This story was produced as part of the Association of Health Care Journalists’ German Work Study Group, with support from the Commonwealth Fund.
BERLIN – Denise Banks-Grasedyck sat inside a bustling food court full of currywurst and German cuisines in Potsdamer Platz, one of Berlin’s largest shopping plazas.
The Louisiana native has lived in the city since 1988 — one year before the fall of the Berlin Wall — and reflected on how she still gets surprised by the differences in her quality of life here versus the United States. She moved to Germany as a military spouse, but like many others who moved to the country, she stayed to enjoy a wealth of benefits, notably the perks of Germany’s universal health care coverage.
“There’s this idea that each person takes care of themselves in America, it’s very individualistic,” she said. “I feel like Germany still has much more of that social idea, that if we all do fairly well, then everybody does better.”
American citizens like Banks-Grasedyck are moving abroad in record numbers these days, drawn by more affordable housing, safer streets, or the allure of quieter politics. For Black Americans who have relocated to Germany — the fifth-most populous destination for U.S. expats — there is another appeal: a health care system that is cheaper and easier to access.
Studies and data on the number of Black Americans abroad, particularly in Germany, are limited. Yet, close to a dozen Black women Capital B spoke to say they are healthier, and their cost of care is more manageable.
“I would venture to say that on a whole, the people who live in Germany are healthier and better cared for than in the United States as a whole, because almost everyone has access to health care, so you don’t necessarily have to wait until you have a medical crisis first to get care,” Banks-Grasedyck said.
In the U.S., her firstborn’s emergency delivery cost $15,000 — a rate she “thankfully” was able to cover through her military family’s insurance. In Germany, where she was a stay-at-home mom, gave birth to her second child, switched jobs, received medical procedures, and launched her own business of 15 years, she was able to navigate throughout life’s transitions without the gamble of a hefty hospital bill or a loss of coverage.
“Not having an extra $15,000 available to deliver your child could be an issue for a lot of families,” she recalled. “I think it’s great that you know that you don’t have to worry that if something goes wrong, you’re going to have medical care.”
Comparatively, more than half of Black Americans have some form of health care debt, compared to about a third of white Americans, a 2022 KFF survey found.
Taking the leap
The brisk fall air of Berlin was a far cry from the warm Southern climate Banks-Grasedyck knew in Louisiana. But she didn’t need perfection — she needed a respite.
Like many Black Americans who travel and move abroad, she had initial concerns about how foreign nationals would treat not just Americans, but their attitudes specifically toward Black Americans, she said.
“I have in general had a positive experience with it. Of course, there are individual experiences where I recognize that this person is not happy with me being here, or with me being,” she said. “I think that’s probably something that we face all over the world, as people of color, Black people and particularly Black women.”
But for her, the risk was worth it. In the U.S., her biggest gripe with the health care system was its exorbitant cost that made it inaccessible for anyone without a lucrative job or consistent paycheck.
“The U.S. and German systems both have state of the art care,” she said. “The main difference is who has access to it.”
Germany’s health care system is widely recognized for assuring patients low out-of-pocket costs and delivering universal health care. Unlike in the U.S., insurance in Germany is tied to the individual, not an employer, and the right to care is codified in law. A typical doctor’s visit is fully covered, and prescriptions are almost always less than 10 euros, or about $12.
Although the costs are better, Black expats say the health care system isn’t without bias and discrimination.
“Germany is no exception when it comes to medical racism,” said Amal Abbass, co-founder of the Tubman Network, a Berlin-based organization supporting Black residents who fall through the cracks of coverage. “Having full legal rights and accessing them are two different things.”
The cost of a “colorblind” approach
One of the biggest differences between the German and U.S. systems is that, not unlike other European countries, Germany does not collect ethnic-based demographic data in medical records. Instead, it uses a “colorblind” approach to health care — a move that’s been both lauded as equality and critiqued as erasure.
Last October, as a battle over health care ground Washington to a 43-day halt, a group of Black women gathered inside a cozy wine shop on a rainy street corner in east Berlin. There, Capital B asked a group of eight Black women who lived in the city how they felt about Germany’s hotly debated “colorblind” approach to health care. The results were split.
Some participants preferred to have the information included in their medical data to help identify disparities in health care and find other potential blind spots affecting those populations. Others agreed with a colorblind approach, preferring that their information be treated the same as everyone else’s. One Afro-German participant said she agreed with the need for a colorblind approach to the health care system only because she did not trust the German government with such information, especially amid rising political and racial tensions globally.
