German East-West mortality difference: two cross-overs driven by smoking

Before the fall of the Berlin Wall, mortality was considerably higher in the former East than West Germany. The gap narrowed rapidly after German unification, particularly for women, to the point that Eastern women aged 50-64 now have lower mortality, despite lower incomes and worse overall living conditions. Prior research shows that lower smoking rates among East German females was a major contributor to this cross-over. However since 1990, higher smoking rates have been observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differentials and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Experience from other countries show that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming a warning example of the consequences of weakening anti-smoking policies and changing behavioral norms.