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EXPLAINED: Why Spain has the lowest death rate in the EU

New Eurostat confirms that Spain has the lowest annual mortality rate in the European Union, so what makes Spain such a healthy place to live?

EXPLAINED: Why Spain has the lowest death rate in the EU
An old man reading the newspaper on a bench in Spain. Photo: AFP

Is the Mediterranian diet? The brilliant free health service? Or simply that the Spaniards are made of sturdier stuff than their fellow Europeans.

The Local takes a look. 

So what do the figures mean: 

Every year, Eurostat, the statistics agency of the European Union, produces a report based on data collected in each EU nation to compare standards of living, healthcare etc.

This report reveals that Spain has just 829 deaths for every 100,000 inhabitants, a figure that is the lowest of all the 28 member states and well below the EU average of 1,002 

Just behind Spain in the low mortality rate stakes is France (838 for every 100,000), Italy (843) and Malta (882). The highest rates were found in Bulgaria (1,600), Latvia and Romania (tied at 1,476).


Photo: monkeybusiness/Depositphotos

What are Spanish people dying of? 

The biggest killer in Spain is cardiovascular disease, followed by cancer, a trend that is replicated across the EU except in Denmark, France, the Netherlands and the United Kingdom, where the biggest killed is cancer. 

 A different study the Global Burden of Disease study in Spain (GBD), exploring deeper into the causes of death in Spain revealed that of the 418,516 people who died in 2016,  80 percent were aged 70 years or older. 

 Non-communicable diseases were the cause in 92.8 percent of cases, accidents in 3.6 percent, and infectious diseases in 3.5 percent.

 Breaking it down even further, we discover that the five main causes of death in Spain are, ischaemic heart disease, which accounted for 14.6 percent of all deaths, Alzheimer disease and other dementias (13.6 percent), stroke (7.1 percent), chronic obstructive pulmonary disease (COPD) (6.9 percent) and lung cancer (5 percent).

Data from Global Burden of Disease study in Spain (GBD) 

High life expectancy 

Clearly connected to the low mortalitiy rate is the fact that Spain has the highest life expectancy at birth among European Union nations and is expected to overtake Japan by 2040 to become the country with highest lifespan in the world.

With a projected average lifespan of nearly 85.8 years, Spain — formerly in 4th place — will dethrone Japan, which sits atop the rankings today with a lifespan of 83.7 years, and will drop to 2nd place in 2040.

Mediterranean diet

The Mediterranean diet is routinely held responsible for Spain's high ranking on the health and life expectancy lists. 

Researchers say eating habits may provide clues to health levels enjoyed by Spain and other countries in southern Europe as a “Mediterranean diet, supplemented with extra-virgin olive oil or nuts, had a lower rate of major cardiovascular events than those assigned to a reduced-fat diet,” according to a study led by the University of Navarra Medical School.

Public healthcare

A huge part of Spain's appearance at the top of the rankings is thanks to the free public healthcare enjoyed by 99.8 percent of the Spanish population, two points above the OECD average, according to El Pais newspaper.

And even though austerity measures during Spain's economic crisis saw the health budget cut, its healthcare professionals and access to services remain among the best in the world,  with Spain ranked eighth in the world for its standard of healthcare, out of 195 countries. 

“Primary care is essentially provided by public providers, specialized family doctors and staff nurses, who provide preventive services to children, women and elderly patients, and acute and chronic care,” according to the European Observatory on Health Systems and Policies 2018 review of Spain.

Photo: pressmaster/Depositphotos

World's best organ donation record 

Part of the outstanding healthcare record is the fact that Spain has been the world leader in organ donation for the last 25 years and consistently breaks its own record for the number of transplants carried out. 

A total of 4,818 organ transplants were carried out in Spain during 2016, beating the record of 4,769 from the year before, according to data published by  the National Transplant Organization (ONT). 

It means that Spain saw 43.4 individual donors per million people (pmp) in 2016, an increase from 39.7 pmp in 2015 and 36 pmp in 2014, “much higher” than the EU average (19.6) and the US average (26.6) according to stats published by Spain's Health Ministry.

Spain has maintained its gold standard in organ donation despite deep austerity cuts which saw public spending on health slashed during the economic crisis years.

Fewer dying on the roads

The studies show the areas where Spain has made huge improvements in recent years. Legislation to improve safety, road safety campaigns and general improvement of the roads and policing means far fewer people are dying in traffic accidents. 

Data reveals that traffic accidents fell to 32nd place on the list of causes of death in 2016, a huge shift from from 1990, when accidents appeared in 8th position on the list. 

Decrease in smoking

Photo: Pedro Armestre/AFP

Although lung cancer is still the number one fatal cancer in Spain findings reveal that things are improving. Smoking bans in restaurants, bars, and the work place as well as public health campaigns has led to a substantial decrease in smoking in the Spanish population.

Between 1980 and 2016, the number of men who smoked dropped from a whopping 41 percent to 26 percent, while women smokers dropped from 21 percent to 17 percent.

