Study Design. Cross-sectional survey with personal interviews. Objective. To study national differences in subjective health, back pain, and self-perceived disability between the United Kingdom and Germany. Summary of Background Data. Back pain is a leading health problem in most Western populations, causing enormous costs to the national health systems. Different prevalence rates were reported from many countries, but rarely as a result of a direct comparison based on an identical study design. Methods. A total of 6,235 male and female participants 50 to 79 years of age (population-based stratified random samples) were recruited in 6 British and 8 German study centers. The interviewer administered standardized questionnaire included a section about presence and severity of back pain. Results. Past and current back pain was more frequent among German participants and different between East and West German centers. The differences in back pain prevalence rates could not be explained by less favorable risk profiles among German respondents. Conclusions. Intercultural differences in perceiving or reporting back pain can be hypothesized as the most likely explanation of the markedly different prevalence rates of the disorder in the United Kingdom and East and West Germany.