Adekunle Adedeji, a research associate at Hamburg University Medical Center, is leading an unprecedented study that examines discrimination in health care toward Africans in Hamburg to help push for a more inclusive health care system. Relying on experiences shared by individuals who chose to be in the study in lieu of limited statistical data, he says he sees the “value, but also sees the problem” behind the colorblind approach.
“Germany is trying to protect a group of people by saying that we are all the same, and we are living in the same country, so we’re still not really recognizing that African people experience the health care system differently. We’re still in a bit of denial,” he said.
Adedeji says that before collecting data, the first step is the German government recognizing that there could be differences in treatment in order to address any disparities that could be found.
“While more data would be good, when there is no system or no structure for it, there is personal information in the open that can also be used to put a person at disadvantage.”
The Afrozensus, the first comprehensive study addressing the perspective and discrimination of Black African and Afrodiasporic people in Germany in 2020, included more than 6,000 participants born in Germany, the U.S., African countries, and other European states.
The study revealed high levels of anti-Black racism in education, housing, and health care. Nearly 15% reported racism in health care, with two-thirds of that group saying doctors often dismissed their complaints, and about 1 in 3 people saying it happened “very often.” These experiences discouraged some from seeking care, the report said.
By comparison, about 1 in 5 Black adults in the U.S. say they have been treated unfairly or with disrespect by a health care provider in the past three years because of their race or ethnic background. And a majority say that at least some of the time, they prepare for possible insults from medical providers or staff or feel they must be very careful about their appearance to be treated fairly.
“Everyone knows that we should have equal treatment, but we know that is not the reality,” Adedji said.
A prescription for Black women in pain
Still, for Black expats in Berlin like Lauren Johnson-Wünscher, the benefits of living in Germany still outweigh the challenges.
Johnson-Wünscher, a Pennsylvania native, left the U.S. in 2018 to live in Berlin. The wife, mother, and wine writer created the Black in Berlin WhatsApp group of nearly 300 women, both American and German, to build connections and share resources about everything from wine pairings to doctor recommendations. In Germany, where Black doctors are spread few and far between, a trusted source and word of mouth carry weight.
“It’s a niche topic, especially for people of color. So like finding a dermatologist who knows Black skin, for example, is tricky. Or finding a mental health licensed practitioner is tricky because you need someone who speaks English,” Johnson-Wünscher said.
But if navigating cultural differences has sometimes required extra effort, the health care, particularly for her pregnancy, has been “top notch and seamless,” she said.
Johnson-Wünscher’s health insurance, Techniker Krankenkasse, or TK, is one of Germany’s largest health insurance plans, serving 11 million people. With it, her prenatal care and delivery expenses were covered at no cost, and any additional fees were optional upgrades for room preferences or additional scans. When her doctor diagnosed her with borderline gestational diabetes, she received glucose monitoring equipment for free, and through her postpartum care, trained English-speaking midwives were actively available.
“I walked out of the hospital with my baby, and that was it,” Johnson-Wünscher said.
In the U.S., Black patients have endured poor medical outcomes and crippling barriers to care for decades. Black Americans are more likely to suffer from chronic illnesses such as diabetes and heart disease and be left with medical bills they can’t pay.
Disparities are particularly striking in maternal health care. Black women are three times more likely to die from birth complications than white women. And crime, the high costs of care, and a scarcity of medical providers in some communities further worsen disparities.
In Johnson-Wünscher’s home state of Pennsylvania, over 12% of women live more than 30 minutes from a birthing facility, higher than the national average. By contrast, when she moved to Germany in 2018, she said she felt “a lot more secure” making the decision to have children there.
When San Diego native India Dobey King moved to Germany, she was struggling to manage her diabetes. Between insulin shots, pills, and dietary changes, her health was still in decline.
“I felt awful,” she said. “Nothing worked.”
After she moved to Germany in 2021, the content creator took to TikTok, amassing nearly 40,000 followers documenting her expat journey and diabetes transformation.
“I have access to higher quality, fresher food here,” she said. “I didn’t come to Germany and start eating salads. But with very little effort with what I’m eating, my diabetes has completely 180’ed itself,” she said in one of her videos.
When she was first diagnosed with diabetes, she would suffer from crippling migraines, as her body craved the sugars prevalent in her American diet. But since moving, Dobey King says she saw a dramatic shift in her health, saying she doesn’t have to take insulin. She has lost weight, and achieved the most stable blood sugar level she had ever experienced since her diagnosis.
“An eight-year problem that I was fighting in the States was fixed in less than 90 days since being in Germany,” Dobey King said.