Health Inequalities In Germany Research Articles

Increasing the use of medical rehabilitation by children and adolescents with migrant background through a multimodal information campaign: protocol of a trend study and accompanying process evaluation (MiMi-Reha-Kids, DRKS00019090).

Chronic illnesses can have an unfavorable impact on the participation opportunities of children and adolescents. The German health care system offers medical rehabilitation in order to prevent negative effects, however, migrant children and adolescents make use of this option less frequently than their peers without a migrant background. A multimodal information campaign was developed to increase the use of medical rehabilitation by children and adolescents with a migrant background, and to reduce disparities in health care. The process evaluation will examine the implementation of a multimodal information campaign intended to increase the use of medical rehabilitation by migrant children and adolescents. The information campaign follows a low-threshold participatory approach. In a first step, persons from different migrant communities in Berlin and Hamburg are trained to become transcultural health mediators. These mediators then share their knowledge about chronic illnesses and medical rehabilitation with other families at information events held in their native language. The transcultural mediators also support migrant families in applying for medical rehabilitation. The effectiveness of the intervention will be tested by a trend study with repeated cross-sectional surveys. For this purpose, all families in the project regions of Berlin and Hamburg whose child has received medical rehabilitation are surveyed annually in order to be able to map changes in the proportions of children and adolescents with a migrant background over the course of the project. The study protocol describes a complex intervention to increase the use of medical rehabilitation by migrant children and adolescents, and the accompanying process evaluation and trend study. The intervention is intended to contribute to reducing health inequalities in Germany. The study described in this protocol will provide extensive data on the multimodal information campaign and can thus help organizations and institutions adapt or further develop similar measures for other regions. German Clinical Trials Register (DRKS00019090).

Protagonist der Sozialepidemiologie: Laudatio zu Ehren von PD Dr. PH Thomas Lampert – Träger der Salomon-Neumann-Medaille 2022

The Salomon Neumann Medal of the German Society for Social Medicine and Prevention (DGSMP) honours individuals and institutions who have made special contributions to preventive and social medicine. In 2022, the medal was awarded to PD Dr. Thomas Lampert, Robert Koch Institute, who has been a strong advocate for reporting on health inequalities in Germany for many years. His extensive work provides a precise cartography of the social determinants of health in Germany after the turn of the millennium.

Intersectional inequalities in physical and mental health by sex, gender and immigration in Germany

Abstract Background The mapping of migration-related health inequalities remains challenging, since immigrant populations constitute a heterogenous socially constructed group whose health experiences differ by social determinants of health. In spite of the increasing awareness that population mobility and its effects on health are highly gendered, an explicit gender perspective in epidemiology is often lacking or limited. Methods To map health inequalities in Germany at the intersection of sex, gender and immigration status, we used data from the German Socioeconomic Panel (SOEP) and applied an intercategorical intersectional approach conducting multilevel linear regression models. We differentiated between sex (male/female) as reported in the survey and gendered social practices, quantified through a gender score (femininity-masculinity continuum). Results We included 20,897 participants in our analyses. We saw an intersectional gradient for physical and mental health. Compared to the reference group, i.e. non-immigrant men with masculine gendered practices, physical and mental health steadily decreased in the intersectional groups that did not embody one or more of these social positions. The highest decreases in health were observed in the intersectional group of immigrant women with feminine gendered practices for physical health (-1.54 CI -2.41;-0.79) and among non-immigrant women with feminine practices for mental health (-2.71 CI -3.19;-2.14). Conclusions We saw differentiated patterns of physical and mental health along the intersectional axes of sex, gender and immigration status, both for physical and mental health. These findings highlight the relevance of these intersections in describing population health statuses and emphasise the need to take them into account when designing public health policies aiming at effectively reducing health inequalities. Key messages Being a man and having masculine gendered practices were associated with higher mental and physical health scores, for both immigrants and non-immigrants. Adopting an intersectional perspective, which takes into account social positions (e.g. gender, immigration status) and their impact on health inequalities, can help to target public health policies.

Health inequalities in Germany: differences in the ‘Healthy migrant effect’ of European, non-European and internal migrants

ABSTRACT The present study aims at comparing physical and mental health outcomes of different migrant groups and the native German population, testing for the presence of a healthy migrant effect (HME) and its potential differences between groups. The HME is marked by an observed health advantage for migrants compared to the host population, which declines with increasing years since migration. Macroeconomic, institutional and cultural differences of sending countries or regions define the pre-migration and the host country situation differently for European, Non-European and internal migrants. These conditions are assumed to have an impact on initial health differences as well as on health differences after longer exposure to the host country. Using cross-sectional data from the 2016 wave of the German Socioeconomic Panel, physical and mental health outcomes (generated from the SF-12) are compared between recent international and internal migration groups (≤10 years since migration), non-recent international and internal migration groups (>10 years since migration) and the native German-born population without migration experience. Propensity score matching analyses reveal the presence of a HME for both European and Non-European migrants, but not for internal migrants. This effect differs on the outcome measure and the native comparison group.

