highlights
Introduction and BackgroundBetween 1949 and 1989, Germany was divided into two separate states: the socialist GDR (German Democratic Republic) and the free market-oriented FRG (Federal Republic of Germany); hereafter, East and West Germany
We identify three distinct processes that took place in East Germany around the time of reunification: (1) a sustained reduction in mortality that started before reunification; (2) a temporary increase in mortality in 1990–1991 that was related to the abrupt social transition, as reflected by socially sensitive causes such as accidents, alcoholrelated diseases, and acute myocardial infarction; and (3) a reunification-driven process of convergence that was mostly caused by the accelerated decline in mortality from cerebrovascular and chronic heart diseases
The mortality trends in East and West Germany provide an illustrative example of the divergence–convergence cycles in mortality (Vallin and Mesle 2004)
Summary
Introduction and BackgroundBetween 1949 and 1989, Germany was divided into two separate states: the socialist GDR (German Democratic Republic) and the free market-oriented FRG (Federal Republic of Germany); hereafter, East and West Germany. The East–West gap had narrowed by the late 1990s, but the mortality differences between the two German parts have persisted, and male life expectancy shows no signs of converging in the near future (Fig. 1). After four decades of living under a sharply different political, social, and economic system, East Germans had to adapt very quickly to the Western socio-economic system when the two parts of Germany reunited in 1990. This reunification process was accompanied by the massive Western investments in the infrastructure of East Germany, including the social security and health care systems (Vogt 2013; Vogt and Kluge 2015). The adoption of the FRG health care system, which gave East Germans improved access to modern drugs and technologies, is reasonably seen as the most obvious explanation for this progress (Nolte and McKee 2000; Vogt and Vaupel 2015)
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