Why Germany Underperforms vs France, Spain, and Italy

Germany is the clearest case of world-class healthcare not being enough on its own. Smoking prevalence runs higher than in its southern European neighbours, and alcohol consumption is higher too.

Obesity is rising — around 25% of adults, against 17% in France — and the German diet is less Mediterranean, with more sedentary urban lifestyles in the northern regions. Lifestyle, not medicine, is the drag.

The East-West Divide

Former East Germany still shows slightly lower life expectancy than the former West — a gap that persisted for decades after the 1990 reunification and is now mostly, but not entirely, closed.

Where it remains visible, in some rural eastern states, it traces back to higher unemployment, economic stress, and historically different healthcare infrastructure.

Where Germany Excels

The strengths are real. World-class hospitals and specialist care, strong occupational health and safety standards, and statutory health insurance covering all residents form a genuinely robust system.

Emergency medicine is excellent, and wait times for specialist care are among the lowest of any universal system anywhere.

Improving Trends

Smoking rates are declining, cancer-screening uptake is increasing, and cardiovascular mortality has fallen significantly since 1990.

Life expectancy at 65 is competitive with European peers — the underperformance is concentrated in working-age mortality from preventable causes. See how your own habits change your forecast with the Life Expectancy Calculator.