Germany

Nikolaus Becker, Hartwig Ziegler

Germany (official name: Federal Republic of Germany) is a nation in central Europe that is bordered on the north by the North Sea, Denmark, and the Baltic Sea; on the east by Poland and the Czech Republic; on the south by Austria and Switzerland; on the west by France; and on the northwest by Luxembourg, Belgium, and the Netherlands. Four transverse physiographic regions span Germany from its northern to its southern boundaries: the northern coastal region, the northern lowland, the central highland, and the southern alpine foothills and mountains. The highest elevation is the Zugspitze (2962 m above sea level). Germany lies in the cooler part of the temperate zone, occupying an intermediate position between the oceanic climate of the west and the continental climate of the east. The climatic difference between the north and south is moderated by the greater elevation of the southern regions. Westerly winds bring in sufficient moisture from the ocean, and precipitation falls all year round. The steady population growth in western Germany after World War II was due in part to an initial 'baby boom' but primarily to an influx of immigrants. Some 9.7 million displaced persons and refugees entered western Germany from the former eastern German regions (GDR) and from neighbouring countries in eastern and southern Europe. The economically driven influx of foreign workers has played the greatest role since the 1960s. After 1972, death rates in the German population began to exceed growth rates. Another cause of the population decline after 1973 was the emigration of foreign workers and their families. As of 1989, almost five million foreigners lived in the western German states (including 1.6 million from Turkey, 610,000 from Yugoslavia and 520,000 from Italy). Since then the population has continued to expand as a result of resettlement. The birth rate in the 1970s was one of the lowest in Europe; in 1978 it was only 0.87% for the German segment of the population, compared with 1.9% for the foreign segment. In 1980 the birth rate rose above 1% for the first time since 1972. The population distribution is quite diverse, due mainly to a century of growth in economic and urban centres. The oldest of these centres is the Ruhr region. At the urban level, large cities in particular have experienced above-average growth since the end of World War II. Recently, however, almost all large cities have been having a decrease in population as a result of migration to suburban areas. The population in the territory of the former GDR increased after the war due to an influx of refugees and resettlement from eastern countries. It then showed a steady decline until the second half of the 1970s. This was due in part to the heavy influx of workers into West Germany up until 1961 and a disproportionately high female population as a result of the war. At the end of the 1980s, people left the eastern portions of Germany in great numbers, most seeking jobs; a total of 2 million people left the east between 1961 and 1990. The regional distribution of the eastern population is non-uniform. In the heavily industrialised southern third the population density reaches 500 adults/km². The remaining land is mostly farmland, and the population density in most of the districts is less than 100 adults/km². The foreign segment of the population is much smaller than in other parts of Germany: less than 2% in 1992 (mostly Vietnamese and Poles). Germany is one of the leading industrialised nations on earth. It has the fourth largest economic gross national product in the world. Germany ranks second only to the U.S. in world trade, posting a positive trade balance despite a traditional deficit in the balance of services and transferrals. Industrial products dominate both imported and exported goods (road vehicles, machinery, chemical and electrical products). The importance of farming for overall economic development has declined steadily in western Germany. As of 1988, agriculture and forestry (including fishing) accounted for just 1.5% of the gross domestic product, but still in 1989, farmlands covered 47% of the territory. Until 1990, farming in eastern Germany was based on large-scale production by 'agricultural production cooperatives'. The process of restructuring agricultural enterprises is not yet complete and is leading to a reduction in total farm acreage. In 1989, about 57% of the total land area in eastern Germany consisted of arable land: 76% of it was farmland and 20% grasslands, meadows and pastures. In 1989, woodlands occupied 29% of the total land area in Germany. Freight traffic utilises both railways and waterways, but private vehicles are by far the dominant mode of passenger transport in Germany. Even public transport relies mainly on street traffic. As of 1989 there were 35 million registered motor vehicles in Germany, with a ratio of 48 passenger cars per 100 inhabitants. Cigarette consumption in Germany rose steadily until the mid-1970s. Then it levelled off and began to decline slightly in the early 1980s. Surveys show that approximately 50% of the male population smoked in the early 1970s. Since then, that percentage has gradually declined, reaching 36% in 1996. In the early 1980s, approximately 30% of the female population were smokers. This decreased slightly in the late 1980s, and the percentage of female smokers in 1996 was about 26%. Smoking habits vary significantly among different age ranges. In 1978 the Saarland had the highest percentage of smokers, equal to 65% of the adult population, followed by North Rhine-Westphalia with approximately 60%. The lowest percentages, at just under 40%, were reported