German Health Care: A Broken System for Asylum-seekers?
German health care, geared to caring for a population of 80 million, is dealing with an unexpected and intimidating challenge by the continuous influx of about 1.1 million refugees in 2015 alone. Escaping poverty, war and repression, as well as family reunification are among the main reasons people attempt to enter Germany both legally and illegally.

Despite having opened its doors to more refugees than any other European country since 2013, Germany restricts asylum-seekers’ health care access to emergency care, treatment for acute diseases and pain, maternity care and vaccinations. Additional care can be provided, however, patients must file various petitions and jump through multiple hoops before getting approval for the same.

The aim of restricting asylum-seekers’ access to German health care dates back to the 1990s when rising numbers of asylum-seekers from former Yugoslavia created a need to reduce Germany’s pull factor. However, it is evident from various studies that this policy has done nothing to bring down the number of people seeking asylum in the country.

In spite of limiting access to health care, the sociomedical system is crumbling with news reports about vaccines not being available for German citizens till 2017 in the normal quantities. Doctors are having to undergo courses in screening and treating diseases like tuberculosis, scabies and psychological trauma.

In addition, there is the cost of material resources like medicines and hospital beds, diagnostic and surgeries that have spiraling economic repercussions. The siphoning of medical services, even in their most basic form, to asylum-seekers, is resented by many German citizens.

However, despite this backlash, there are many reasons for the country to consider providing full access to German health care, both for asylum seekers and undocumented immigrants. The most obvious of these is that any communicable disease can skyrocket the economic cost to the country by a loss of productivity.

In addition, according to experts such as Dr. David Ingleby from the University of Amsterdam, research has shown that, “denying easy and early access to healthcare not only ignores the right to health but actually increases costs: a new study estimated that since their introduction, these restrictive policies have increased the cost of healthcare by 376 euros per year for each asylum seeker.” Clearly, restrictive policies benefit neither immigrants nor state.

Some states like Bremen and Hamburg have been providing their asylum-seekers with health insurance cards like those used by the general population. These enable direct access to doctors and hospitals without having to apply for a certificate of entitlement.

Officially, the restriction on acute and emergency services remains, but the decision is now moved to the doctor’s medical discretion and no longer made by a municipal administrator. An innovative solution, this could be extended to the legal system, resting the decision of what warrants medical attention to the hands of those in the know.

Another solution being considered is granting anonymous insurance certificates that allow refugees without proof of citizenship to seek medical help without legal repercussions. In Berlin alone, up to 250,000 people live without any personal identity documents which are essential to get full medical treatment, making this idea almost a necessity.

In order to provide funding for these and other such policies for less restrictive health care, the European Union Health Program released a statement pledging fund actions supporting the Member States under particular migratory pressure in January this year. Hopefully, with this positive impetus, the German health care system will move to a more inclusive model for both asylum-seekers and undocumented immigrants.

Mallika Khanna

Photo: Flickr

he Top Diseases in Germany and Poverty's Effects on Health

Even the most prosperous countries struggle to combat epidemics, which often disproportionately affect the poor. The top diseases in Germany, where poverty is on the rise despite a growing economy, are heart and lung diseases.

Top Diseases in Germany: Facts and Figures

Although the prevalence of ischemic heart disease dropped by 8.2% from 2005-2015, it remains the leading cause of premature death in Germany, closely followed by lung cancer, which has risen by 3.6% in as many years.

Studies by the German Health Update (GEDA) support a correlation between poverty and disease, and more specifically, heart and lung disease. Women at risk of poverty statistically experience more bronchial asthma and higher blood lipid levels, which can lead to cardiac disease, than their high-income counterparts. Likewise, low-income men proved more susceptible to heart problems, among other ailments, than high-income men of the same age group.

The obvious question is why? Low-income Germans engage in more health-risk behavior than the upper-class. GEDA finds that men and women who are at-risk-of-poverty are 1.3 times more likely to smoke than those with high-incomes, and due to a lack of exercise and a higher consumption of budget foods like potatoes, white bread and sausages, the ratio of obesity for low-income to high-income women is 3.3 to 1, and for men 1.6 to 1.

But can this health disparity really be reduced to the habitual differences between Germany’s rich and the poor? The GEDA study also attributes increased disease incidence among the poor to psychosocial stress. Experiences of exclusion, social comparison and anxieties about the future, all of which are more common to the impoverished, cause health-impairing stress, which insufficient social support exacerbates.

In an interview with the Foreign Policy Group in February 2016, a low-income woman named Heike Wagner explains, “If you don’t have any money [in Berlin], it’s really hard to be part of the group. Going to a bar, to the movies, you can’t do it…If you have friends with a good job, it’s tough to keep up those friendships.” In addition to the inaccessibility of healthy foods, the absence of physical recreation, the prominence of dangerous habits and the general stress of financial insecurity, social isolation deteriorates the health of Germany’s poor.

Because of the tight entanglement of income and health, combatting poverty ought to further the cause of disease prevention. With poverty “at its highest level in Germany since reunification 25 years ago,” political efforts to protect citizens’ health are crucial.

Programs Designed to Reduce Disease and Poverty

Among several efforts to reduce the top diseases in Germany across all economic backgrounds, the Federal Center for Health Education coordinates the Health Promotion for the Socially Disadvantaged network. Meanwhile, Federal Health Reporting continuously monitors and publishes data on the link between poverty and health to educate the public and inspire political change.

