What does it mean for you to be healthy

What does being healthy mean and how many people are there?

"A healthy patient is just not examined carefully enough," it is sometimes said. If medical examinations actually make us sick, Krautreporter reader M. wants to know. “I've been overweight since my youth,” the 47-year-old writes to me, “come up the stairs more slowly than others, can't run up a mountain. I have a lot of niggles. Others would probably say I was sick. But I don't see myself that way. "

The Body Mass Index (BMI) was an iron law and an irrefutable indicator of obesity - anyone who was above it should slim down to prevent greater risks such as heart disease. KR reader M. also submitted to the dictates of diets for years. She has struggled to maintain her weight for many years. For about as long she has to listen to “serious and less serious people” about all of the things she is supposedly doing wrong. The editor in corporate communications feels healthy, although she should be objectively ill, so to speak. The informative value of the BMI has recently been fundamentally questioned by doctors. The waist size plays a much greater role in health, because the risk of heart disease is not determined by the amount of fat, but by its distribution in the body. Or maybe it's not the fault of the fat.

Recent studies contradict a direct link between normal weight and better health. On the contrary, it seems that overweight people even have a slightly lower risk of death. Yet most of us automatically associate being slim with being healthy. In medicine, it is said that, in addition to smoking, a sedentary lifestyle, lipid metabolism disorders, high blood pressure and diabetes, being severely overweight is a major risk factor for cardiovascular diseases and is therefore jointly responsible for one of the most common causes of death in women and men in Germany. This is what the Robert Koch Institute writes in its report “Health in Germany” (PDF). According to leading health scientists like Ingrid Mühlhauser, "what has been called overweight up to now is actually normal weight". That’s a thing with limit or guideline values. They can change, and suddenly people who were previously considered perfectly healthy are worth treating.

Take the limit for diabetes. That's less than a pinch of sugar per deciliter of blood. Almost ten percent of Germans would have to be diabetic because they are at this measured value. But they are not. 20 years ago the value was a little higher, it was lowered so that you can start treatment earlier. (Thanks Daniel for pointing out the really enlightening article in Brand Eins.) The same applies to cholesterol or high blood pressure. According to the World Health Organization (WHO), blood pressure of 160 was normal in 1980, but ten years later the value was lowered to 140, then increased to 130 in 2000 and now again to 140.

Krautreporter reader Simone also doubts the supposedly clear allocation of illness vs. health. She writes to me: “Anyone who is tinkering with their own career often suffers from psychosomatic complaints due to the stress; I had everything from palpitations to insomnia to irritable bowel syndrome. I would be interested to know whether people with symptoms like this describe themselves as sick or healthy. I actually cannot answer the question for myself ad hoc. "

Krautreporter reader M. interprets being healthy for herself as follows: “My brain works sufficiently well. I can think for myself and do it. I can feed myself, I have a job that I like. I cycle a lot, read a lot, am a serial junkie and love my two cats and my husband. "

This means she belongs to the majority of Germans: according to their own assessment, around three quarters of all adults feel healthy, only just under three percent rate their health as poor. Only with advancing age is it rated increasingly poorly. 94 percent also rate the health of their children as good to very good. Poor people feel that they are less healthy than those with better earnings. A regional comparison also shows that women from Bavaria and men from Schleswig-Holstein and Hamburg rate their health better than the national average. In contrast, women and men from Brandenburg are below the national average.

Health is based on a complex network of social, cultural and biological factors. Nobody has yet been able to fully decipher their secret. Entire dissertations and specialist books were written on this question. And there is still no uniform definition. According to the WHO, it describes a "state of perfect physical, mental and social well-being and not just the absence of illness and ailments." The Federal Social Court defines it as the "state of body and mind that enables people to exercise all physical and mental functions." For diseases and related health problems, the regularly updated international statistical classification of the WHO (ICD-10) is available to doctors.

I would like to throw a few data-based highlights on our health and answer the following questions: How often do people go to the doctor and which doctors do they see? How many hospital cases are there? And how high are the expenditures for health and illness?

Some time ago I read the headline in a daily newspaper: "The higher the price, the more often the operation." A study by the Hamburg Center for Health Economics and the TU Berlin on the "volume development" in clinics seems to confirm this primal fear of people to be completely unnecessarily exposed to the risks of medical intervention in order for the clinics to operate profitably. The number of hospital cases has actually increased by almost a tenth over the past ten years and was 19.6 million in 2014. Particularly cost-intensive, planned interventions such as intervertebral disc, knee or hip joint operations are affected by the increase.

Patients spent a good week in hospital on average. The most common diagnoses were: heart failure (433,000), followed by mental and behavioral disorders due to alcohol (340,000) and atrial fibrillation and flutter (290,000). If you want to know exactly, you will find an exact analysis of cases, days and diagnoses of the statutory health insurances as well as the most frequent operations here.

More than 80 percent of the population between the ages of 30 and 64 see a doctor within a year. The proportion of people over 45 is slightly higher. The statement that women go to the doctor more often than men is put into perspective when the visits to the gynecologist are factored out. General practitioners are visited less often by women than by men.

Now to the costs. There is no doubt that the health economy is an immense economic factor. This is shown by the following data: In 2014, a total of 328 billion euros was spent on health in Germany. This corresponds to 4,050 euros per inhabitant and means an increase of slightly more than four percent compared to the previous year. Illness costs are the current health expenditures minus the investments in the health care system.

The majority is financed by the statutory health insurance funds (194 billion euros in 2013), another part by private individuals (28 billion euros). A good quarter, however, is consumer spending (76 billion euros) and flows into privately financed products and services related to health. The industry with the highest turnover is the pharmaceutical industry (42 billion euros in 2012), followed by medical technology (22.8 billion euros in 2013) and biotechnology (2.9 billion euros in 2012). Every eighth employed person works in the health sector across Germany, that is 5.2 million people. If you add wellness, health tourism and the like, more than 6 million people work here.

Seen in this way, health is not just an individual matter, but a social factor. To get back to yourself, dear M., you write that you have let yourself be unsettled by the talk, have tried a lot and ultimately wasted a lot of time that you “could have spent” “living with and being happy”. So I would like to end with the health scientist Ingrid Mühlhauser. She demands: “People trust medicine. That confidence was to be seriously shaken. Discuss. Doctors have long been used to making decisions for us. That has to change. ”So I thank you for your question, dear M. She reminded me that we shouldn't leave our minds outside the door when we visit the doctor, but should be critical patients.


Lead picture: François Cluzet as a paraplegic Philippe and Omar Sy as his caretaker Driss in “Pretty Best Friends” (© Senator Film Verleih).