Translation of a-t 2026; 57: 22-3

Comparison of the German healthcare system with other EU healthcare systems - highest costs, worst performing in terms of prevention

Through the Public Health Index, AOK and the German Cancer Research Centre (Deutsches Krebsforschungszentrum, DKFZ) are comparing how well scientifically recommended prevention measures are implemented in Germany and 17 other countries in northern and central Europe for the first time.¹ Of these countries, Germany spends the most per capita on healthcare, but is one of the worst performing when it comes to implementing prevention strategies in the fields of smoking, alcohol consumption, nutrition and exercise, with 37 out of a possible 100 points (17th out of 18). Great Britain is in first place with 73 points.¹ The authors of the index criticise the lack of political will in Germany to implement effective prevention strategies that could be used to decrease non-communicable diseases such as addiction, cancer, obesity, diabetes, tooth decay and others. The counterproductive influence of lobbyists, meanwhile, is significant (a-t 2025; 56: 89-90). The attractiveness of alcohol and smoking could be reduced, for example, by restricting advertising and (since the price is a significant tool for managing consumption) through appreciable tax rises. The additional revenue could also be used to promote prevention measures.^1,2 To improve nutrition, the prevalence of high-energy, highly processed foods³ that contain large quantities of sugar, salt and additives⁴ and sugar consumption overall should be reduced dramatically. Here in Germany, the annual consumption is 41 kg per capita (2023), corresponding to 38 sugar cubes weighing 3 g per day.⁵ A tax that is tiered by sugar content, particularly on sugary drinks, can cause providers to reduce the sugar content of their products significantly to avoid the tax, as is the case in Great Britain (a-t 2024; 55: 6-7). A corresponding motion, which was also supported by numerous medical organisations such as the German Medical Association, was recently rejected at the CDU party conference,⁶ which we find entirely incomprehensible. As with alcohol, Federal Minister of Health Nina WARKEN wants to rely exclusively on information and voluntary action when it comes to sugar consumption.⁷ Overall, the index shows the fatal coexistence of extreme healthcare expenditure and insufficient strategies to promote health through prevention. The federal government is responsible for ensuring effective prevention that reduces the extent of lifestyle-related diseases, the associated suffering and the subsequent costs. The annual economic burden of tobacco consumption borne by the healthcare system is currently estimated at 97 billion euros here in Germany, and for obesity and alcohol consumption the figures are 63 billion and 57 billion euros, respectively,¹ –Ed.

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