Toward a Generational Drift in Health in Spain?

Over the past decades, the increase in life expectancy across countries around the world has been spectacular. The Spanish case deserves special attention, as it is a country that moved from a particularly disadvantageous position after the hardships of the Civil War to a position of global leadership in recent years. While in 1940 life expectancy in Spain was approximately 50 years, by 2025 it stands at around 84 years (just behind a handful of countries such as Switzerland, Japan, and South Korea).

As longevity has advanced almost everywhere in the world, an important and still unresolved debate has emerged about the state of health in which these “additional” years of life will be lived. If declining mortality is not accompanied by a comparable decrease in the onset of disability or disease, people will live increasingly longer lives but in poor health — a dynamic with enormous consequences for the sustainability of health care, pension, and long-term care systems (Gruenberg 1977). To better understand what kind of prospective health scenarios we are moving toward, it is essential to document in detail the patterns of onset of those diseases that limit not only the number of years lived but also the quality of life. To that end, it is necessary to gather information not only on the prevalence of such diseases but also on their incidence (that is, the ages at which they begin to develop).

In an attempt to shed light on these issues, a recent study carried out between the Center for Demographic Studies and Pompeu Fabra University used health and mortality records from Catalonia to compare health status among different Catalan generations between 2010 and 2021 (Permanyer et al. 2025). The age-adjusted results, comparing the level of prevalence of multimorbidity (that is, the percentage of the population simultaneously suffering from several chronic diseases), suggest that younger generations tend to experience worse health outcomes than their predecessors at the same age. For example, by age 25, 25% of Catalan women born between 1980 and 1989 suffered from “basic” multimorbidity (meaning they had at least two chronic diseases). That percentage rises to 37% for women born a decade later (between 1990 and 1999) when they reach the same age of 25. This pattern is not exclusive to these two groups but is systematically repeated for all cohorts and ages for which such comparisons can be made.

This striking result is consistent with the conclusions reached in another recent study conducted across various regions of the European Union and the United States (Gimeno et al. 2024). That study also shows that younger generations tend to experience worse health outcomes than their predecessors at the same age, using a wide range of indicators (such as the prevalence of chronic diseases and disability, mobility measures, obesity, etc.), leading the authors to ask whether a “generational drift in health” may be taking place. The results of the previous study suggest that such a generational drift may indeed be occurring in Catalonia and, quite likely, in the rest of Spain.

These results raise important new questions that urgently need to be addressed. On one hand, we must ask whether the higher prevalence of multimorbidity in younger generations will translate into poorer quality of life or higher levels of disability in the future. On the other hand, it is necessary to investigate the key factors that have led to this situation in order to understand it and, as far as possible, reverse it. In this regard, the emergence of mental health disorders has been one of the main contributors to the rise in multimorbidity in Catalonia — especially among younger generations (it is no coincidence that Spain is one of the countries with the highest prescription rates of benzodiazepines and other sedatives in the world).

To make matters more complex, it is very difficult to determine whether the observed increases in the prevalence of multimorbidity are due to (1) a “true” or “objective” deterioration in the underlying health of the population, (2) a growing trend toward overdiagnosis among health professionals (O’Sullivan 2025), or (3) behavioral changes in how people seek health care. These behaviors, in turn, may be influenced by the results of public health programs, such as disease screening campaigns. In addition, the emergence of new technologies, such as diagnostic tools guided by artificial intelligence, could lead to increasingly early diagnoses that might eventually help prevent the progression of certain diseases — thereby triggering a radical change in our capacity for early disease detection. In this context, it is imperative that the medical profession and health systems as a whole engage in a deep debate about the meaning of these findings (for example: how should we intervene when discovering that an otherwise healthy individual has an above-average probability of developing a certain disease in the distant future?).

Whatever the explanatory mechanism behind these striking results, there is no doubt that they reflect a real increase in demand within public health systems — a worrying phenomenon that calls for the development of evidence-based policies. To address the major questions raised by these trends and face the challenges of population aging, much more research will be needed on the fundamental determinants, which may vary across space and time. Among other things, it will be necessary to collect information with unprecedented detail (combining longitudinal data not only from the medical/health sphere but also including individual and contextual sociodemographic characteristics), as well as to foster an interdisciplinary collaboration effort that brings together knowledge from the life sciences, the social sciences, and the humanities.

References

Gimeno, L., Goisis, A., Dowd, J.B., & Ploubidis, G.B. (2024). “Cohort Differences in Physical Health and Disability in the United States and Europe.” The Journals of Gerontology: Series B, Volume 79, Issue 8, gbae113. https://doi.org/10.1093/geronb/gbae113

Gruenberg, E.M. (1977). “The Failures of Success.” The Milbank Memorial Fund Quarterly. Health and Society, 55 (1): 3–24. JSTOR. https://doi.org/10.2307/3349592

O’Sullivan, Suzanne (2025). “The Era of Diagnosis: How the Medical Obsession with Labeling Is Making Us Sick.” Editorial Ariel.

Permanyer, I., Gumà, J., Trias-Llimós, S. & Solé-Auró, A. (2025), “Multimorbidity trends in Catalonia, 2010-2021: a population-based cohort study”, International Journal of Epidemiology (in press).