The State of Public Health in the U.S. Compared to Spain

The State of Public Health in the U.S. Compared to Spain

The Business and Culture Study Abroad spring break was a trip to remember. The group had the opportunity to immerse themselves into the culture of the Spanish people. We learned about so many different aspects of Spanish life. We saw firsthand how Spanish people speak, act, conduct themselves, eat, drink, sleep, and enjoy the company of others. The trip was an eye-opening experience for all of us. I had the opportunity to truly see the world through a different lens. I have lived in America my entire life. I only knew one way of life before participating in this program. The American lifestyle couldn’t be more different than the Spanish lifestyle. It showed me that there is more than one way to live a fulfilling life. In America, we work, and work, and work some more. We are always trying to innovate, improve, and get the next job promotion. While this has its benefits and is shown in the success of our economy, it also has drawbacks. Spanish people on the other hand work to live. They put much less emphasis on the importance of work. They have shorter work weeks and more employee security. While this practice may be a hindrance to innovation and growth, Spaniards would rather choose to spend their time living a more satisfying life. This was one of my biggest takeaways from this trip. It showed me that these cultural differences represent tradeoffs. Americans value prestige while Spaniards value truly living. This cultural difference explains a lot about Spain and its people. This cultural difference also contributes to the state of health and chronic illness in these two countries. Cultural incentives have created an opposing trajectory between the health of Americans and the health of Spanish people. I am very interested in health and wellness and am constantly doing personal research on these matters and it is an industry I see myself being a part of in the future. 

To begin, I will be talking about the current state of health in both the United States and Spain. 

Figure 1: Stephan J. Guyenet

Obesity prevalence has been on a steady incline over the last 65 years. Americans are by far the most unhealthy developed country in the world. According to World Obesity, one in five children are obese, and forty-three percent of adults are obese. According to the CDC, roughly 42% of Americans have two or more chronic illnesses. The United States is by far the most chronically ill country in the developed world.  According to WorldOMeter, the United States’ life expectancy is 79.46 Years. The U.S. has nearly double the health expenditures per capita compared to the next highest country. According to the World Bank Group the United States spends $12,474 on health care expenditures per capita. 

Comparatively, Spain has had much more success in terms of public health. According to worldobesity.org, 10.6% of children are obese and 16.5% of adults are obese. According to WorldOMeter the Spanish life expectancy is 83.8 Years.According to the World Bank Group, Spain spends $3,245 on healthcare expenditures per capita. 

How can this paradox exist? Why is the health of these populations so different? Why are we as Americans lagging so far behind other nations in these issues? Shouldn’t the most powerful, developed, and prosperous nation of all time be a leader in global health? According to my research and experiences in Spain, a long line of incentives, and lifestyle choices result in this paradox. 

To continue, I will talk about the food systems of the United States and Spain. The United States economy is a true capitalism. Through our experiences in Spain, specifically when we met with the diplomat, we learned that Spain doesn’t have capitalism. Capitalism has allowed the United States to flourish, without it, we wouldn’t be the most powerful nation in the world. Spain’s economy is more aligned with socialist values. There is a lot more government regulation and bureaucracy. This hinders economic growth and innovation but has allowed the food system to remain safer for consumers. 

The food system of the United States is much different than that of other developed nations. Financial incentives for food companies to cut costs, make food more addictive, and make it last longer have resulted in food quality that is toxic to its population. There are a few key differences in rules and regulations for the food system of the United States. First is the Generally Recognized As Safe (GRAS) process. Foods that are thought to be ok, don’t have to go through the official food and drug (FDA) approval process. Instead, food manufacturers are the ones who have the responsibility to tell the FDA if they believe one of their ingredients might be harmful. This system is flawed and creates an immense conflict of interest. Companies are essentially responsible for regulating some ingredients themselves. For example,  if a large food corporation has an ingredient they use that makes their product last longer, taste better, and cost less to produce, why would they feel inclined to tell the FDA that the ingredient is harmful? The system results in companies turning a blind eye and knowingly using ingredients that are detrimental to health. The next difference is pesticides. In the United States, farmers are using 72 pesticides that are banned in the EU. These pesticides benefit food corporations, by increasing their crop yields, but at the expense of the safety of the food. Pesticides kill pests. If they are used to poison pests, it only makes sense that human consumption of pesticides are micro poisons that are terrible for our health. This has been shown in many studies that suggest pesticides may have immense endocrine disruptions to humans’ gut health. The quality of meats is also an issue in the United States. Livestock antibiotic use in the U.S. is nearly double that of the EU. Antibiotic use and lifestyle placement allow food corporations to create more food at a much cheaper cost. The animals are fed an unhealthy diet and live in disease-ridden conditions. Antibiotic use creates meat that is of a much lower quality and results in many harmful side effects after consumption. The United States also allows many growth hormones to be used in its animals to make the animals grow faster, and bigger. Another key difference is ingredients and preservatives that are allowed in the United States, but not in most of Europe are food coloring such as Red 40, Ractopamine, Brominated vegetable oil, Butylated hydroxyanisole, Azodicarbonamide, potassium bromate and many more. The key feature of all these practices in the United States is that these chemicals aren’t being used to make food safer. All of these chemicals have been shown to be toxic for humans, yet the regulatory system has allowed corporations to use these ingredients to make themselves more money. This is largely due to the cultural impact of capitalism. Capitalism in the United States has resulted in a system where companies are doing everything they can to win, at the expense of the consumer. 

