Abstract
Objective
To document the effects of sudden economic change on death rates for occupants of cars in the former German Democratic Republic (East Germany).
Design
Ecological time series study of East Germany in comparison with the former Federal Republic of Germany (West Germany) before and after reunification in 1990.
Setting
East and West Germany from 1985 to 1996.
Subjects
Populations of East and West Germany between 1985 and 1996.
Main outcome measures
Death rates for occupants of cars.
Results
After the reunification of Germany, East Germany experienced a sudden, temporary affluence and a concomitant fourfold increase in death rates for car occupants between 1989 and 1991. Although death rates increased in all age groups, young adults (aged 18-24) were most affected. The death rate per 100 000 population for those aged 18-20 years increased 11-fold between 1989 and 1991; for those aged 21-24 years the increase was eightfold.
Conclusion
A tragic consequence of the reunification of Germany was a dramatic increase in the death rate for car occupants. Sudden economic change and availability of cars resulted in both a rise in vehicle ownership and an increase in the number of inexperienced drivers on roads that were ill prepared for the increased traffic. The lesson learnt from Germany is that during times of economic change and modernisation, measures to prevent the predictable injury deaths that will result need to be considered.
Key messages
German reunification was associated with a fourfold increase in death rates for car occupants in former East Germany between 1989 and 1991, young adults having an 11-fold increase
Access to previously unobtainable cars and the youth and inexperience of drivers contributed to the increased traffic accidents in East Germany after reunification
Although modernisation of underdeveloped nations and their economies is ultimately beneficial, it can prove fatal without appropriate injury prevention measures
Public health and medical communities must take the lead in ensuring that economic change does not adversely affect the health and safety of the public
Introduction
On 9 November 1989 the Berlin Wall came down. Overnight, residents of the former German Democratic Republic (East Germany) gained access to previously unavailable Western cars. By the middle of 1990 East German currency was converted one for one to the currency of the former German Federal Republic (West Germany), enabling East Germans to buy cars.1 Analysis of death rates for car occupants in Germany during the period of reunification provided a unique opportunity to document the effect on traffic accidents of sudden economic improvements.
Methods
The International Road Traffic and Accident Database (version 1.1), maintained by the German Federal Ministry of Transport, provided data for East and West Germany on population, numbers and types of vehicles, the number of kilometres driven, the length of the road network, and death rates.2 Overall and age specific death rates after reunification were compared with average death rates over the five years (1985-9) before reunification. Analyses were restricted to deaths because data on injuries are subject to reporting biases3 and unlikely to be comparable for two countries undergoing governmental changes.
Results
The death rate for occupants of cars in East Germany rose from 4 per 100 000 population in 1989 to 16 per 100 000 in 1991. Similarly, the death rate per billion kilometres travelled increased from 14 in 1989 to 42 in 1991 (fig 1). The number of excess deaths in East Germany was 1223 in 1990 and 2021 in 1991 compared with the average annual number of deaths during 1985-9 (table 1). In contrast, the death rate for car occupants in West Germany remained largely unchanged.
Figure 1.
Death rates for occupants of cars for former East and West Germany
Table 1.
Numbers of deaths per 100 000 population for occupants of cars of different ages in former East Germany before, during, and after reunification in 1990
| Year | Age group (years)
|
||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0-5 | 6-9 | 10-14 | 15-17 | 18-20 | 21-24 | 25-64 | ⩾65 | Total | |
| 1985 | 17 | 7 | 6 | 8 | 20 | 37 | 265 | 40 | 400 |
| 1986 | 24 | 12 | 8 | 5 | 33 | 50 | 274 | 43 | 449 |
| 1987 | 15 | 3 | 9 | 4 | 21 | 46 | 270 | 35 | 403 |
| 1988 | 14 | 12 | 8 | 4 | 24 | 55 | 289 | 43 | 449 |
| 1989 | 17 | 6 | 14 | 11 | 33 | 57 | 387 | 69 | 594 |
| 1990 | 38 | 20 | 27 | 56 | 236 | 226 | 989 | 90 | 1682 |
| 1991 | 35 | 25 | 21 | 74 | 324 | 391 | 1481 | 129 | 2480 |
| 1992 | 35 | 16 | 33 | 84 | 267 | 311 | 1291 | 131 | 2168 |
| 1993 | 25 | 12 | 36 | 72 | 234 | 331 | 1232 | 98 | 2040 |
| 1994 | 19 | 10 | 25 | 100 | 299 | 262 | 1174 | 103 | 1992 |
| 1995 | 10 | 17 | 25 | 113 | 322 | 275 | 1059 | 132 | 1953 |
| 1996 | 8 | 11 | 20 | 109 | 344 | 214 | 994 | 121 | 1821 |
Whereas all age groups in East Germany experienced higher death rates for car occupants, those aged 18-20 years showed the largest increase between 1989 and 1991, from 5 per 100 000 to 54 per 100 000—an 11-fold increase (fig 2). Death rates for those aged 21-24 increased eightfold, from 5 per 100 000 to 44 per 100 000. Death rates for other road users showed much smaller increases, from 1.4 to 1.5 for motorcyclists, 3.2 to 3.6 for pedestrians, and 1 to 1.3 for bicyclists.
