I recently spent a lot of time in Spain, did a lot of reading about Spain, and got some surprises.
The Spanish are the longest-lived people in Europe (barring tiny places like Monaco and San Marino), and are between the 5th and 10th most long-lived nation in the world, depending on who is counting.
The Spanish live several years longer than Americans, and also exceed Canadians, French, British, Germans, Greeks, Italians. Estimated life expectancy, per the WHO, is 80 for men and 86 for women.
They spend 9% of their GDP on healthcare, half what the US spends (17-18%). And because the US has a higher GDP per capita, the Spanish actually spend about 1/3 as much as Americans on healthcare, or $3,000 per person per year, while the US now spends $10,000 pppy.
How do the Spanish do it? Do they have really healthy diets and lifestyles?
I would answer that what I thought was an optimal diet (mainly fresh fruits and vegetables) may not be. Or, at least, such a diet does not seem to explain Spanish longevity.
As far as diet goes, the consumption of vegetables in Spain (besides potatoes) is LOW. The consumption of bread and meat is HIGH. Most of the meat is ham, from black pigs that ate oak acorns in the wild. Iberian ham is 'dry cured': soaked in brine and then hung up for 1-3 years.
In The New Spaniards (2006 edition) John Hooper reports that Spaniards spend more on lottery tickets than they do on fruits, vegetables and dairy, combined.
The Spanish eat a lot of pastry, and the pastries are very sweet and very high in saturated fats. (More so than in the US.) I have never seen so many pastry and candy shops per capita as in Spain. It seems the 'evils' of sugar and saturated fats are not causing the Spanish problems.
The Spanish tend to consume smaller amounts at each sitting, eating about 5 times a day. They definitely eat more (locally grown) olives, olive oil, and almonds than Americans.
They spend a lot of time outdoors, and there is a LOT of sunshine. Jerez (the sherry capital) gets between 3,000 and 3,200 hours of sunshine each year, for example.
The Spanish drink a lot of coffee and get an hour less sleep per night than the rest of Europe, perhaps because the midday break for 3-4 hours results in late nights. Thirty per cent are smokers. Alcohol consumption is about average for Europe.
Spanish city centers tend to be difficult to drive in, and more and more streets have been pedestrianized. I believe the Spanish walk a lot more than Americans, but could not find data on this. In terms of formal exercise, Spaniards seem like Americans. The OECD claims there is more obesity in Spain than in most western European countries, while I found the Spanish to be slim.
So, there you have it. Neither diet, weight, smoking, drinking, sleep or exercise explain Spain's remarkable longevity.
I have to admit that, despite copious study and a professional focus on healthy lifestyle, I have been ignorant. I apologize for the certainty with which I counseled patients about diet in the past. OTOH, it is possible that if the Spanish started eating more fruits, veggies and dairy and less pastries, they would live even longer. But how do you ask the winners of the longevity race to change?
And now excuse me while I grab a sunny table at a cafe and get a Napoletana (a chocolate-filled croissant) and a cafe Americano.