While in Spain, this is not the case. Many food corporations pride themselves on making products that are grown responsibly. This can be reflected in our visits to the olive oil farm and the orange farm. The government involvement in business in Spain has created a value system that isn’t as worried about making the highest possible margin on its products. While American companies have to cut costs to survive, Spanish companies pride themselves on making products that are of higher quality. Our visits to the brewery, olive oil farm, and the orange farm highlighted this practice. While beer is not a healthy food, the business approach of the general manager we spoke with, emphasized the importance of quality. They know that their beer isn’t going to be as profitable as other large corporations, but they pride themselves on making a beer that uses higher quality ingredients and tastes better. This is an example of how Spanish culture aligns itself more with making better products, rather than a quick buck. Next, at the olive oil farm, we learned about how much they value quality. They ensure that all of their trees remain organic to ensure a high-quality product. Olive oil is a healthy fat and is used a lot in Spanish food. The representative who spoke with us showed great pride in creating a product that was healthy for human consumption. We learned about how to test olive oil and know the difference between virgin, extra virgin, and the best olive oils. We tasted the oils and could see differences in the smell, bitterness, and aroma of the grocery store oils and their homegrown oils. This was another example of a business that could be using pesticides, GMOs, and herbicides to create more products at a cheaper price, but rather the Spanish company prides itself on making an oil that they would want their kids to eat. We learned that Spain is the largest producer of olive oil in the world, even bigger than Italy. Olive Oil was used in many dishes that I ate in Spain and the prevalence of this fat in the restaurants is another example of how the Spanish culture prefers quality over profit. While using seed oils such as peanut, soybean, canola, sunflower, or other cheap oils, would make their margins much stronger, many of the restaurants we ate at used high-quality olive oil in their foods. The oil made the food taste amazing and much healthier for human consumption. The third company we visited was the orange company. This was another company that prided its work on using safe, organic practices to create products that are of the highest quality. The man we spoke with showed us their cleaning room. They don’t even use water on their oranges to clean them due to the levels of fluoride and chlorine in water. They also used creative techniques to combat a pest issue on their oranges. They added minerals to their irrigation system to help get rid of the pest. While a pesticide would likely be easier, cheaper, and more effective, the company ensures the fruits they make are healthy for consumption. These are three great examples of how the cultural values of Spain result in food businesses creating products that are better for humans to consume. These food companies put their customers first, rather than using practices that would make them more money, at the expense of the customer.

Furthermore, the next fundamental difference that helps to explain this paradox is walking. According to Google, Americans walk an average of 4,774 steps per day while Spaniards walk an average of 9,530 steps per day. Walking is one of the strongest indicators of longevity. Walking is generally considered one of the most important things someone can do for their body. According to the NIH, “In conclusion, the evidence overwhelmingly supports walking as a powerful anti-aging intervention that can reduce the risk of chronic age-related diseases…” 

It is entrenched in Spanish culture to walk places. Whether it is strolling to dinner, the store, or just going for a walk, this means of getting around is prevalent in Spain.  While we were in Spain, I saw so many people out on the streets walking.Obviously in Madrid, given how large of a city it is, walking may be more practical than driving places.  However,  Thursday night in Sevilla, on our way to the Flamenco show and while we were sitting outside at dinner, the sheer volume of walkers was insane to me. The streets were packed with people, and it was just a typical Thursday night. You would never see something like this in the United States. In the U.S. people are always in such a hurry. I can attest to this as well from personal experience. I feel like I never have time to walk to get food or walk to the grocery store. While these walks would be less than thirty minutes, my schedule doesn’t allow me to do it. I have classes to attend, homework to do, lifts to be at, practice, and all of my other responsibilities. This type of lifestyle is well-established in the American cultural system. Everything is transactional, I am doing an activity because it is part of my day. Days are hectic, stressful, and fast-paced. Conversely, I saw the opposite in Spain. On weekdays, people walk the streets at a leisurely pace, stopping and talking with others. They live life at a much slower pace. An example of this was when I was at lunch across from our hotel in Sevilla. Some man was just walking his dog in the middle of the day and stopped next to the tapas restaurant where we were eating. He paused, looked inside for a moment, and then appeared to just decide to order a beer on a whim. No plan in place, just letting the day take him where it did. Little gestures like these show the real freedom many Spaniards have in their lives to do what they want instead of what they have to do, and this is a reflection of their cultural value discussed above. 