Figure 2.
Death rates per 100 000 population for car occupants by age in former East Germany
Between 1989 and 1991 the number of cars increased by 41% in East Germany and the number of kilometres travelled increased by 38% (table 2). In contrast, the values in West Germany remained constant or decreased. The total length of the road networks in East Germany increased by only 3% between 1989 and 1992.
Table 2.
Data on cars in former East and West Germany before, during, and after reunification in 1990
| Year | Former East Germany
|
Former West Germany
|
|||||||
|---|---|---|---|---|---|---|---|---|---|
| No of cars owned (×103) | Increase (%) | No of km travelled (×109) | Increase (%) | No of cars owned (×103) | Increase (%) | No of km travelled (×109) | Increase (%) | ||
| 1985 | 3398 | 33 700 | 25 845 | 332 451 | |||||
| 1986 | 3558 | 4.7 | 35 700 | 5.9 | 26 917 | 4.1 | 359 492 | 8.1 | |
| 1987 | 3699 | 4.0 | 37 600 | 5.3 | 27 908 | 3.7 | 383 764 | 6.8 | |
| 1988 | 3846 | 4.0 | 40 000 | 6.4 | 28 878 | 3.5 | 405 747 | 5.7 | |
| 1989 | 4004 | 4.1 | 42 800 | 7.0 | 29 755 | 3.0 | 415 427 | 2.4 | |
| 1990 | 4952 | 23.7 | 51 500 | 20.3 | 30 685 | 3.1 | 431 488 | 3.9 | |
| 1991 | 5630 | 13.7 | 59 117 | 14.8 | 31 322 | 2.1 | 437 292 | 1.4 | |
| 1992 | 5940 | 5.5 | 69 288 | 17.2 | 32 007 | 2.2 | 440 671 | 0.8 | |
| 1993 | 6240 | 5.1 | 76 469 | 10.4 | 32 652 | 2.0 | 441 354 | 0.3 | |
| 1994 | 6681 | 7.1 | 77 397 | 1.2 | 33 084 | 1.3 | 428 307 | −3.0 | |
| 1995 | 6881 | 3.0 | 80 700 | 4.3 | 33 524 | 1.3 | 433 700 | 1.3 | |
| 1996 | 7031 | 2.2 | 81 800 | 1.4 | 33 957 | 1.3 | 435 200 | 0.3 | |
Discussion
The effects of reunification on East Germany provide rare insight into the impact of major economic change on traffic deaths. Between 1989 and 1991 East Germans experienced a sudden temporary affluence and access to previously unavailable cars. Kühnen and Brüning reported that the overall death rate for traffic accidents more than doubled in East Germany between 1989 and 1991.4 Our examination of the separate effects of reunification on car occupants and other road users showed a fourfold increase in death rates for car occupants, with an 11-fold increase for those aged 18-20 years. These age specific mortality analyses extend previous governmental transportation studies of the effects of reunification4,5 by focusing on the deaths of car occupants and by highlighting the critical effect of young drivers’ inexperience on traffic accidents during periods of economic development.
After reunification many East Germans bought cars, as shown by a 41% increase in the number of cars from 1989 to 1991. Typically, a car was the first major purchase made by East German citizens long deprived of them (M A K Kühnen, personal communication). Many drivers, especially those involved in crashes, were young and inexperienced.6
Changes in East Germany
Few improvements were made to the roads to prepare for this period of burgeoning travel. From mid-1990 to the end of 1997 DM76bn were invested in the transport infrastructure of East Germany. However, only about DM32bn went to improving roads, and not until the middle of 1990. The provision of safety equipment, such as guard rails and emergency telephones, on East German highways was not completed until the end of 1994.7 In addition, East German speed limits of 100 km/h on motorways (autobahns) were strictly enforced before reunification but were harmonised with the West German recommendation of 130 km/h after reunification (U Meissner, personal communication).
The fourfold increase in the death rate for car occupants during the two years when the number of cars and the distance travelled both increased by about 40% is understandable in the light of what is known about young and inexperienced drivers. In the United States in 1990, for example, drivers aged 16 had more than three times as many fatal crashes per million miles driven as did drivers aged 25 and older.8 For drivers aged 16-19 as a group the crash rate based on mileage was seven times that for drivers aged 35-64.9
Increased traffic volume and inadequate roads doubtless contributed to the increased death rates in East Germany. If increased traffic volume had been the central factor, however, larger increases in death rates for other road users would have occurred. Furthermore, the quality of East German roads was poor both before and after reunification, but death rates did not rise until after reunification. Thus, the central factor contributing to the drastic increase in death rate for car occupants apparently was the great increase in unskilled drivers.
Changes in West Germany
West Germany had similar traffic adjusted death rates before reunification but did not show similar increases after reunification. Furthermore, the number of cars and distance travelled in West Germany remained constant or decreased. Thus, reunification seems to have had little effect on car travel and death rates in West Germany. The people of West Germany had access to world markets before reunification, so the opening of the borders did not increase the access to cars by inexperienced drivers.