The German Heart Foundation (GHF) sponsors school programs which aim to impart preventative habits early in life. Skipping Hearts teaches children rope skipping and educates them about their hearts’ reactions to exercise and diet. GHF also brings the European Non-Smoking Project’s “Be Smart — Do Not Start” program into German schools.

Every November, GHF hosts a national campaign called Heart Weeks to inform the public about heart health. Cardiologists and heart health professionals give more than 1,200 seminars in hospitals and clinics across Germany.

Additionally, the National Action Plan, IN FORM, spreads awareness about nutrition, physical activity and well-being to encourage citizens to adopt healthy lifestyles. The program began in 2008 and is set to conclude in 2020.

Robin Lee

Photo: Flickr

Germany and Its Dedication to Improving Welfare Efforts

Although Germany is experiencing record-low unemployment and the economy has been improving over the years, overall poverty in Germany is increasing. Since Germany’s reunification in 1990, the poverty rate has never been higher than its current state. Ulrich Schneider — chief executive of Germany’s Equal Welfare Organization — was quoted in an article by the “Deutsche Welle” saying “Poverty has never been as high and the regional disunity has never run as deep.”

In 2013, a survey titled “Living in Europe” released results showing that 16.2 million people in Germany were victims of poverty. That astounding number makes up 20.3% of the German population. As previously stated, poverty in Germany has been increasing over the years and the statistics only support that fact. The percentage of the impoverished German population has ranged from 19.6 to 21.9 since 2008. The poverty issue in Germany has affected men and women alike, but it has affected children more than anything.

In 2014, there were an estimated 1.9 million minors growing up in impoverished households in Germany. Surprisingly, that number shot up by 52,000 in the span of one year. This horrific statistic will haunt the lives of many for years to come. Statistics show “that 57.2 percent of children between the ages of seven and 15 had been supported by basic welfare for a period of at least three years.” Anette Stein — an expert working at the Bertelsmann Foundation — knows from work experience: “The longer that a child lives on welfare, the worse the consequences are.”

The consequences of welfare are horrible because welfare-dependent children are not just affected financially, but also physically and socially. Welfare dependent children have higher chances of struggling in social situations, struggling with health issues and struggling with education.

How Germany is Trying to Appease Poverty

Schneider is aware of Germany’s current status and has proposed to appease the situation by increasing welfare rates and creating more employment opportunities. It was decided in 2015 that in order to create thousands of new jobs for poverty-stricken German citizens, a substantial amount of money would have to be spent. Andre Nahles — a German Labor Minister — stated Germany “will use 2.7 billion euros ($3 billion) from the European Social Fund, plus 4.3 billion euros from within Germany.”

This plan will create 26 different programs within Germany and run until the year 2020. The German labor industry claims that almost 40% of the money will be invested in “the promotion of social integration and the battle against poverty.”

Although Germany is currently in a poor position, their current state does not come as much of a surprise. Statisticians have reported that the European Union as a whole is in worse shape than Germany. Twenty-four point five percent of the EU’s population is facing poverty and social exclusion. Additionally, “16.7 percent of the population was at risk of poverty, 9.6 percent significantly material-disadvantaged and 10.7 percent were living in households with very low labor market participation.”

Germany has a lot of improvements to make before it can get back on track as a country, but it is attacking its problems head-on. The Germans have not shied away from improving welfare efforts and have implemented plans for progression. With Germany’s economy on the rise and the unemployment rate on the decline, it should only be a matter of time before poverty in Germany takes a turn for the better.

Terry J. Halloran

Photo: Flickr

Child Poverty in Germany

Germany has been a relatively wealthy country for years, performing well above average on the economic and social fronts. However, child poverty in Germany is a surprising new trend sweeping the nation.

Several reasons underlie this trend, but perhaps the most important of them is insufficient unemployment benefits. These benefits are called Hartz IV welfare benefits and are often used to help unemployed people afford basic necessities such as food and shelter.

An increasing dependence on welfare payments has rendered approximately 2 million children in Germany impoverished. Annette Stein, a professional from the Bertelsmann Foundation in Germany states, “The longer that a child lives on welfare, the worse the consequences are.”

This can be particularly true for children who have spent a substantial period of their life in penurious conditions, which can take a serious toll on their mental and physical development, their self-esteem and overall health.

According to a report published by the UNICEF, in 2001, 10.2 percent of all German children suffered from poverty. Poverty is determined with respect to half of the median income level, and anything below this level is deemed to be inadequate to support a healthy lifestyle.

UNICEF report also noted that single parent households showed disproportionately greater rates of child poverty. This suggests that measures should be implemented in Germany to connect single parents with potential job opportunities that match their qualifications and skills. This is likely to improve household income and thus decrease child poverty.

Recently, Wolfgang Schäuble, the finance minister of Germany, declared an increase of two pounds in benefits offered to children. Opponents of this change argue that this increase is unlikely to significantly impact rates of child poverty in Germany.

Poverty among children in Germany is not usually due to an inability to afford necessities, but rather an incapacity to further develop themselves as well-rounded individuals through education and healthy eating.

While the situation appears bleak on the exterior, a lot can be done to change the financial predicament of children in Germany. A reduction in child poverty in Germany can be achieved through subsidies to farms and food industries to lower the price of healthy products, distribution of grants or scholarships to students for school; a thorough re-assessment of the adequate amount of benefit required to allow children to sustain and develop themselves as holistic individuals.

Tanvi Ambulkar
Photo: Flickr