Differences in avoidable mortality between urban and rural regions in the German Baltic Sea Area since reunification

Michael Mühlichen, Federal Institute for Population Research (BiB)

Still, 25 years after reunification, mortality rates in Germany are not evenly distributed, primarily to the disadvantage of the eastern, but also the northern states. Consequently, in the northeastern-most state of Mecklenburg-Vorpommern (MV), average life expectancy is lower than in most other German federal states, also in comparison to its western neighboring state of Schleswig-Holstein (SH) although - with its special position as a popular recreational and holiday destination - it actually possesses favorable prerequisites for long life (e.g. good air quality, little industry, seaside location, many lakes and forests). Via methods of direct standardization and decomposition and using the official German cause of death statistics, this contribution shows that the mortality difference in this formerly divided region primarily concerns men, and there it is especially due to an urban-rural gradient in MV: Whereas the urban regions of MV have reached the mortality level of the urban areas of SH in recent years, the rural areas of MV still show a significantly higher mortality level than the other regions. On the one hand, these regional differences in men are caused by a higher mortality from causes amenable to health care. On the other hand, even the urban regions of MV still exhibit a significantly higher mortality from causes that should be avoidable through primary prevention. The results show that the accessibility of medical care in the thinly populated areas of MV is still improvable and that health policies should focus more on men and preventing risky behaviour, especially smoking and alcohol abuse. The mortality development in the German Baltic Sea is of peculiar general research interest since the consequences of political separation and reunification for health and life expectancy have the unique character of a ‘natural experiment’.