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Changing health inequalities in east and west Germany since unification


  • Nolte, Ellen
  • McKee, Martin


The unification of Germany in 1990 brought about substantial social and economic changes in its eastern part, with new uncertainties and, despite increasing overall income, rising inequality. This paper explores the potential impact on health of these changes during the 1990s, looking specifically at income-related health inequalities in east and west Germany and its modulation by psychosocial factors. We used data from the German Socio-Economic Panel (GSOEP) for the years 1992 and 1997, including individuals aged 25+. We investigated changes in self-perceived health in the two parts of Germany and its socio-economic and psychosocial determinants. Analyses estimated odds ratios of less than good health using logistic regression. In 1992, 47% of east Germans rated their health worse than good compared with 54% in the west. By 1997, the east-west gap in self-rated health had disappeared, with the prevalence of poor health increasing to 56% in both parts. Income and education were important determinants of health in east and west, with, in the age-sex-adjusted model, those having available less than 60% of median equivalent income being at increased risk of poor health in 1992 (OReast 2.39, 1.45-3.94; ORwest 2.04, 1.65-2.52). Addition of education reduced the strength of this relationship only slightly. In the west, income-related health inequalities widened between 1992 and 1997 yet the initially stronger gradient declined in the east, despite an overall increase in income inequality (OReast 1.63, 1.04-2.56; ORwest 2.65, 2.19-3.21). The impact of education remained stable. Psychosocial variables were important determinants, mediating the effects of income, with leisure-cultural social involvement exerting the strongest effect in both east and west. The results show that, unlike in the west, the overall increase in income inequality in east Germany between 1992 and 1997 was not accompanied by a simultaneous increase in income-related health inequalities. This suggests that mechanisms involved in the association of socio-economic factors and health possibly behave differently in east and west.

Suggested Citation

  • Nolte, Ellen & McKee, Martin, 2004. "Changing health inequalities in east and west Germany since unification," Social Science & Medicine, Elsevier, vol. 58(1), pages 119-136, January.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:1:p:119-136

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    Cited by:

    1. Jens Klein & Nico Vonneilich & Sebastian Baumeister & Thomas Kohlmann & Olaf Knesebeck, 2012. "Do social relations explain health inequalities? Evidence from a longitudinal survey in a changing eastern German region," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 57(3), pages 619-627, June.
    2. Hans-Martin von Gaudecker & Rembrandt D. Scholz, 2006. "Lifetime earnings and life expectancy," MPIDR Working Papers WP-2006-008, Max Planck Institute for Demographic Research, Rostock, Germany.
    3. Barnett, Ross & Pearce, Jamie & Moon, Graham, 2005. "Does social inequality matter? Changing ethnic socio-economic disparities and Maori smoking in New Zealand, 1981-1996," Social Science & Medicine, Elsevier, vol. 60(7), pages 1515-1526, April.
    4. Rainer Göb & Christopher McCollin & Maria Ramalhoto, 2007. "Ordinal Methodology in the Analysis of Likert Scales," Quality & Quantity: International Journal of Methodology, Springer, vol. 41(5), pages 601-626, October.
    5. MAZEIKAITE Gintare & O'DONOGHUE Cathal & SOLOGON Denisa, 2017. "Decomposing health inequality in the EU," LISER Working Paper Series 2017-02, LISER.
    6. Hans-Martin von Gaudecker & Rembrandt D. Scholz, 2007. "Differential mortality by lifetime earnings in Germany," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 17(4), pages 83-108, August.
    7. Duclos, Jean-Yves & Leblanc, Josée & Sahn, David E., 2011. "Comparing population distributions from bin-aggregated sample data: An application to historical height data from France," Economics & Human Biology, Elsevier, vol. 9(4), pages 419-437.
    8. Barnett, Ross & Pearce, Jamie & Moon, Graham, 2009. "Community inequality and smoking cessation in New Zealand, 1981-2006," Social Science & Medicine, Elsevier, vol. 68(5), pages 876-884, March.
    9. Lars Kroll & Thomas Lampert, 2011. "Changing health inequalities in Germany from 1994 to 2008 between employed and unemployed adults," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(3), pages 329-339, June.
    10. Furnée, Carina A. & Pfann, Gerard A., 2010. "Individual vulnerability and the nurturing state: The case of self-reported health and relative income," Social Science & Medicine, Elsevier, vol. 71(1), pages 125-133, July.
    11. Siegel, Martin & Vogt, Verena & Sundmacher, Leonie, 2014. "From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011," Social Science & Medicine, Elsevier, vol. 108(C), pages 10-19.


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