The division of Germany after the second world war has often been recognised as providing a unique opportunity to evaluate “a natural experiment in history”,1 one in which a homogenous population had been artificially separated for 45 years. The possible consequences for health of exposure to two very different social models have, however, received relatively little attention.

When the Berlin Wall came down in November 1989, followed by the announcement by the West German Chancellor of a 10 point plan for “overcoming the division of Germany and Europe”, leading, eventually, to the unification of the German Democratic Republic (GDR) and the Federal Republic of Germany (FRG), the “natural experiment” entered its second phase.

Unification led to a fundamental transformation in the East, and, initially, a massive economic decline. By the end of 1990 the industrial output had fallen to 49% of what it had been at the …