The “Wessis” (Western Germans) have always believed it: in the East, they’re just slacking off. Such a crude and primitively populist interpretation might arise from the BKK Health Report 2024 if one were to ignore the underlying facts. However, there are valid reasons for regional clusters of illnesses, which this article aims to highlight.

Causes of Illness

Musculoskeletal disorders are well-known culprits. Prolonged sitting at a desk harms the back just as sustained kneeling affects the knees of plumbers. More interesting, because it is less obvious, is the issue of respiratory system illnesses highlighted in our graphic. In our current era, we often unconsciously distinguish between the time before and after the COVID-19 pandemic. “Do you remember when…?” “Was that before or after COVID?” One lingering effect of COVID-19 is so-called “long COVID,” which has caused long-term damage, including to the respiratory system. (Source: BKK Dachverband)

Regional Distribution

However, these numbers alone do not explain the regional disparities in sick leave rates. Among the six main categories of illness causes, five are dominated by eastern federal states:

• Mecklenburg-Western Pomerania: Muscles and skeleton
• Brandenburg: Respiratory system
• Saxony-Anhalt: Digestive and cardiovascular systems
• Thuringia: Poisoning

The Saarland records the highest number of sick days due to mental health issues.

Causes of Disparities

The 2024 BKK Health Report attributes the inequality in sick leave days to socioeconomic and sociodemographic factors. (Source: BKK Dachverband)

In northern Hesse, districts such as Werra-Meißner-Kreis, Schwalm-Eder, Waldeck-Frankenberg, and Hersfeld-Rothenburg—regions considered structurally weak—show deviations of more than 15% above the national average.

Sociodemographic factors also include access to medical care. The number of patients per doctor inevitably impacts recovery outcomes. (Source: KBV)

In addition to the negative example of East Germany, the light pink shading of many Bavarian and Baden-Württemberg districts correlates with lower absenteeism in southern Germany.

Possible Solutions

Policymakers in Berlin and state capitals have limited options if they wish to reduce illness-related absenteeism. One approach would be the unlikely miracle of revitalizing structurally weak regions during times of economic downturn—an idea that has already proven ineffective even during periods of full economic capacity.

Another approach, introduced in 2019/2020, is the rural doctor quota. This initiative allows students who lack top grades (an “A” average) to study medicine if they commit to working as doctors in rural areas for ten years after graduation. The idea has been well-received, with five times as many applicants as there are spots for these special study programs.