Aging without diseases healthy aging is possible
Healthy aging rarely works in Germany
BERLIN. "According to the OECD health data, the German health system offers a high-quality infrastructure and excellent access to health care for the entire population" - with this compliment, the Organization for Economic Cooperation and Development (OECD) relativized the critical description that the German Ethics Council on Hospital Care in Germany published almost at the same time.
But the perspectives are also different: while the Ethics Council starts from a theoretical ideal of justice, the OECD broadens the view of the globe and relativizes the national navel gaze.
So much seems certain: in terms of offer, convenience and degrees of freedom, the German health care system is in the top group in an international comparison.
Seniors with above-average illnesses
It looks completely different if you look at the medical outcome and focus on the state of health of the older population. The fact is: the differences in life expectancy among the leading industrial nations are minimal: if you look at five European countries, a Frenchman who has just turned 65 lives another 21.7 years.
His German peer dies 2.1 years earlier. A British man has just as long a remaining life expectancy as a German, the Norwegian only manages four months more.
The decisive difference lies in the number of healthy years in old age: And here the 65-year-old Norwegian can look forward to 15 years of good and healthy quality of life, while his German peer spends just 6.5 years healthy - but almost two thirds of his retirement is plagued by illness, pain or need for care.
This cannot be explained by the oil wealth of the Norwegians and the comparatively high per capita health expenditure.
Sweden and Great Britain limit health expenditure in their unit systems through prioritization, rationing and waiting times - this does not seem to have a negative effect on health.
Spending on prevention does not explain why Swedes and Norwegians stay healthy in old age, but Germans do not.
Germany and Sweden invest the same amount in prevention, each with 3.1 percent of health expenditure, Norway with 2.8 percent even less, and France just two percent.
In Germany: higher incidence of some chronic diseases
The OECD notes that the Federal Republic is facing a number of age-related challenges in the health sector, the causes of which cannot be found in medicine alone.
The problem emerges even before the above-average burden of disease in old age: "The proportion of people between the ages of 50 and 56 with serious health problems is higher in Germany than in comparable countries, although considerable differences can be observed depending on the socio-economic background." writes the OECD.
The incidence of some chronic diseases, including cardiovascular disease, cancer, diabetes and mental illness, is above the EU average, as is the prevalence of dementia in people over 65.
One reason for this can be work: On the one hand, it is decisive for material living standards and quality of life - on the other hand, it can also be the cause of stress and poor health. What is striking is what distinguishes Germany from the OECD average.
This is measured in three dimensions: Income quality and labor market security, parameters in which Germany scores above average. For the third parameter - the quality of the working environment - the value for Germany is considerably below the OECD average.
Few companies consult psychologists
The OECD names the following reasons for this:
- Few employers regularly analyze the reasons for sick leave. The percentage of companies consulting psychologists is one of the lowest in the EU.
- There are practically no financial incentives for companies to offer workplace prevention. Other countries such as Switzerland or the Netherlands have bonus-malus systems that are organized through disability insurance.
- The state occupational health and safety supervision in Germany was cut from 4,500 to 3,000 jobs between 1995 and 2015 - but better advice to small and medium-sized employers would be essential.
- Applicable protective provisions are not applied to precarious workers, violations often go unpunished.
But the behavior of the individual is also the cause of illness and ailments appearing prematurely: Smoking, excessive alcohol consumption and obesity are reasons for widespread and increasing widespread diseases that lead to early retirement and a decline in quality of life in old age.
With the Prevention Act, even more financial resources are mobilized in order to focus on prevention in living environments. The emerging programs mainly focus on information, education, insight and the resulting changes in behavior - an effect, especially in vulnerable parts of the population, is uncertain.
With the exception of tobacco policy, which has used the special consumption tax as an instrument to reduce consumption with great success (especially among young people), German health and consumer policy dispenses with this option in all other areas of consumption.
Only recently was the sugar tax demanded by the German Diabetes Society categorically rejected. The prices - especially for unhealthy food - in Germany are the lowest among comparable European countries due to tough competition at trade level compared to other wealthy industrial nations. Excessive consumption leaves no regrets, at least for the wallet, even when income is tight.
Large and growing sections of the elderly population will have to pay a high price for this inconsistency in two respects: an above-average and long burden of disease in advanced age and increasing poverty in old age.
Risk of old-age poverty
The economic effects of illness in old age can already be seen in an international comparison:
- In the age group of 55 to 64 year olds, the proportion of employed persons in Germany is 69 percent, in Sweden almost 80 percent, in New Zealand even 86 percent. The state of health and the ability to work are likely to be one factor among others.
- In the age group of 65 to 74 year olds, the employment rate of Germans is only seven percent, in Great Britain and Norway 13 percent, in Sweden even 15 percent.
These two age groups - their health and productivity - are becoming increasingly important for society and the economy if the consequences of the inevitable and inevitable demographic change are to be mitigated.
The alternatives are not very encouraging: higher contribution burdens for the active generation, increasing risk of poverty in old age.
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