Migration and health in Germany-available data sources

Migration background plays an important role in analyses of health inequalities in Germany. The heterogeneity of people with and without migration background requires adifferentiated recording of migration-related characteristics. The latest overview of representative data sources from the Health Reporting (GBE) that included information on migration background was compiled in 2008. The aim of this article is to describe existing data sources reporting the health situation of people with and without amigration background. Starting from the websites and publications of owners of GBE data, representative studies and routine data sources were identified. All sources that consider at least one migration-related characteristic were included. For all included studies, migration-related characteristics, information on the social situation, and health-related indicators were collected. A total of 46data sources (including 19routine data sources and 27studies) were included. The most common indicators of the migration background are nationality (n = 36) and the country of birth (n = 29). Health-related indicators cover awide range of issues. Routine data sources continue to collect little information on the migration background (usually only nationality) and thus constrain migration-differentiated analyses of the health situation. Survey data allow for more nuanced analysis. However, the actual analysis possibilities and content knowledge of the respective data sources were not the subject of this article.

Health inequalities in Germany and in international comparison: trends and developments over time.

Social epidemiological research has consistently demonstrated that people with a low socioeconomic status are particularly at risk of diseases, health complaints and functional limitations, and die at younger ages than those with a higher socioeconomic status. Greater stresses and strains in the workplace, family and living environment are under discussion as possible explanations. Health-related behaviours, psycho-social factors and personal resources, which are important in coping with everyday demands, certainly also play a role. From a public health and health policy perspective, reducing these health inequalities is an important goal. Insights into developments and trends in health inequalities over time can contribute towards highlighting new and emerging problems, and can thus help identify possible target groups and settings for relevant interventions. At the same time, these insights provide a basis upon which the success of policies and programmes that have already been implemented can be analysed and measured. Against this background, this review examines how health inequalities in Germany have developed over the last 20 to 30 years and places its findings within the context of the latest international research in this field.

Pathways between perceived discrimination and health among immigrants: evidence from a large national panel survey in Germany

Objective. Discrimination is an important determinant of health, and its experience may contribute to the emergence of health inequalities between immigrants and nonimmigrants. We examine pathways between perceived discrimination and health among immigrants in Germany: (1) whether perceptions of discrimination predict self-reported mental and physical health (SF-12), or (2) whether poor mental and physical health predict perceptions of discrimination, and (3) whether discrimination affects physical health via mental health.Design. Data on immigrants come from the German Socio-Economic Panel (SOEP) from the years 2002 to 2010 (N = 8,307), a large national panel survey. Random and fixed effects regression models have been estimated.Results. Perceptions of discrimination affect mental and physical health. The effect of perceived discrimination on physical health is mediated by its effect on mental health. Our analyses do not support the notion that mental and physical health predict the subsequent reporting of discrimination. Different immigrant groups are differentially exposed to perceived discrimination.Conclusion. In spite of anti-discrimination laws, the health of immigrants in Germany is negatively affected by perceived discrimination. Differential exposure to perceived discrimination may be seen as a mechanism contributing to the emergence of health inequalities in Germany.

From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011

Individual socio-economic status and the respective socio-economic and political contexts are both important determinants of health. Welfare regimes may be linked with health and health inequalities through two potential pathways: first, they may influence the associations between socio-economic status and health. Second, they may influence the income-related distributions of socio-economic determinants of health within a society. Using the Socio-Economic Panel (SOEP) for the years 1994–2011, we analyze how income-related health inequalities evolved in the context of the transformation from a conservative to a liberal welfare system in Germany. We use the concentration index to measure health inequalities, and the annual concentration indices are decomposed to reveal how the contributions of the explanatory variables age, sex, income, education, and occupation changed over time. The changes in the contributions are further decomposed to distinguish whether changes in health inequalities stem from redistributions of the explanatory variables, from changes in their associations with health, or from changes in their means. Income-related health inequalities to the disadvantage of the economically deprived roughly doubled over time, which can largely be explained by changes in the contributions of individual characteristics representing weaker labor market positions, particularly income and unemployment. The social and labor market reforms coincide with the observed changes in the distributions of these characteristics and, to a lesser extent, with changes of their associations with health.

Ecological analysis of social risk factors for Rotavirus infections in Berlin, Germany, 2007–2009

