An expert's point of view on a current event.

Spain’s Formula to Live Forever

The country is set to boast the world’s longest life expectancy by 2040. What are the Spanish doing right?

An elderly couple sit in Setenil de las Bodegas near Cádiz on Dec. 2, 2018, during Andalusia's regional election.
An elderly couple sit in Setenil de las Bodegas near Cádiz on Dec. 2, 2018, during Andalusia's regional election. JORGE GUERRERO/AFP/Getty Images

If you want to live to 100, you should consider moving to Spain. According to a recent study, the country is set to overtake Japan as the nation with the longest life expectancy by 2040. Spain’s population has an average life expectancy of 82.9 years as of 2016, according to the study, published in October 2018 by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. Spain topped the 2040 list ahead of Japan and Singapore, while the United States fell to 64th in the rankings, down from 43rd for 2016 life expectancy.

The rosy outlook for Spanish citizens has also been underscored by other studies, including one published in February by Bloomberg, which ranked Spain as the world’s healthiest country, based on metrics including life expectancy and diet but also on environmental factors like access to clean water and sanitation.

Spain’s good health reflects some natural advantages, including a mild climate that has already convinced scores of Northern Europeans to retire there. It boasts great produce that the country promotes as part of its healthy Mediterranean diet. But its record longevity is also a testimony to strong welfare policies and social cohesion, ensuring older people not only benefit from a public health care system but also from family and community support.

In contrast to the United States, where the issue of universal public health care remains hotly disputed, Spain is among the Western countries that has long guaranteed universal health care. The system offers any resident of Spain access to emergency and primary health care without requiring any payment from the patient. Last year, the Socialist government passed a decree to ensure migrants can also see a doctor, even if they are in Spain without any legal registration and without contributing income taxes to the system. The system is similar to that of many other European countries, with the distinction that each region of Spain administers its own health care system, under the power distribution arrangements agreed to during Spain’s return to democracy after the death of the dictator Francisco Franco in 1975.

However, beyond 2040, there are reasons to be concerned about the sustainability of the Spanish model. A dwindling workforce may raise financing issues as the portion of residents subject to income tax falls. Spain has one of the world’s lowest fertility rates—on average 1.3 children per woman. “There’s no country that wouldn’t be proud of having the longest life expectancy, but we also need to look beyond 2040 and know that if we cannot boost the birthrate, we will at least need more immigration” to sustain Spain’s workforce, said Jon Darpón, a medical doctor and the health minister of the Basque Country, in northeastern Spain.

Some doctors are also ringing alarm bells over whether Spaniards are abandoning the traditional Mediterranean diet, heavily based on fish and olive oil, which has been shown to reduce cardiovascular disease. As part of its studies, the World Health Organization has highlighted not only the switch to fast food but also declining consumption of traditional produce in Southern Europe, including fresh fruit and vegetables. For instance, only about 30 percent of children in Spain now eat fruit daily.

“What we call the Mediterranean diet is what we used to eat, what we know we should be eating, but what we’re probably no longer really eating as a society,” said Usune Etxeberria, a nutritionist and researcher at the Basque Culinary Center. “Today our life expectancy has got much longer, but our obesity is also rising, which shows that we are no longer following the diet of our grandparents, who clearly ate much more frugally.”

Efforts are now being made in Spain to counter rising obesity among children. At Azti, a food research center based in the Basque Country, I watched visiting schoolchildren sample a pasta dish with broccoli and mussels. As the children learned how to prepare the dish and then tasted the food, smiles mostly replaced frowns on their faces. “We’re trying to show them that there’s more to pasta than macaroni and cheese,” explained Mertxe Caro, a food researcher at Azti.

The Basque Country, which has its own language and has long sought a high degree of autonomy from the Spanish state, is in several ways leading efforts to supplement Spain’s health system with other methods that can promote health throughout the lives of its citizens.

The Basques pride themselves on living in a paradise for food lovers. In recent decades, gastronomy has become one of Spain’s main calling cards, spearheaded by famous chefs such as Ferran Adrià, whose El Bulli restaurant in northeastern Catalonia won several awards as the world’s best before closing in 2011. And the Basques have more than played their part in this food success story. The Basque region is home to 23 Michelin-starred establishments and the Basques have incorporated food into community life in the unique form of gastronomic societies, called txokos, whose members gather regularly to cook their own meals.

Beyond cooking clubs, this type of attachment to social cohesion has resulted in several associations across the country that complement the public health care system to help the sick and aging. For instance, the 530 members of Asparbi, an association for people with Parkinson’s disease, each pay 80 euros per year to visit Asparbi’s community center on the outskirts of Bilbao whenever they want. They can spend several hours switching between activities that range from working with a speech therapist to learning Pilates. In one session, a group rehearsed a song about sailing. To improve their coordination, the singing teacher also made them combine the lyrics with arm gestures that evoked rowing on the sea.

Begoña Diez Arrola, a nurse by training, founded Asparbi in 1994 after her mother was diagnosed with Parkinson’s. “At first, my mother didn’t want anybody to even know she was ill, so that made me realize how quickly things spiral downward if people are left to feel ashamed and alone,” she said.

The Basque authorities have also been encouraging citizens to better monitor their health and test early for possible diseases, as part of a shift toward preventative health care since the 1990s. In 2018, the Basque region launched a free screening program for cervical cancer, adding to existing programs for breast or colon cancer. Spain’s other regions have also introduced similar programs, although not always as extensively.

“With little investment, you can get great results,” said Amaia Etxebarria Altuna, a doctor at the Galdakao hospital outside Bilbao. “The alternative is shown by countries that end up spending huge sums on technology, medical equipment, and resources to resolve problems that need not have been made so complex.”

Indeed, Spain spends comparatively less money on health care than many other European countries, including the largest ones on the continent. According to the most recent data from the OECD, Spain spent $3,371 per capita on health care in 2017, compared to $4,092 for France or $5,728 for Germany. But its demographics and finances mean Spain faces challenges to sustain a state pension system based on the retirement age of 65. In fact, Spain’s social security fund sustained major losses during the global financial crisis in 2008, reaching a deficit of nearly 19 billion euros (about $21 billion) in 2017. Since then, thousands of retirees have taken to the streets, holding demonstrations to defend their state pension rights against any possible government reform that could cut their benefits.

Spain spends comparatively less money on health care than many other European countries.

“In Spain, we haven’t so far taken the same measures as other countries to help complement the revenues that older people should get, if we don’t want to condemn them to living worse-off,” said Antonio Huertas, the head of Mapfre, a leading insurance company, and the co-author of a book on the economics of aging.

In April’s election, which Prime Minister Pedro Sánchez and his Socialist party won, all the candidates debated Spain’s dwindling workforce, but without offering any definitive solution. As the population ages and growth slows, Sánchez and his successors will be increasingly forced to grapple with the need for new policies to address the country’s needs.

Despite its population’s current longevity, without significant changes, Spain may be in for a policy headache in the long run. “You don’t have to be a Harvard mathematician to see that the numbers don’t add up in the longer term,” said Bittor Oroz Izagirre, the Basque region’s deputy minister for agriculture and food policy. “We all know that this country, like much of Europe, risks turning into a nursing home reliant on a pensions system that will falter at some point.”


Raphael Minder is the Spain and Portugal correspondent for the New York Times and the author of the book, The Struggle for Catalonia: Rebel Politics in Spain.  Twitter: @RaphaelMinder