Spain has reached 49 million inhabitants for the first time on 1 January 2025 and, as the National Institute of Statistics points out, «the population growth is due to the increase in the number of people born abroad, as those born in Spain are decreasing». I thought it would be interesting to take this record in the historical series of the population register in Spain and its characteristics as a reference to reflect in this blog entry on its current consequences for health care and also for the more immediate future of our National Health System.
I still remember watching when I was young, and many of my generation will too, that current affairs programme on TVE (when there were only two channels on television) called «35 million Spaniards», which is now celebrating its 50th anniversary. Well then. We have already reached 49 million inhabitants and at this rate (458,000 more residents in the last year alone), we will reach 50 million in little more than a year
In order to make this analysis of the impact of population growth on health care I will first briefly outline some of the objective data provided by the INE in its latest population report (all the information can be found here).
First of all, attention must be paid to the rate of population growth. Spain is home to nearly 3 million more people in the last decade. Have health infrastructures, material resources and the number of professionals increased in proportion to this increase in population? Definitely not.
The INE itself points out that the increase in the number of inhabitants is due to the arrival of people born in other countries, because in Spain there have been fewer births than deaths, which gives us another important clue as to the largest age groups in today’s society and also in that which is expected in the coming years. The population born in Spain has fallen by 800,000 in the last decade due to the negative demographic balance (more people die than are born), but the number of residents born abroad has risen from 5.9 million to 9.4 million in ten years. This brings us to another statistic, which confirms the ageing of the population, the associated increase in chronic pathologies and the new healthcare needs that I have referred to in other posts on this blog. And the INE gives a hard fact: in 2002, the largest group of citizens was aged between 20 and 40; in 2025 they will be aged between 40 and 60. And in a few years’ time, this generation, with many retirees, will have health care needs for which the system is not prepared: neither to adapt infrastructures and technology, nor to adapt the training offered at universities, nor that of specialists in medicine and nursing (MIR and EIR), nor the public places…
And we cannot ignore the location of this population increase. Unfortunately, empty Spain remains empty or has little growth, and there are even regions that are gradually losing population. However, in absolute numbers, Madrid (749,846), Catalonia (698,660) and Valencia (469,204) lead the way in terms of the most significant accumulated population increases over 10 years. In percentage terms, as they have a smaller population, the Balearic Islands, Murcia and the Canary Islands practically equal them, with increases of between 7 and 12% in the number of residents. The rhetorical question I posed earlier about the increase in resources (material and human) for health care, , I now apply to these regions in particular. And the answer is also negative. The problems associated with health care, however, are much more pressing in these regions. Because regardless of the origin of the population, what is undeniable is that they have many more citizens to look after in terms of their health and well-being.
Finally, a brief reference to the nationalities that have grown the most in terms of the number of residents in Spain: Colombia, Venezuela and Morocco (in that order). The average age of the immigrant population from abroad in 2020 (latest INE data) was 32 years, i.e. a young population that in the coming years is likely to have offspring and generate new care needs (remember that births in Spain have plummeted in the last 10 years).
To sum up. In addition to the problem of an ageing population, the increase in chronic illnesses, overburdened primary care and endless and intolerable waiting lists, we must now add the factor of the significant increase in the population, which now requires universal, quality healthcare. A need which, with each passing year, generates more problems for an adequate response from the health system, which does not react to the speed at which society is changing, nor does it adapt, nor does it incorporate sufficient resources, infrastructure or personnel to meet the new needs of resident citizens, regardless of where they were born. Moreover, it seems that the aim of some politicians is to introduce more rigidities into the system, rather than flexibility to adapt to this social reality.
Let’s be clear. At this rate of population growth and in order to maintain the quality standards of Spanish healthcare, it will be essential to build new hospitals, introduce technology to support professionals with artificial intelligence, define new roles in nursing and pharmacy … and all this has not been done in the last ten years and there is no planning, nor does it seem that it will be done in the near future.
In this context, it would be very easy to say that public-private partnerships will be more necessary than ever to help public administrations respond to this complex environment in which we are going to move. But I would prefer that you draw your own conclusions, after analysing the data I have presented.