The situation in Europe
1. State of health
Spain is an area of Europe that enjoys relatively high levels of good health. This is reflected in objective indicators, among them lifespan and the mortality and morbidity rates, but also in citizens’ perceptions. Adjusting for age to prevent any undue influence of the various population pyramids, the percentage of the adult population who perceive their state of health to be poor is lower in Spain than the European average, and this advantage grew in 2017, the year in which the country ranked sixth for this parameter. Even though the morbidity rates are not very different to those of the European Union as a whole, Spain has succeeded in reducing the morbidity rate associated with the main diseases more quickly and intensively than other countries since the 1990s. Spain currently ranks among the five countries in the European Union with the lowest morbidity rates for ischemic heart disease, cerebrovascular disease and breast cancer and in some cases leads the table. Among the negative trends, it should be noted that the mortality rate among women for lung cancer is lower than the European average but it is nevertheless rising. Also on the rise since the beginning of this century is the incidence of syphilis and other sexually transmitted diseases (Ministry of Health, Social Services and Equality, 2017) in Spain and in Europe as a whole. Between 2012 and 2016, the number of cases of gonorrhoea, one of the diseases that has spread the most, went from seven to 15 out of every 100,000 inhabitants in Spain and from 13 to 19 out of every 100,000 inhabitants across the whole of the European Union according to data supplied by the European Centre for Disease Prevention and Control.
The situation with regard to limitations in activities of daily living due to health problems has also evolved favourably in Spain in comparison with its European neighbours. Following its mid-table position in 2009, the data for 2017 place Spain as the fourth country in the European Union with the lowest percentage of adults who declare that they suffer from some type of limitation (moderate or severe), and as the second country in a comparison of just severe limitations (figure 19). If the data for 2018 confirm this trend, it would be an improvement with potentially positive implications with regard to the future demand for long-term care. Indeed, it is among the population of adults over the age of 65 that there has been the biggest drop in the prevalence State of health of self-perceived severe limitations, both in Spain and in the average across the European Union. Using more recent data, Spain would occupy the fifth best position in the European ranking.
2. Healthy lifestyle habits
Spain occupies a mid-table position with regard to the adoption of healthy lifestyle habits in Europe, though there are differences depending on the indicator considered: Spain has a healthier diet, but also a higher level of consumption of illegal drugs such as cocaine or cannabis. Twenty-three per cent of adults smoke on a daily basis, a percentage similar to the European average and one that represents an improvement over the past. Patterns of alcohol consumption are not easily comparable due to differences in national customs: Spain has comparatively more people who drink on a daily basis but also a higher percentage of people who are teetotal according to the data collected by Eurostat.
Adherence to the Mediterranean diet is often regarded as one of the factors that might explain the longer lifespan in countries such as Spain, which, together with France, leads the European ranking for this indicator. The Mediterranean diet, which is rich in fruit, vegetables, grains, legumes, fish and olive oil, is deemed by the World Health Organization to have proven positive effects on people’s health. According to the data for 2014, Spain stands out within the European Union as a country with a low percentage of the population who do not eat enough fruit and vegetables (figure 20).
Along with diet, another factor that may have health-related consequences is citizens’ habits in relation to physical activity. Spain does not emerge in a positive light in this area: just over half (53.1%) of adults dedicate no time during the week to physical activities regarded as beneficial for health. According to this indicator, the European average is 50.7%, whereas the rates in countries with the lowest levels of sedentary lifestyles (Austria, Sweden, Finland and Denmark) are around 20%. The greatest age related differences in relation to the European average are to be found among senior citizens (aged over 65). In light of the importance of exercise in improving quality of life and preventing diseases (at any age), it is important to encourage physical activity, particularly among senior citizens.
Obesity is a growing health problem in Europe due to the combination of poor diets and insufficient physical activity. In 2014, Spain as a country had a prevalence of obesity higher than the European average (figure 22). The problem tends to increase with age in all countries and does so particularly in Spain, where adults aged over 65 are comparatively more obese (23.8%) than the average of the EU-28 (19.9%). However, perhaps the most worrying trend in Europe, in addition to that among adults over the age of 65, is the rise in obesity among young people. The rate of obesity among adults aged 25 to 34 stood at 10% in the EU and at 11.2% in Spain.
With regard to drug use, in 2015 Spain was one of the five countries in the European Union with the highest prevalence of illegal drug use among teenagers and young adults aged 15 to 34. Cannabis is the most widespread illegal drug consumed by the European population. In most countries, the percentage of teenagers and adults aged 15 to 34 who had consumed cannabis in the previous twelve months rose between 2008 and 2016. However, Spain is one of the seven countries in the European Union where this consumption fell between 2008 and 2016.
3. Access to healthcare
Most European countries have universal health systems geared towards guaranteeing healthcare for all their citizens. As a result, the indicators concerning the inaccessibility of the health system are very low in this region of the world: fewer than 5% of adults declare they did not visit the doctor or dentist during the previous year for financial reasons or because of waiting lists or because it was too far to travel. In the case of general healthcare, the values for this indicator are practically zero in Spain, which tops a European ranking for 2017 in which the worst positions are occupied by Greece and Estonia (with values exceeding 10%). With regard to dental care, the inability to access this type of care exceeded 10% in Portugal, Greece and Estonia but nowhere else. This indicator rose in Spain during the financial crisis and went on to exceed the European average, which was still the case in 2017 (4% in Spain as opposed to the European average of 2.9%).
The European Health Survey carried out in European countries around 2014 included detailed questions to make it possible to compare access to healthcare (figure 24). The results expand on and confirm the situation outlined above: the Spanish healthcare system is one of the most accessible for citizens as far as general medical care, medication and mental healthcare are concerned, but performed worse than the European average in dental care. Conversely, Spain dropped down the table to eleventh position due to responses given to the question in the survey regarding the excessive delay in healthcare due to waiting lists.
4. Access to dependency care
The ageing population will mean that there will be a growing demand for long-term care in all countries, though people’s state of health may influence the way this evolves. The social need for this type of care among senior citizens can be estimated by analysing the frequency with which people in this group declare they are severely limited by health problems when it comes to performing activities of daily living. The available data show that Spain obtained better results in this indicator than the European average in both 2009 and 2017 following a greater reduction than that observed in Europe as a whole. It should be noted, however, that the figures are based on a single question that has a certain subjective element to it, as a consequence of which this improvement should be viewed with caution.
There is no European statistic that makes it possible to analyse how meeting this social need has evolved in the various countries, but the OECD furnishes comparable data for 18 Western countries (OECD, 2017). According to their figures, the percentage of senior citizens receiving long-term care in Spain remains lower than the OECD average (13%) even though it rose between 2005 and 2015, when it stood at 8.5%. In addition, a higher proportion of senior citizens receive care in their own homes. This reflects not only people’s preferences, but also restrictions associated with the lack of places in residential care homes and day centres available for them.