There's been a shakeup in the rankings, and a challenger has taken the #1 spot from Italy as the world's healthiest lifestyle- Spain.

The 2019 Bloomberg Healthiest Country Index ranked Spain #1, ahead of former #1 Italy (now #2). The last time the index was published in 2017, Spain ranked 6th. 

Spain scored a 92.8 out of 100. Spain currently holds the world's 3rd longest lifespan trailing only Japan and Switzerland. By 2040 Spain is expected to be crowned with the world's longest lifespan, averaging 86 years.

Valencia Spain

Shangri-La does exist.


In comparison, Cuba ranked #30 in this year's index. 

The United States ranked #35. Eek. 

What was Measured?

To calculate the rankings the study included a wide variety of metrics, including but not limited to:

  • death by disease/injury
  • lifespan
  • cardiovascular risks
  • obesity, tobacco use
  • alcohol consumption
  • physical inactivity
  • childhood malnutrition
  • mental health
  • vaccination coverage
  • access to clean water, clean air and sanitation

At least 2 of those metrics are hotly debated topics in the United States right now, and just about all of them pose serious public health challenges somewhere in America.

Spain's 2 Driving Forces of Healthy Living

  1. The now iconic Mediterranean diet.
  2. Quality, universal healthcare.

Spain's flagship newspaper El Pais lays out the reasons for success.

“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."

The benefits of the Mediterranean diet seem endless. The diet also points to: healthy brain aginglower risk of depression, lower risk of stroke in women, a lower risk of obesity, to name a few. 

El Pais continues, commenting on Spain's healthcare system:

“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.”

In the past decade, Spain has benefited from a reduction in cardiovascular disease and cancer.

siesta infographic

I fully endorse this message.

Declining Health in U.S.

Meanwhile, what 2 driving forces cause the U.S. to stumble in at #35?

  1. "Deaths of despair"
  2. Obesity

Lifespan in the U.S. gets shortened by "deaths of despair" defined as: 

"Rising drug and alcohol overdoses, suicides, and disease from chronic alcoholism -- labeled "deaths of despair" by one expert -- are cutting the lives of white Americans short by nearly a half a year on average."

Worse yet, we suffer from an obesity epidemic with 40% of American adults classified as obese.

"Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death."

More to Health Than Just Physical

A new system called The Indigo Wellbeing Index goes beyond physical health to include things like government healthcare spending, depression, happiness and more to rank countries with thriving citizens. 

The United States does not rank in the top 25, due to depression, obesity and inactivity, et al.

The index finds that wealth and wellness don't seem to correlate. Of the top 25 countries, only 5 are G-20 countries with the world's largest economies.

Many of the countries that rank above the U.S. are third world, like Guatemala, which I visited last December and I can attest to their lack of wealth. 

Smaller countries, with less wealth, but growing economies dominate the list. 

Lesser Known Keys to Health and Wellness

Let's get back to Spain. There are other key ingredients to healthy, happy living and wellness than just physical health and diet. 

Expats and visitors to Spain share their insights, with the consensus being "quality food, good weather, a healthy and relaxed lifestyle, and solid health care."

Ok, so we already know about healthcare and quality food. Although I'll add that I once heard (I can't find a source to prove it though) that Madrid consumes more fish and seafood than any city in the world except for Tokyo. Madridians penchant for eating sea life is even more astounding when you think about how the city is landlocked and Tokyo is adjacent to the ocean.

mercado de san miguel madrid

Mercado de San Miguel, Madrid

Other factors contribute to a wellness ecosystem: pace of life, climate, sunshine, outdoor active living, car optional living, living near water and work-life balance.

The Facts from Someone Who Has Lived There

Full disclosure in the spirit of transparency: I'm absolutely biased because I lived in Spain for some years.

I first lived in Seville, then I moved to Madrid.

I love Spain, the lifestyle and many aspects of their culture. 

I reaped the benefits quickly and easily. 

Let's look at those other wellness factors I mentioned above.

Pace of Life

Spain is easy come, easy go. Spaniards tend to embrace a carefree attitude about most things, maybe even bordering on cavalier. 

This is summed up by something I heard once in Madrid, in regards to marijuana. Although it's illegal there, for the most part, police don't enforce prohibition. As a local told me "they just don't see it." In other words, the police aren't bothered by it. 

Also, until you've sat for a few hours in a terraza eating tapas, Spanish ham and drinking a glass of red wine, you've never fully realized how life can sloooow down to a drip and how once it does, you can fully live in the present.

tapas

Free tapa you might get when you buy a beer or wine for 2 euros

Climate/Sunshine

Spain has a mild climate generally speaking. Believe it or not, it can get cold there and does snow, especially in the mountains. Madrid experiences winter for sure, and anywhere north of there as well. 

If it snows, it usually doesn't stay or stick overnight. When winter comes and it does snow, Spaniards are delighted, as they love to go ski in the mountains. 

When it is winter, you almost always have to wear sunglasses. This makes a HUGE difference in life. Despite cold and maybe snow, you're still motivated to get out of bed and live life. 

Madrid averages around 2,700+ sunshine hours a year. You can wear shorts and a t-shirt for about 8 or 9 months out of the year, although everyone will know you're an American.

Outdoor Active Living

One BIG difference between life in the States vs. life in Spain is that our downtowns are designed for business. 

In Spain, the city center is designed for leisure. Whether it's large, public plazas to sit in and people watch, shopping, eating or drinking, city centers are all conducive to pedestrian life. If you know what la marcha is, you know what I'm talking about.

Remember all that sunlight? Yeah, you want to be outside in it all the time, enjoying those city centers, whatever it is you decide to do. 

