The stereotype of large extended families in southern Europe is long gone. The lowest
fertility rates (average number of children per woman) in Europe are now in Spain, Italy, Cyprus and Bosnia (all 1.3 child per woman), followed by Portugal, Malta, Croatia, Greece, Ukraine and Poland (1.4). So extended families don't explain better health or longer life expectancies in Italy and Spain.
As for exercising, WHO data on the
prevalence of insufficient physical activity shows that the least physically active countries in Europe are Germany (40% of adults not getting enough exercice), Portugal (37.5%), then Italy (36%). Spain does well (22%) though. In other words, it's not as big a factor as people would think. Italians can be among the least physically active and still rank on top for health.
I think that the quality of healthcare is far more important for life expectancy, although not necessarily for "feeling healthy". It seems quite difficult to assess the quality of healthcare in a country.
The WHO has attempted to
rank healthcare systems in 2000 and among countries with over 5 million inhabitants the top 5 was France, Italy, Spain, Austria and Japan.
A 2016 study published in The Lancet measured performance on the Healthcare Access and Quality Index for 195 countries. Here is their ranking. Italy 9th, Japan 12th, Spain 19th, France 20th... Not much in common with the WHO ranking.
Numbeo create
their own healthcare ranking based on
numerous factors and this time had Taiwan, South Korea and Japan on top, with France 5th, Spain 6th, but Italy 40th. So who is right?