In the early 1960s, the gap between Spain and Portugal in terms of life expectancy at birth was very large (6.5 years in favour of Spanish women and 7.2 years in favour of Spanish men). Excess mortality in Portugal was due mainly to high death rates among babies, children and adolescents. Today, the gap is much narrower, although Portuguese life expectancy (81.3 years for females and 74.9 years for males in 2005) is still around two years lower than in Spain, which ranks among European leaders. In this article, Vladimir CANUDAS-ROMO and his colleagues analyse this change by examining the impact of mortality by age and by major cause of death on the life expectancy differential between the two countries over the last fifty years. They pinpoint the areas upon which health policies should focus in order to close the gap between Portugal and its neighbour.
The second half of the twentieth century marked a clear change in mortality patterns across Europe. The trends in mortality in Northern and Southern Europe began to converge after the 1970s (Monnier and Rychtarikova, 1991), partially due a decline in deaths from external causes and cardiovascular diseases which in most industrialized countries made it possible for life expectancy to continue increasing (Meslé and Vallin, 2002).
A comparative analysis of trends in Spain versus Portugal is important because while these countries are contiguous, they exhibit a large gap in life expectancy. In 2005, life expectancy at birth (e^sub 0^) for Spanish females was among the highest in Western Europe (83.5 years), whereas e^sub 0^ for Portuguese males it was among the lowest (74.9 years) (Human Mortality Database, 2007). These two countries thus represent the two extremes in mortality within Western Europe (United Nations, 2006). This differential is the largest observed between contiguous countries in the whole of Western Europe and calls for research to help explain it. A detailed comparison of mortality trends in these two countries that share the Iberian Peninsula may provide clues for understanding the convergences and divergences in mortality between European countries.
During the past decades, both countries have undergone a profound and similar process of modernization. Spain and Portugal both overthrew a dictatorial regime in the mid-1970s, both entered the EU in 1986, and both have weak welfare states. Furthermore, both countries experienced substantial immigration during the 1990s (Canudas-Romo et al., 2006, Glei et al., 2006). These economic, political and social transformations have brought radical changes in standards of living, lifestyle and attitudes, particularly for younger generations.
Furthermore, the two countries share common risk factors associated with certain types of mortality. For example, Portugal, followed closely by Spain, has been found to suffer from the highest rates of excess winter mortality in Western Europe (Healy, 2003). Thermal efficiency in housing, as well as income inequality, show a clear association with extreme temperature mortality (Keatinge et al, 2000; Healy, 2003). Regarding lifestyle habits, the diffusion of cigarette smoking began later in Portugal and Spain compared with other Western European countries, particularly for women; these two countries are likely to experience future declines in the female advantage for causes of death related to smoking (Pampel, 2005). Reports of alcohol consumption show similar high levels in the Iberian Peninsula (Ramstedt, 2002). Studies indicate that 65% of the population of southern Europe, including Spain and Portugal, follow a Mediterranean diet compared with 35% in northern Europe; this diet together with other habits and lifestyle factors was associated with lower mortality rates for certain causes (Knoops et al., 2004). Diet, lifestyle habits and standards of living have changed over time, and they have influenced the mortality patterns of the two populations under study. …