Spaniards live on the streets. They walk everywhere. 

And if they're not walking, they're up to something. Of course all the boys and men love to play soccer. Not far behind is their love of basketball. I played in a few quality pickup b-ball games there.

Also, if you're not at the beach in the summer in Spain, you're doing life wrong.

cabo de gata

Cabo de Gata

Car Optional Living

Spain has excellent public transportation, whether train, metro, bus, whatever. I lived there the entire time without a car. Many people do.

Not only does this reduce pollution, but it lightens your budget allowing you the financial freedom to enjoy life in different ways, that you're not able to in the States. 

No car + sunshine + Mediterranean diet + walking = no obesity.

When I moved to Spain, I lost about 20 pounds in less than 4 months from doing...NOTHING.

Just changing to the Mediterranean diet and walking everywhere because of not owning a car, made the extra pounds melt off of me with ease.

Living Near Water

Not everyone can enjoy this luxury in Spain, but it does amplify the already inherent, stout wellness aspects of the country.

Living by water has been proven to increase your wellness

There's oceanside magic in Spain. One of my favorite words is chiringuito. It means beach bar. Yes, there are bar/restaurants right on the beach in Spain. And by on the beach, I don't mean adjacent on a slab of concrete. 

No, I mean sitting directly on the sand, on the beach. You also haven't lived until you've enjoyed a 2 or 3 hour lazy, weekend, seafood feast at a chiringuito.

Just about any beach bar between Gibraltar and Barcelona will work. The Med beats the Atlantic side hands down, but there will be some Spaniards who disagree.

chiringuito

Chiringuito in Barcelona

Work-Life Balance

It's incredible and possibly the best in the world.

This is the biggest difference between Spain and much of southern Europe vs. the United States.

Here we live to work.

There they work to live.

Our puritanical work ethic can lead us astray from allowing ourselves to just be, and enjoy life at a relaxing pace.

We're always chasing that next dollar, that next gadget, that next car or house.

Spain isn't materialistic, as the country prefers a higher, intangible quality of life that owning stuff doesn't provide.

They live a fuller life, getting by on less.

I was a part-time teacher of English as a foreign language there. I worked 20-25 hours a week, which allowed me to rent a nice apartment in downtown Madrid.

I spent a third of my monthly income on rent/bills, another third on spend money and I saved the last third to go on vacations and traveling. 

Virtually everyone in Spain gets the entire month of August off. Almost the whole country is on vacation automatically. 

The same goes for the period from Christmas until 3 Kings Day in early January. 

You also get off a boatload of Catholic holidays. Maybe 10 or more a year?

This doesn't take into account the vacation time you get off from work.

I probably worked less than half the amount there as I did in the States and didn't suffer one bit.

Another favorite word of mine in Spanish is puente. It means bridge, but is used in a slang way.

terraza

How you might spend your puente.

If Spain celebrated Thanksgiving, they'd make it a puente. Everyone would take off the Friday after Thanksgiving, to make the "bridge" from the holiday to the weekend. This is a regular occurrence around weekday holidays in Spain.

La Vida Buena

Ironically, Spain doesn't have much of a strength training culture. Physically, they're not built to be muscular and since they're naturally in good shape, they don't show much interest in gyms.

However, of all Spanish cities, Barcelona is the most open and cosmopolitan. Barca welcomes global trends and embraces change. So much so, that you'll find CrossFit boxes in Barca.

It doesn't hurt that they eat so healthy without even trying. You will never see anything advertised or marketed in Spain as "organic." Why?

Because everything is already organic. All their food is natural, so the marketing label of "organic" is unnecessary. I could write a whole other blog on this subject alone.

But I digress. This is what I'd like to leave you with. 

Alhambra

La Alhambra, Granada

I read a book once while living in Madrid called The Consolations of Philosophy by Alain de Botton. The book makes an excellent read.

de Botton does a superb job of decoding philosophy and putting it into laymen's terms. He eliminates all the headiness and haughtiness. Philosophy is simply learning how to live life better. In other words- wellness.

In the book he talks about a trip Nietzsche took to Italy which changed him. He stayed on a "leafy avenue" on the edge of Sorrento, overlooking the bay and Mount Vesuvius where "a small garden with fig and orange trees, cypresses and grape arbours led down to the sea."

Nietzsche and his friends visited Pompeii, Vesuvius, Greek temples, and read classic Greek and French philosophy. The experience prompted a revelatory breakthrough for him:

"And as he swam in the Mediterranean, ate food cooked in olive oil rather than butter, breathed warm air and read Montaigne and Stendhal (‘These little things – nutriment, place, climate, recreation, the whole casuistry of selfishness – are beyond all conception of greater importance than anything that has been considered of importance hitherto’), Nietzsche gradually changed his philosophy of pain and pleasure, and with it, his perspective on difficulty. Watching the sun set over the Bay of Naples at the end of October 1876, he was infused with a new, quite un-Schopenhauerian faith in existence. He felt that he had been old at the beginning of his life, and shed tears at the thought that he had been saved at the last moment."

Does that lifestyle sound familiar?

One of Nietzsche's colleagues reported never seeing him so lively and saw him laughing aloud from sheer joy.

If you know anything of Nietzsche, you know this behavior is the antithesis of his former being. 

If living the world's healthiest lifestyle turned Nietzsche from an ornery curmudgeon into a lover of life, think about what it can do for you. 

Thanks again for reading Fringe Nation, if anyone made it this far. If you have any experience living in Spain, or secrets to living the world's healthiest lifestyle, please share with us in the comments below.

Stay awesome and go beyond the ordinary!


Adam Miezio
Adam Miezio

Author