49 Million

Spain has reached 49 million inhabitants for the first time as of January 1, 2025, and, as pointed out by the National Institute of Statistics, "the population growth is due to the increase of people born abroad, as those born in Spain decrease." I have found it interesting to take this record from 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 healthcare and also in the immediate future for our National Health System.

I still remember watching when I was young, and many of my generation will too, that current affairs program on TVE (when there were only two channels on television) called "35 Million Spaniards," which would now celebrate its 50th anniversary. Well. We have already reached 49 million inhabitants and at this rate (458,000 more residents just in the last year), we will reach 50 million in just over a year. 

To conduct this analysis on the impact of population increase on healthcare, I will first briefly present some of the objective data provided by the INE in its latest population report (all information can be consulted here). 

First, attention must be paid to the rate of population growth. Spain hosts nearly 3 million more people in the last decade. And since 2022 the increase is around half a million annually. Have healthcare infrastructures, material resources, and the number of professionals increased in proportion to this population increase? Definitely not.

The INE itself points out that the increase in inhabitants is due to the arrival of people born in other countries because in Spain fewer births than deaths have been registered, which gives us another important clue about the largest age groups in today's society and also in what is assumed for the coming years. The population born in Spain has decreased by 800,000 inhabitants in the last decade due to the negative demographic balance (more people die than are born), but the number of residents born abroad has gone from 5.9 to 9.4 million people in ten years. This leads us to another fact, which confirms the aging of the population, the increase in associated chronic diseases, and the new healthcare needs I have referenced in other entries to this blog. And the INE provides a compelling fact: in 2002, the largest group of citizens was between 20 and 40 years old; in 2025 they are between 40 and 60 years old. And in a few years, 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 adjust the educational offer in universities, nor that of Medicine and Nursing specialists (MIR and EIR), nor public positions…

We can't ignore the location of this population increase. Unfortunately, empty Spain remains empty or has little growth, and there are even regions that are slowly losing population. However, in absolute numbers Madrid (749,846), Catalonia (698,660) and Cvalenciana (469,204) lead the most significant population increases accumulated over 10 years. In percentage, due to having a smaller population, Balearic Islands, Murcia, and Canary Islands practically match them by increasing the number of residents by between 7 and 12%. The rhetorical question I previously posed about the increase in resources (material and human) for healthcare now applies to these regions specifically. And the answer is also negative. The problems associated with healthcare, 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 care for in terms of their health and well-being.

Finally, a brief reference to the nationalities that have grown the most in number of residents in Spain: Colombia, Venezuela, and Morocco (in that order). The average age of the immigrant population from abroad was in 2020 (latest INE data) 32 years, that is, a young population that in the coming years will likely have offspring and generate new care needs (let's remember that births in Spain have plummeted in the last 10 years).

In summary. To the problem of population aging, the increase in chronic diseases, an overwhelmed Primary Care, and the endless and intolerable waiting lists, we must now add the factor of the significant population increase that already requires universal and quality healthcare. A need that each passing year generates more problems for an adequate response from the health system, which doesn't react at the speed at which society changes, nor adapts, nor incorporates sufficient resources, infrastructure, or personnel to meet the new needs of resident citizens, regardless of where they were born. Moreover, it seems that the goal of some politicians is to introduce more rigidities to the system, instead of flexibility to adapt to this social reality.

Let's be clear. At this rate of population growth and wanting to maintain the quality standards that Spanish Healthcare has, it will be essential to build new hospitals and primary care centers, introduce technology that supports professionals with artificial intelligence, define new roles in Nursing and Pharmacy … and all this has not been done in the last ten years nor is there 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 collaboration will be more necessary than ever to help public administrations respond to this complex environment in which we are going to move. But I prefer that you draw the conclusions after analyzing the data I have presented.