Implications
Although such rapid changes are unlikely to occur elsewhere, knowledge gained from the period of German reunification could save lives in countries where economic development is proceeding more gradually and where large shifts in the characteristics of road users are occurring. For example, in countries such as China inexperienced drivers are replacing bicyclists. Understanding the effects of economic change on traffic accidents is essential for policy makers in developing countries and for international organisations that aid in the development of such countries.
Although modernisation of underdeveloped nations and their economies is ultimately beneficial, it can be fatal for the citizens if appropriate measures to prevent injury are not instituted. Measures that can be quickly instituted include attention to excessive speed, use of seat belts, action on drink driving, improvements to roads, and special restrictions on young drivers.3,8,10–15 The medical and public health communities of countries experiencing substantial economic development can lead in efforts to ensure that modernisation is not accompanied by tragic increases in deaths and injuries.
Acknowledgments
We thank Paul Gutoskie of Transport Canada and Axel Wiest for their technical help and the German Federal Highway Research Institute (BASt) for compiling the International Road Traffic Accident Database and for technical help. We also acknowledge the help of Elisa Moll and the support of TraumaLink: the Interdisciplinary Pediatric Injury Control Research Center at the Children’s Hospital of Philadelphia.
Footnotes
Funding: This work was funded by State Farm Insurance Companies as part of the initiative Partners for Child Passenger Safety and by grant R49/CCR.302486 from the National Center for Injury Prevention and Control to the Johns Hopkins Center for Injury Research and Policy.
Competing interests: None declared.
References
- 1.Lewis D, McKenzie J. The new Germany: social, political, and cultural challenges of unification. Exeter: University of Exeter; 1995. [Google Scholar]
- 2.Bundesanstalt für Strassenwesen. IRTAD PC user’s guide. Bergisch Gladbach, Germany: German Federal Highway Research Institute (BASt); 1997. [Google Scholar]
- 3.Barss P, Smith G, Baker S, Mohan D. Injury prevention: an international perspective. New York: Oxford University Press; 1998. [Google Scholar]
- 4.Kühnen MA, Brühning E. Unfallsituation und Motorisierungsentwicklung in Deutschland [Accidents and the current state of motorisation in Germany]. Berlin: Berichte der Bundesanstalt für Strassenwesen; 1993. (Deutsch-polnisches seminar uber strassenverkehrssicherheit.) [Google Scholar]
- 5.Brühning E, Kühnen MA. Strukturvergleich der Unfallgeschehens in den neuen und alten Bundesländern [A comparison of the circumstances of accidents in the new and old federal states]. Berlin: Berichte der Bundesanstalt für Strassenwesen; 1993. (Verkehtssicherheit im vereinten Deutschland.) [Google Scholar]
- 6.Bundesanstalt für Strassenwesen. Verkehrssicherheit im vereinten Deutschland [Traffic safety in reunified Germany]. Bergisch Gladbach, Germany: German Federal Highway Research Institute (BASt); 1993. [Google Scholar]
- 7.Bundesministerium für Verkehr. Transport infrastructure investments of the federal government in the new federal states. 1998. www.bmv.de/vdegb.htm Available at www.bmv.de/vdegb.htm [accessed 4 January 1999]. [accessed 4 January 1999]. [Google Scholar]
- 8.Williams A, Preusser D, Ulmer R, Weinstein H. Characteristics of fatal crashes of 16-year-old drivers: implications for licensure policies. J Public Health Policy. 1995;16:347–360. [PubMed] [Google Scholar]
- 9.Li G, Baker S, Langlois J, Kelen G. Are female drivers safer? An application of the decomposition method. Epidemiology. 1998;9:379–384. [PubMed] [Google Scholar]
- 10.Baker S, O’Neill B, Ginsburg M, Guohua L. The injury fact book. New York: Oxford University Press; 1992. [Google Scholar]
- 11.Gallaher M, Sewell C, Flint S, Herndon J, Graff H, Fenner J, et al. Effects of the 65 mph speed limit on rural interstate fatalities in New Mexico. JAMA. 1989;262:2243–2245. [PubMed] [Google Scholar]
- 12.Hingson R, Heeren T, Winter M. Lower legal blood alcohol limits for young drivers. Public Health Rep. 1994;109:738–744. [PMC free article] [PubMed] [Google Scholar]
- 13.Rivara F, Thompson D, Cummings P. Effectiveness of primary and secondary enforced seat belt laws. Am J Prev Med. 1999;16 (suppl 1):30–39. doi: 10.1016/s0749-3797(98)00113-5. [DOI] [PubMed] [Google Scholar]
- 14.Robertson L. Reducing death on the road: the effects of minimum safety standards, publicized crash tests, seat belts, and alcohol. Am J Public Health. 1996;86:31–34. doi: 10.2105/ajph.86.1.31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Williams AF, Preusser DF. Night driving restrictions for youthful drivers: a literature review and commentary. J Public Health Policy. 1997;18:334–345. [PubMed] [Google Scholar]