The Impact of Improvements in Medical Care Resources on Homicide Trends: The Case of Germany (1977–2011)


This paper addresses whether improvements in healthcare that have taken place since the second half of the twentieth century have contributed to a decrease in the number of homicide victims in Germany. Our study accessed data on healthcare medical resources, mortality, and life expectancy primarily from the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD) Health Statistics, as well crime data from Interpol’s International Crime Statistics and the European Sourcebook of Crime and Criminal Justice Statistics. The results corroborate the hypothesis when the analysis takes into consideration a time span of more than half a century and remains plausible when it covers the last two decades.

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  1. 1.

    According to Blath (2007: 64): “There is some evidence from criminological research (local victimizations surveys) and from other sources that the reporting behavior of the general public but also control and enforcement behavior of the police have changed”. However, these research findings, available in German language only, do not allow establishing trends in reporting and recording practices.

  2. 2.

    More generally, Barlow and Barlow (1988) showed how emergency service response times were correlated with aggravated assaults and homicides in such a way that death rates fell substantially (from 20% to 4%) when the patient received care within 20 min subsequent to the attack. The importance of emergency services response times has been highlighted by several authors (e.g., Granath, 2012, Smit et al. 2012). Indeed, this kind of indicator has a relatively longstanding tradition in criminology. In the 1950s, explaining trends in the United States, Wolfgang (1958) was already emphasizing its impact upon death. However, there are no reliable indicators of the response time of emergency services that intervene in cases of attempted homicide or assault in Germany.

  3. 3.

    Data on physicians refer to practising physicians and covers the number of physicians who are actively practising medicine in public and private institutions and provide services directly to patients (OECD 2016).

  4. 4.

    Data on nurses refers to practising nurses and includes professional nurses with a 3-year education and associate professional nurses with a 1-year education (OECD 2016).

  5. 5.

    Data includes equipment installed in all types of hospitals and in all sectors (public, not-for-profit, and private) (OECD 2016).

  6. 6.

    MRI is an imaging technique designed to visualize internal structures of the body using magnetic and electromagnetic fields, which induce a resonance effect of hydrogen atoms (OECD 2016).

  7. 7.

    CT scanners are X-ray machines that combine many with the aid of a computer to generate cross-sectional views and three-dimensional images of internal organs and bodily structures (OECD 2016).

  8. 8.

    PET scanners are a highly specialized imaging techniques using short-lived radioactive substances that produces three-dimensional images (OECD 2016).

  9. 9.

    The downward bias did not affect homicides recorded by the police because, at the beginning of the 1990s, in the framework of the Mauerschützen-Prozesse (Berlin Wall shooters trials), >150 Todesschützen soldiers who allegedly killed people attempting to flee East Germany were tried for homicide. Even though some events had taken place years earlier, their crimes were recorded as intentional homicide in police statistics, which explains partially the increase observed in them.

  10. 10.

    As mentioned above, national police crime statistics are available in Germany since 1954, but this research is based in the international sources that compiled them according to standardized international definitions.

  11. 11.

    National statistics follow the German criminal code and use the concept of vorsätzliche Tötungsdelikte (intentional homicides). Interpol data followed that concept. The European Sourcebook definition of intentional homicide, however, excludes the category of euthanasia and includes the category of assault leading to death. Thus, German figures in the European Sourcebook exclude the category of Tötung auf Verlangen (homicide on demand of the victim), which represents a negligible quantity of cases, but include the category of Körperverletzung mit Todesfolge (intentional bodily injury leading to death). Formerly, the latter figures were considerable but since the 1990s have become a very small number. The reason is that the concept of bedingter Vorsatz (conditional intention) has been broadened, with the consequence of an increase in the number of homicides. Therefore, a difference between the European Sourcebook and Interpol exists, but it is small (Jehle, Jöerg-Martin, personal communication, 5 October 2017).

  12. 12.

    The correlation is not stronger because of the divergence between both indicators at the beginning of the 1990s (see footnote 9).


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Correspondence to Antonia Linde.



Fig. 9

Percentage of attempted homicides among total homicides (1977–2011) and percentage of homicides with firearms among completed homicides (1995–2010), in Germany

Fig. 10

Percentage of aggravated assaults among total assaults (1990–2011) in Germany

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Linde, A. The Impact of Improvements in Medical Care Resources on Homicide Trends: The Case of Germany (1977–2011). Eur J Crim Policy Res 24, 99–119 (2018).

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  • Homicide
  • Medical care
  • Firearms
  • Aggravated assault
  • Germany