BackgroundSocioeconomic factors are increasingly recognised as related to health inequalities in Germany and are also identified as important contributing factors for an increased risk of acquiring infections. The aim of the present study was to describe in an ecological analysis the impact of different social factors on the risk of acquiring infectious diseases in an urban setting. The specific outcome of interest was the distribution of Rotavirus infections, which are a leading cause of acute gastroenteritis among infants and also a burden in the elderly in Germany. The results may help to generate more specific hypothesis for infectious disease transmission.MethodsWe analysed the spatial distribution of hospitalized patients with Rotavirus infections in Berlin, Germany. The association between the small area incidence and different socio-demographic and economic variables was investigated in order to identify spatial relations and risk factors. Our spatial analysis included 447 neighbourhood areas of similar population size in the city of Berlin. We included all laboratory-confirmed cases of patients hospitalized due to Rotavirus infections and notified between 01/01/2007 and 31/12/2009. We excluded travel-associated and nosocomial infections. A spatial Bayesian Poisson regression model was used for the statistical analysis of incidences at neighbourhood level in relation to socio-demographic variables.ResultsAltogether, 2,370 patients fulfilled the case definition. The disease mapping indicates a number of urban quarters to be highly affected by the disease. In the multivariable spatial regression model, two risk factors were identified for infants (<4 year olds): Rotavirus incidence increased by 4.95% for each additional percent of unemployed inhabitants in the neighbourhood (95% credibility interval (CI): 3.10%-6.74%) and by 0.53% for each additional percent of children attending day care in the neighbourhood (95% CI: 0.00%-1.06%). We found no evidence for an association with the proportion of foreign residents, population density, the residential quality of accommodations and resident changes in the neighbourhood.ConclusionsNeighbourhoods with a high unemployment rate and high day care attendance rate appear to be particularly affected by Rotavirus in the population of Berlin. Public health promotion programs should be developed for the affected areas. Due to the ecological study-design, risk pathways on an individual patient level remain to be elucidated.

Changing health inequalities in Germany from 1994 to 2008 between employed and unemployed adults

Unemployment is a major determinant of health. We investigate whether health inequalities with regards to employment status have changed in Germany. We used longitudinal data for the years 1994-2008 from a representative panel study (GSOEP). The sample consisted of respondents aged 30-59 years (15 waves, 21,329 persons, 129,526 observations). We analyzed trends and determinants of self-rated health status by employment status using logistic regression and fixed-effects logistic panel models. Health inequalities by employment status increased significantly by 72% in men and by 16% in women after controlling covariates. The trends were partly mediated by consequences of unemployment such as income loss, income poverty, life satisfaction and economic sorrows. Using regression models for panel data we confirmed that the observed increases in health inequalities at the population level also exist at the individual level. Altogether, our findings indicate that health inequalities with regards to employment status increased among men between 1994 and 2008. This observation is in line with increasing income inequalities in Germany and with increasing health inequalities in other European countries.

Privatverschuldung und Mortalität: Untersuchung auf Ebene der Kreise und kreisfreien Städte Deutschlands

Little is known about the influence of individual debts on health inequalities in Germany. Studies from English-language countries have shown that indebtedness is a great burden in every-day life that leads to mental stress and is related to negative health outcomes. Our paper, for the first time, analyses the role of indebtedness on mortality in Germany. Using ecological level data of Germany's 439 administrative districts, we assessed the role of unemployment, income, educational level, population density, regional prosperity, number of hospital beds and of the independent effect of indebtedness on mortality. The variance explained by indebtedness was determined by means of multiple linear regression models. Data were provided by the Federal Statistical Office of Germany and Schufa Holding AG. Indebtedness and unemployment are moderately correlated. Even so, a significant independent effect of indebtedness on mortality can be shown. Indebtedness contributes to the explanation of health inequalities and, together with other socioeconomic factors and the federal state, explains 59% of the variance in age-standardised district level mortality. Indebtedness explains 6% of variance. For the first time in Germany, this study shows that indebtedness not only influences population health as a result of low income or unemployment but also has an independent, albeit rather small, effect. Studies focussing on social inequity and health should further examine the role of indebtedness and also include an analysis on the individual level.

Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk?

BackgroundSocioeconomic status is a predictor not only of mortality, but also of cardiovascular risk and morbidity. An ongoing debate in the field of social inequalities and health focuses on two questions: 1) Is individual health status associated with individual income as well as with income inequality at the aggregate (e. g. regional) level? 2) If there is such an association, does it operate via a psychosocial pathway (e.g. stress) or via a "neo-materialistic" pathway (e.g. systematic under-investment in societal infrastructures)? For the first time in Germany, we here investigate the association between cardiovascular health status and income inequality at the area level, controlling for individual socio-economic status.MethodsIndividual-level explanatory variables (age, socio-economic status) and outcome data (body mass index, blood pressure, cholesterol level) as well as the regional-level variable (proportion of relative poverty) were taken from the baseline survey of the German Cardiovascular Prevention Study, a cross-sectional, community-based, multi-center intervention study, comprising six socio-economically diverse intervention regions, each with about 1800 participants aged 25–69 years. Multilevel modeling was used to examine the effects of individual and regional level variables.ResultsRegional effects are small compared to individual effects for all risk factors analyzed. Most of the total variance is explained at the individual level. Only for diastolic blood pressure in men and for cholesterol in both men and women is a statistically significant effect visible at the regional level.ConclusionOur analysis does not support the assumption that in Germany cardiovascular risk factors were to a large extent associated with income inequality at regional level.

Programmes and projects to tackle health inequalities in Germany and Europe

Hintergrund Gesundheitliche Ungleichheiten sind fur alle europaischen Lander dokumentiert. Auch in Deutschland besteht ein deutlicher Zusammenhang zwischen der Schichtzugehorigkeit und dem Mortalitatsrisiko, und auch in Deutschland findet sich seit einigen Jahren ein verstarktes Engagement im Umgang mit sozial bedingten ungleichen Gesundheitschancen.