Another distinguishing difference that I believe affects the health of a population is relationships. Relationships keep people young, they give them something to live for. There have been studies that show how relationships truly have positive benefits for health. According to the CDC, social relationships have been shown to prolong life and increase health and well-being. Relationships get older people out of the house, keep them moving, and contribute to their feeling young. One of the coolest things I saw was at dinner Thursday night in Sevilla. At the table next to us, there were four ladies who all appeared to be in their 80’s. They were out to dinner, drinking their wine and having an amazing time. They were screaming hysterically, crying with laughter and just enjoying their time together. Conversely in America, I never see older groups of friends out and about. It’s usually just old couples sitting at tables in silence, or speaking in a shallow voice. My grandparents are a good example of this. My paternal grandparents have started to get a little more active, going on walks, and meeting up with friends occasionally, but it is not their norm. My maternal grandparents are mostly homebound unless they have a doctor’s appointment. They rarely socialize with anyone besides the family. Both sets of my grandparents have chosen to spend their senior years at home, reading the news and watching television. It seems to be rooted in American culture that when you get older, you stop being active and seek comfort. I saw countless other examples of the importance of relationships in Spain. We learned in our meeting with the diplomat that Spanish people are very relationship-driven. Nothing is transactional with them, people go out to dinner to spend time building relationships. Many business deals and negotiations require a prior personal relationship to be present for it to be successful. They spend long periods of time together out to lunch or dinner. I experienced this firsthand, while every dinner we had was at least two hours long. They serve bread, drinks, food, dessert, and coffee at a leisurely pace. This allows for more time spent with other people and developing connections. In America, people live to work their entire lives, and by the time they are done working, they don’t truly know how to relax, get out of the house, and enjoy the company of other people. However, the Spanish in general seem to be social butterflies for the entirety of their lives. They work to live, going to the club, going to the bar, going out to dinner with friends. The significance of strong relationships are very important for not just emotional health and happiness, but physical as well. Human biologist Gary Brecka always says that aging is the pursuit of comfort. When people stop getting out of their comfort zone, going out, and being around other people, aging begins to occur. 

My experience in Spain was surreal. I truly got to experience Spanish culture and learn about their lifestyles. The experience really opened my eyes to a different way to live life. I never thought about it until now, but I have realized that I have grown up in a bubble. I have learned one way of life, the fast-paced, prestige-based value system of the United States. I never knew that people could live in such a different way. I have always judged myself by how successful I am, in school, sports, and work. I viewed these things as the only things that truly mattered to show self-worth.  In Spain, it is not the same, people aren’t solely judged on how successful they are. Their self-worth comes from relationships and spending time with the people they love. 

Competition is needed to stimulate innovation. Without it, the world will cease to improve. Achievement is absolutely necessary for the betterment of society. While both the Spanish and American value systems have their own drawbacks, I think this experience has shown me the importance of finding a more well-rounded lifestyle. A better balance is definitely necessary as shown through the state of  America’s health. More balance can improve the lives of many Americans with a cleaner food supply, more exercise, and more time spent building relationships. In my short time in Spain, I noticed the lifestyle, the long dinners, and the social gatherings of the culture started to help me develop relationships with others. At Michigan State, I have never really had the opportunity to get to know classmates or teachers, but rather most of my friends came from baseball. The shared meals and experiencing the Spanish way of life helped me develop strong relationships with Jorge and the members of our group that will last. This is just a week-long example of what incorporating some of these aspects into my life can do for my future. I will try to find more balance and more time to spend freely with others. This experience has shown me that the way I grew up isn’t the only way to live a life.  Incorporating some of these Spanish values into my day-to-day activities can help me live a more fulfilling life.  

References 

Centers for Disease Control and Prevention. (2024, February 29). Chronic disease 

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says, A., says, G., says, O. C., & says, D. B. (2017, October 13). Home. Stephan J Guyenet PhD. https://www.stephanguyenet.com/obesity-prevalence-continues-to-increase-in-the-us/ 

Homepage. World Obesity Federation. (2025, March 3). 

https://www.worldobesity.org/

 

Life expectancy of the World Population. Worldometer. (n.d.). 

https://www.worldometers.info/demographics/life-expectancy/ 

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Ungvari, Z., Fazekas-Pongor, V., Csiszar, A., & Kunutsor, S. K. (2023, December). 

The multifaceted benefits of walking for healthy aging: From blue zones to molecular mechanisms. GeroScience. https://pmc.ncbi.nlm.nih.gov/articles/pmc10643563/