Abstract
Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50–69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.
Highlights
Germany was divided into East and West from 1949 until the fall of the Berlin Wall and subsequent reunification in 1990
For the age groups 50–64, for which earlier research has shown that total mortality is lower in the East than in the West, the lung cancer mortality difference is projected to narrow and eventually reverse; lung cancer is forecast to increase in the East as a result of increased smoking and is declining in the West
After the reunification in 1990, the German East-West mortality difference narrowed rapidly for women; by the late 1990s and early 2000s, mortality in the age group 50–64 had fallen below that of the West. This mortality crossover has been attributed to the higher smoking of the West German cohorts
Summary
Germany was divided into East and West from 1949 until the fall of the Berlin Wall and subsequent reunification in 1990. Over the decades of separation, the East increasingly lagged behind the West in living standards, health care, and life expectancy. By 1989, East German life expectancy was 2.4 and 2.6 years less than that of the West for men and women, respectively (Human Mortality Database 2016). Following the adoption of the West German social, economic, and political system, East Germans benefited from access to a modern Western health system that helped to reduce circulatory mortality as the prime cause of death. In addition to improved living standards and the adoption of Western health care technology, the convergence may have been driven in part by decreases in psychosocial stress resulting from the deprived living and working conditions in the East (Cockerham 1999; Häussler et al 1995; Riphahn 1999)
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