Germany Faces Significant Shortcomings in Preventive Healthcare Measures

Germany, despite being one of the highest spenders on healthcare in Europe, continues to underperform in the area of disease prevention according to a newly developed Public Health Index. This index, created through a collaboration between the AOK Federal Association and the German Cancer Research Center, evaluates the degree to which 18 European nations have implemented scientifically recommended public health policies.

In recent years, Germany has fallen below the European Union average in life expectancy. In 2022, Germany allocated 12.6 percent of its gross domestic product to healthcare, compared to the EU average of 10.4 percent. Per capita, this amounted to approximately 5,300 euros, a figure about 50 percent above the EU average. However, these substantial investments have not translated into better health outcomes. For example, the country registers a higher-than-average mortality rate following acute heart attacks, and hospital admissions for chronic diseases such as diabetes, asthma, chronic obstructive pulmonary disease (COPD), and heart failure remain elevated.

The Public Health Index assesses countries based on the adoption of preventive strategies in four main areas: tobacco use, alcohol consumption, nutrition, and physical activity. Germany ranked 17th out of 18, performing particularly poorly in the areas of tobacco, alcohol, and nutrition, while physical activity initiatives placed it in the lower middle range.

Countries such as the United Kingdom, Finland, and Ireland achieved the highest scores, driven by the widespread implementation of preventive measures. These include standardized school meal requirements, health-focused fiscal policies, and protective regulations for children, such as advertising restrictions. By comparison, Germany lacks nationwide, legally binding regulations for school food offerings, relying instead on guidelines provided by the German Nutrition Society.

Alcohol availability in Germany also contributes to its low ranking. High-proof alcoholic beverages are accessible almost everywhere, including at petrol stations, and are available round-the-clock. In contrast, some countries restrict alcohol sales to licensed shops with limited hours and higher minimum age requirements. Germany also stands out as having the most affordable alcohol prices within the EU, with legal purchase of beer, wine, and sparkling wine permitted from the age of 16.

The report highlights that the effectiveness of preventive measures should not be solely assessed by current health outcomes. For example, the United Kingdom introduced ambitious policies in response to growing health issues such as rising obesity rates. Measures like tiered taxation on sugary drinks may take years or even decades before their full impact is visible.

Experts emphasize that successful prevention requires coordinated action beyond the healthcare sector alone. The environment in Germany makes unhealthy choices--such as consuming excessive and unhealthy foods or alcohol--both easy and affordable. Other European governments have demonstrated that policies can be structured to encourage healthier choices without imposing excessive burdens on the economy or society.

The Public Health Index is scheduled for biennial updates to monitor progress and identify areas for improvement, with intentions to expand the scope to include more countries and additional domains, such as mental health and media consumption. The findings highlight a pressing need for Germany to address existing gaps in preventive healthcare policy in order to reduce future disease burdens and improve population health outcomes.