in southern Baden Würtemberg and Bavaria. Corresponding data are not available for the former GDR. Alcohol consumption in Germany has risen steadily over the past decades. It was initially higher in the west and than in the east, but by the 1980s the consumption rates had become approximately equal. Today Germany has one of the highest rates of alcohol consumption in the world. Cancer incidence registration Nationwide cancer registration has been practiced in the eastern part of Germany since 1961. In the past, there were only two regions in western Germany that maintained cancer registries: Hamburg and the Saarland. Because of confidentiality rules that restrict the reporting of medical data, the cancer detection in the Hamburg registry has declined markedly during the past years. As a result, the incidence figures in this Atlas are based entirely on the cancer registries of the former GDR and the Saarland. The Saarland Cancer Registry is a population-based registry covering the population of this federal state in the southwest of Germany. Bordering France and Luxembourg, Saarland is the second smallest state in the Federal Republic, covering an area of 2,570 km². The population monitored by the registry in 1990 was 1.07 million (population density: 417 per km²) or 1.3% of the whole German population. About 48% of the area of Saarland is used for agricultural purposes, 33% is forest, and the remaining 19% includes housing areas, water and recreational areas. The active population is 41% of the total (1990), of which 42% is employed in industry, 19% in commerce and transport, 1.3% in agriculture and 38% in other services. The Registry was established in 1967 as an integrated unit of the State Statistical Office and is based on the Saarland Law on Cancer Registration, which came into force in 1979. Since its inception, the Registry has been financed by the government of the Saarland and by regular subsidies from the Federal Ministry of Health. The basic system of the Saarland Cancer Registry is a centralised registration of individual records including personal identifiers which do not require the consent of the registered patients. Notification is voluntary. Hospitals, physicians and persons acting on their behalf have a right, not a duty, to report cancer cases without violating their professional obligations. The sources of information are hospitals, outpatient departments, pathology and radiotherapy departments and private practitioners. To minimise underregistration, death certificates are also used as data sources. The use of multiple sources warrants a high level of completeness. The first date of cancer diagnosis is taken as an index date for incidence and survival, without regard to the type of diagnostic verification. Due to very restrictive legal regulations, the follow-up of patients is largely passive. The files of registered cases are linked annually with all death certificates. For those patients whose first notification to the registry is by death certificate, the notifying physician is asked for additional information such as date of diagnosis, treatment, etc. If no additional information can be obtained through follow-up, patients are nevertheless included in incidence calculations as DCO-cases. There is no regular matching with migration data for people leaving the Saarland area. A Federal Law on Cancer Registration came into force in Germany on 1st January 1995. This law provides for the establishment of a network of regional cancer registries covering the entire country, and places the individual German states under an obligation to set up epidemiological cancer registries by 1st January 1999. At the moment, the legal and technical basis of the existing registries varies considerably from one to another. This legal framework grants the states considerable scope for design, reporting system and organisation of the state registries. In order to ensure that the registries can be used sensibly for purposes of epidemiological cancer research, extensive precautions have to be taken to guarantee the comparability of the data collected by registration systems, which in some cases differ considerably from one another. The contents, therefore, have been standardised to a very large extent, and methodological uniformity was developed despite the divergences in the state laws for cancer registration. Most of the German registries are still in an initial phase or have an inadequate level of completeness of incidence data. Mortality The official cause-of-death statistics underlying the mortality data for all of Germany are based on official death certificates filled out in accordance with WHO international standards. After a physician fills out the death certificate, it is forwarded through the community records office and health office to the statistical bureau of the appropriate state. There the cause of death is coded according to the current ICD revision and assigned to the commune in which the deceased person last resided. Then, in several states, the death certificate is returned for permanent filing to the health office of the community in which the person died. In other states it is returned to the health office of the community in which the deceased last resided. Causes of death in western Germany have always been ICD-coded by specially trained personnel who ensure compliance with uniform standards that do not vary from one stage to the next. In the former GDR by contrast, the physicians who filled out the death certificates did all coding. This raises quality problems. After reunification, the coding procedures that had been established in western Germany continue to be practiced in both parts of the country.

back