Why Do We Live So Long in Spain? (And Why It’s Not Just a Miracle of the Mediterranean Diet)
In just a few decades, Spain has gone from being a country with rather short life expectancy to becoming one of the longest-lived nations in the world. To grasp the scale of this reality, let’s remember that at the beginning of the 20th century, life expectancy at birth was around 35 years. This, as we’ve pointed out before, doesn’t just mean we had “shorter” old ages or shorter lives, but that child and youth mortality was extremely high. Women could have up to nine children, and only three might survive into adulthood (this was the case for my great-grandmother, for example). This was largely due to limited access to healthcare, lack of knowledge about diseases, poor nutrition, and widespread poverty. Regarding high child and youth mortality, let’s remember that having a doctor present at birth was not common; more than one woman I interviewed told me she had been working in the fields right up until the moment of labor, and some even had to give birth along a roadside. Under such conditions, every natural process was much harder. And harsh—very harsh.
Today, we are far from that reality (thank goodness), and life expectancy in Spain exceeds 83 years, the highest in the European Union and the third highest in the world, only behind Japan and Switzerland. Projections show that women born in Spain in 2035 will live an average of more than 87 years. It’s truly an achievement—one of those wonders we should be claiming proudly, yet we often forget about, or worse, frame as the “problem” of aging.
This achievement is neither accidental nor linked to the much-hyped artificial intelligence (and I mention it, absurdly enough, just to remind us to give each issue the weight it deserves—or even to encourage us to pay a little more attention). Behind this major accomplishment are many factors—better hygiene, better nutrition, more education—but above all, there’s a silent engine that has changed our lives: the development of a strong welfare state (yes, the same one that has been “weakened” over time and so heavily criticized), and within it, a public, universal, high-quality healthcare system.
We’re not just talking about curing diseases, but about saving (or enabling the development of) millions of lives. Since the arrival of democracy in Spain (marked, among other things, by that long transition between 1975 and 1986), our country has completely transformed its healthcare system. I want to highlight this so we better understand what healthcare cuts mean today and how they put not just our present but also our future at risk. In Spain, the starting point for better healthcare (and the path toward better aging and longer life expectancy) was the 1986 General Health Law. With this law—the first of its kind in Spain—the National Health System was created, and Primary Care was promoted. Health centers were built throughout the country (including in villages and poorer neighborhoods), and the training of healthcare professionals was expanded. Of course, this process was slow, so it took a while to reach certain areas and populations. Today, we have health centers close to home, but that wasn’t the case in the late 80s, for instance. Grassroots activism played a major role in this process (which we still badly need, for this and many other causes), because while policies matter, so do ordinary people. In the world we come from, imagine what it meant to have to leave at dawn with a baby whose fever wouldn’t break—the fear and stress, the feeling of helplessness when there was no doctor nearby or when you couldn’t afford one. This still happens today in many countries. That’s why it’s so hard for me to understand the disdain for healthcare and why we allow its dismantling. In just four decades, Spain doubled its public healthcare spending and the number of doctors (and the presence of women in the profession gradually increased too). Nursing was also dignified—a struggle that began with Florence Nightingale in 1860 and that nurses (mostly women, increasingly better trained) continue to fight for today (a shout-out to all the professionals advocating for the necessity and dignity of their profession).
As a result of this evolution (not without its difficulties, mind you), Spain has one of the most effective and equitable healthcare systems in the world: everyone has access to healthcare, regardless of whether they are rich or poor. Avoidable deaths from diseases like heart conditions or certain cancers are lower here than in most European countries. Universal healthcare also positively affects even the most selfish among us: if your neighbor is healthy, you’re less likely to get sick. Thus, arguments against universal healthcare (or arguments in favor of the U.S. model, where you pay for your own illnesses and where life expectancy is plummeting) could be described as “throwing stones at your own roof.” Personally, I don’t wish for anyone to have a sick baby they can’t afford to take to the doctor, nor for anyone to suffer pain because society deems they don’t “deserve” medical care. Healthcare is not about deserving it—it’s about needing it. The same applies to caregiving, as I’ve said before.
Well-being isn’t just measured in years of life, but in years lived with health and autonomy. Thanks to the control of many chronic and degenerative diseases, most people in Spain up to age 74 consider their health good or very good. However, there is some concern about recent setbacks (possibly influenced by COVID): healthy life expectancy at age 65 rose from 9.7 years in 2004 to 12.4 years in 2019, but has since declined back to 9.7 years in 2022 (the latest available figure). Personally, I think we should pay close attention to this trend and better analyze its relationship with cuts to healthcare and social welfare. We don’t want to become like the United States—that supposedly wealthy country where neoliberal “every man for himself” policies have caused a sharp drop in life expectancy, even if TV sometimes tries to convince us otherwise.
Undoubtedly, this is the topic that concerns me the most (despite the overall positive tone of this post, which I want to emphasize). Beyond the nuance of this recent negative data point, there’s still a lot to do; there are inequalities we need to address between different regions and population groups (for example, life expectancy among the Roma community in Spain is much lower). But if today Spain is a country where people live longer and better, it is thanks to a collective commitment—sometimes silent, sometimes hotly debated—to social protection.
Aging should not be a problem, but an opportunity. And that is only possible when the State ensures not only that we live longer, but also that living longer means living better. For everyone.
