title: Imbalances in the German public health system - numbers of state-certified occupational physicians and relation to socioeconomic data.
abstract: BACKGROUND
  State-certified occupational physicians who work as civil servants in the Federal Republic of Germany are key players in the German Public Health system. They control i.e. the legal compliance in occupational health and participate in the occupational disease procedures. Despite the role model function of the German Public health system for many developing countries, this area of Public health is debated to have been hampered in the past years by a disregard concerning structural developments.
  
  
  METHODS
  Different databases were screened for occupational health benchmarks. Obtained data were compared to socioeconomic data and indices were calculated.
  
  
  RESULTS
  The overall numbers of State-certified occupational physicians decreased in Germany between 1992 and 2012 from 136 to 86 (63 %). On the single state level, the ratios of State-certified occupational physicians per 1 Mio. working population ranged from 8 for the state of Saarland to 0.8 for the state of North Rhine Westphalia. A general difference was found for old versus new German states. Also, large differences were present for the ratios of State-certified occupational physicians per 106employees towards public debt per capita (€) and the ratios of State-certified occupational physicians per Gross Domestic Product (GDP) in the 16 German states in 2012.
  
  
  CONCLUSIONS
  In striking contrast to the WHO document on the Occupational safety and health (OSH) system that states in its executive summary that the human and institutional capacities of the German occupational health system are very strong in both quantity and quality, we here show extreme imbalances present at the single state levels that developed over the past 20 years. With a regard to the increasing complexity of the economic system a reversal of this trend should be demanded.
authors.affiliation: The Institute of Occupational Medicine, Social Medicine and Environmental Medicine, School of Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Gyo
authors.affiliation: The Institute of Occupational Medicine, Social Medicine and Environmental Medicine, School of Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Boll
authors.affiliation: The Institute of Occupational Medicine, Social Medicine and Environmental Medicine, School of Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Dörthe
authors.initials: D
authors.lastname: Brüggmann
authors.affiliation: The Institute of Occupational Medicine, Social Medicine and Environmental Medicine, School of Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Klingelhöfer
authors.affiliation: The Institute of Occupational Medicine, Social Medicine and Environmental Medicine, School of Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Quarcoo
authors.affiliation: The Institute of Occupational Medicine, Social Medicine and Environmental Medicine, School of Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: David A
authors.initials: DA
authors.lastname: Groneberg
keywords: Occupational health; Public health administration