Trouble ahead? 

However, Spain shouldn't be too complacent. 

Experts warn of an obesity crisis in Europe of “enormous proportions”, and that is expected to hit Spain too with 80 percent of Spanish men and 55 percent of Spanish women predicted to be overweight by 2030.

“More work needs to be done to control risk factors such as alcohol abuse and to further reduce smoking, particularly among adolescents, and overweight and obesity in children,” warned Dr. Joan B Soriano, associate professor at the Autonomous University of Madrid and Hospital La Princesa and coordinator of the GBD study in Spain.

READ ALSO: Secret to long life? Spaniard lived to 107 on 'red wine diet' 

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How Spain could stamp out smoking

A fifth of Spain's population smokes on a daily basis. With such high numbers, here's how the country's pulmonologists propose to get smokers to quit.

Spain plans to get people to quit smoking
How Spain plans to get people to stop smoking. Photo: Khalil MAZRAAWI / AFP

For many outsiders, Spain is a nation of smokers. 

The stats from Spain’s Ministry of Health show that 23.3 percent of men smoke every day in Spain, compared with 16.4 percent of women.

For both males and females, the highest number of smokers are aged between 25 and 34, meaning that it’s the younger population who are smoking slightly more than the older generations. 

Spain’s pulmonologists are now pushing for the country’s tobacco laws to be tightened, claiming that reform is needed after the last legislation was approved a decade ago.

READ ALSO: Spain warns against smoking and vaping in public to avoid Covid infections

Why is smoking such a problem in Spain and what is being done about it?

The latest stats from the Spanish Ministry of Health show that lung cancer, often caused by smoking, is the third most frequently diagnosed cancer in Spain, with 29,549 cases diagnosed so far in 2021.

Given these high figures Spain’s Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has proposed five measures to help get people to stop smoking.

SEPAR points out that every time anti-smoking legislation is reformed and things for smokers made more difficult, the prevalence of smoking decreases.  

Smoking on terraces was banned in some regions during the pandemic. Photo: CRISTINA QUICLER / AFP
  • Price of tobacco to rise in 2022

The first point on their list is to raise the price of tobacco, which must cover all forms, from cigarettes to cigars, through to rolling tobacco, and electronic cigarettes.  

This first measure may soon become a reality as the Spanish government has already predicted that the price of tobacco will rise in 2022, after several years of stagnation.  

It is expected that tobacco will be responsible for almost a third of all special taxes received in 2022, equating to €21.8 billion.

According to the World Health Organization (WHO), “cheap tobacco” in Spain guarantees “a percentage of smokers above 30 percent”.

In Spain, the price of a pack of tobacco is around €5, which is much cheaper than in other countries. In Australia for example, a pack of tobacco costs around €22, and in the United Kingdom and France, each pack of tobacco costs around €12.4 and €10.5, respectively.

According to Dr. Carlos A. Jiménez Ruiz, pulmonologist and president of the society, the current anti-smoking law has “some deficiencies” that need to be addressed in order to develop legislation that is more effective and efficient, especially with regard to the prevention of tobacco consumption in young people, but also in helping smokers to stop smoking and in protecting the health of non-smokers. 

READ ALSO – Maps: Which beaches in Spain have banned smoking?

Besides increasing the cost of tobacco SEPAR proposes four other measures to get Spain to quit smoking. These include:

  • Banning the consumption of tobacco in public spaces, even outdoors
    During the pandemic, several regions approved a regulation to prohibit smoking on terraces. SEPAR proposes that smoking be prohibited not only in spaces such as terraces but also in sports stadiums, beaches, parks and bullrings, and that fines should be imposed for those who do not comply.

  • Establish generic packaging
    SEPAR also wants Spain to introduce generic packaging, which means no logos and images of the tobacco companies. This measure has also proven to lower the sales of tobacco in countries where it has been implemented, such as Australia and New Zealand. According to the latest statistics from the Australian National Drug Strategy Household Survey around 11.6 percent of adults in Australia smoke daily. 

  • The regulation of other smoking devices
    Despite the fact that all products that burn tobacco such as cigarettes are already regulated, SEPAR believes that it is also necessary to regulate the sale, consumption and advertising of electronic cigarettes. This is because e-cigarettes have become particularly popular among young people. 

  • Promote help for those seeking to quit smoking
    The last proposal is the creation and development of special units in public health departments to help people to stop smoking and to put more funds towards these programmes. 

How does Spain compare with other European countries when it comes to smoking?

According to the Organisation for Economic Cooperation and Development (OECD), while Spain does have a high number of smokers there are still several European countries that have more. The European countries with the highest number of smokers are Greece, Bulgaria and Hungary.

The latest European survey from 2020 shows that 42 percent of Greeks claim to be smokers, which is only slightly above Spain. 

On the other side, the European countries with the lowest number of smokers are mainly Nordic countries, such as Sweden, Finland, Iceland and Norway.