In the Ruhr area he “didn’t even want to hang dead over the fence,” said Düsseldorf’s former mayor Dirk Elbers (CDU). in the local election campaign twelve years ago. But the fact is that you are much more likely to do this here than in other German regions.

Gelsenkirchen is one of the cities with the lowest life expectancy in Germany. Men born here in 2020 will live to an average of 75.91 years, women 80.61 years. At the other end of the scale is Unterhaching near Munich. Here in the Munich district, men live to be around 81.2 years old, and women even live to be 83.5 years old.

The big difference between the two regions: Gelsenkirchen is the city with the highest socio-economic Deprivation in Germany. Unterhaching has the lowest. The Robert Koch Institute shows through regular studies that this contributes significantly to life expectancy. The bad thing: the scissors are getting further and further apart. In 2005, people in socially and economically weak regions died between 2.6 (women) and 5.7 (men) years earlier than their counterparts in rich regions. In 2022 it was already 4.3 years for women and 7.2 years for men.

Five factors are crucial

This life expectancy gap has many causes. People who live in economically weak regions are disadvantaged in many areas of life. Economists measure this deprivation by factors such as the unemployment rate, average educational attainment, household income and the debt ratio in a region. Poverty that costs life is therefore not purely monetary. Measured purely in terms of average income, Gelsenkirchen is actually above the national average. Instead, the following factors play a role in faster death:

• The Living situationwhich means both the apartment itself and the location of an apartment. Poorer people are more likely to live in poor locations and pay a higher proportion of their income for this.
• Poorer people often have one unhealthy lifestylewhich in turn is based on a lack of money.
• People from deprived regions have lower educational qualifications. They are less likely to be academics and more often have no school qualification at all.
• Have children of parents from more deprived regions worse starting chances. This applies, for example, to early childhood education at home, but also to opportunities for advancement at school.
• People in disadvantaged regions get sick more often. They have a higher risk of chronic illnesses and mental health problems. At the same time, their access to healthcare is limited.

A congress on this topic took place in Berlin this week. Around 1,300 people from science, civil society and politics discussed aspects of “poverty and health”. Most of the problems of socio-economically deprived regions can actually be solved politically. This would not only have individual but also social advantages. That’s how it would work.

The living situation

If you have little money, you have little choice in the housing market. He is then only left with the cheapest apartments in a city. They are usually the smallest and the ones with the worst location. Often there is a noisy main road or highway passing next door, so you can’t hear the birds chirping in the meadows. The distances to supermarkets and green spaces are further.

According to the Federal Statistical Office, the poorest people in Germany spend around 50 percent of their income on rent and additional costs. Among the richest it is only 31 percent. This means there is less money left over for other things – including food. International studies, such as the WHO, show that cramped living conditions significantly increase the risk of infectious and cardiovascular diseases. The Federal Environment Agency has proven that socially disadvantaged people in Germany are exposed to higher levels of pollutants in the air they breathe. They also have fewer opportunities to recover in nearby green spaces.

• The simplest way to improve the living situation of socially disadvantaged people would be more social housing. Such state-subsidized housing usually have lower rents. Socially disadvantaged people would either have to spend less of their income here or could afford more housing. Both would significantly improve their living situation.
• However, municipalities would have to pay attention to new apartments to build in healthy locations. This requires improved urban planning in many places. Less traffic noise, fewer air pollutants and more green spaces actually help all city residents.
• Existing apartments would have to be specifically renovated. Finally, poor people are more likely to live in houses that are infested with mold or poorly insulated. Here the state can set higher minimum standards or control existing standards more strictly.
• Direct help would be a higher housing benefit. The federal government last increased this in 2025. On average, those affected now receive a subsidy of 400 euros per month. The question of financial viability remains open.

The educational problems

The educational success of children in Germany is still strongly linked to their parents’ home. The National Education Report of the Leibniz Institute for Educational Research and Information for 2024 names three important risk situations:

• Low-skilled parents are often unable to support their children at school. For example, after a certain class you can no longer check homework or help with studying for exams. Around 15 percent of all children in Germany grow up with this risk situation.
• 24 percent of all children live in one financial distress. This is defined by the fact that they live below the at-risk-of-poverty threshold of 60 percent of the median income. This has an impact on school success because such children are less able to participate in school life and suffer from greater stress at home. Those who live precariously have a harder time concentrating on homework. If you’re hungry, the same goes.
• There is also one more social distress. For around ten percent of children, this occurs because their parents are unemployed. The education report classifies this as problematic for two reasons. Firstly, children lack a role model when it comes to their future professional lives. Secondly, parents with jobs have better networks when it comes to finding internships or apprenticeships for children.

Many children in Germany suffer from several of these risk situations. This is especially true if they come from low-income families. The more risks a child is exposed to, the less likely it is that they will attend a school where they can graduate from high school. In addition, socio-economically deprived children are less likely to receive a recommendation for secondary school despite the same level of performance from primary school teachers. Since higher education later correlates with higher income, poorer education automatically leads to health problems. This is why life expectancy is lower here.

• Daycare centers and schools must be better equipped. On the one hand, this affects the available places, especially in all-day care, but also the relationship between educators and teachers and children. The state governments would have to put special efforts into the socio-economically deprived regions, for example in the form of social workers and language support.
• The social participation of poorer children is already made possible through the education and participation package. Children also receive subsidies for school trips, sports clubs and school supplies. However, according to the Paritätisches Wohlfahrtsverband, the benefits only reach around 20 percent of children because they have to be applied for separately. The Child Protection Association and the Paritätischer Wohlfahrtsverband are therefore calling for a lump sum to be transferred to parents instead.
• An important point is this directly combating child poverty. That would be something like the one planned by the Greens in the traffic light Basic child protection been possible. A step in this direction is that, according to the federal government’s plans, parents will no longer have to apply for child benefit from 2027, but will receive it directly from birth.

The health problems

Ultimately, poor people die earlier because their health is poorer. There are a variety of reasons for this in addition to the living situation and poorer educational opportunities. This means that poorer people are less able to afford healthy foods such as fresh fruit and vegetables. They also often don’t have the time to cook nutritious meals. Because their lives are generally more stressful, they are more likely to resort to unhealthy lifestyles such as smoking or drinking. The constant stress of life also leads to more frequent mental health problems. During the Corona period, more poor people also fell ill and died from Covid-19 than rich people.

Access to the healthcare system is also not equally distributed. According to the Robert Koch Institute, people with lower incomes go for preventive examinations much less frequently. Doctors and health insurance companies don’t generally refuse them, but many people simply have less knowledge about which examinations they can take. The same applies to many illnesses: people with socio-economic stress usually do not have the mental resources to wade through applications, various specialists, referrals and services. Destatis has also proven for 2024 that there are actually fewer general practitioners and specialists in structurally weak regions.

• There is generally one in Germany Shortage of doctors. There are many reasons for this, but recruiting more doctors and locating them particularly in structurally weak regions and rural areas would improve the lives of everyone in the country.
• The National Prevention Conference, which includes the health insurance association GKV and the pension insurance, suggests integrating more health offers into everyday life. Simple preventive examinations could take place in kindergartens, schools, companies or even department stores. Insurers also suggest distributing more information and offering free consultations at such locations. As with many solutions, this would help everyone, but especially those who are socially disadvantaged. The Conference of Health Ministers will address this issue in 2025, but there have been no concrete improvements yet.
• The OECD recommends that all members reduce bureaucracy in the health system. What always sounds cumbersome here means, for example, the introduction of apps for making appointments, fewer applications and referrals and clear patient paths – for example from the general practitioner to the specialist.