Correspondence (reply): In Reply

We thank both our correspondents for their comments and additions.

Professor Gillissen’s hypothesis, that the changes we reported for health and satisfaction with life compared with 1973 were not so much because of the rural environment and peripheralization of our study region but social transformation as a result of the GDR’s downfall, is consistent with discussions that we ourselves had in the context of the project as well as in the final report (1). Regrettably we did not give enough space in our article to discussing this important hypothesis. We tried to control the “transformation effects” by comparing data from the Rural Health Study (Landesgesundheitsstudie, LGS) with data from national health reports for the old and new federal states. The LGS data show consistently worse regional results than the national data for the new states in total. From this we deduced our hypothesis, that in addition to the “transformation effect” (2), the rural character and peripheralization of our study region had a role. However, we were not able to come up with a direct proof. The reason, among others, is poor comparability of our LGS data with other surveys in health and social reporting. We used our hypothesis of rural character and peripheralization to provide one interpretation, which we presented using the arguments mentioned above and the choice of the term peripheralization. Something that supports our modernization theory is the fact that in spite of pervasive social dislocations in the context of the GDR’s breakdown, living conditions and the rural population’s health have improved compared with 1973.

We agree with Dr Hofmeister’s interpretation that the decrease in the proportion of persons who had sufficient time to eat or for their main meal contributed to the increase in the rate of obesity, and we will consider this hypothesis in planned further analysis of the data regarding nutrition. We also agree that classifications of physical-exercise activity would be more meaningful if data on energy consumption were available. In our online supplement, we explained reasons for why statements about the change of the reported frequencies are to be interpreted with caution on the basis of the different operationalizations used in precursor studies. If, in common with Rütten et al. (3), one defined a time period of two hours or more of exercise as health-promoting, the people surveyed in the Rural Health Study in 1973 reach proportions of 5.4% and in 2004/08 of 20.8% after adjusting for age. Although the results should be interpreted with caution, our result, that exercise activity has increased in the long term, is therefore confirmed (with the exception of one drop, in 1994).