Israel
- Public Health in Israel
Increasing life expectancy
Israel has been a pioneer in the contemporary concept and practice of
Public Health and as a result has one of the world’s healthiest
populations. The country's success in pursuing effective Public Health
policies is reflected in the fact that a nation of immigrants, who have
arrived during the past 54 years principally from North Africa, the
former Soviet Union and Central Europe, has one of the highest average
life expectancies in the world.
This has been accomplished despite the fact that Israel has absorbed
Holocaust survivors and a large proportion of immigrants suffering from
tuberculosis, malnutrition, heart disease and every type of cancer. At
present, 25% of all cancer patients in Israel are newcomers from the
former Soviet Union including tens of thousands from parts of the
Ukraine and Belorussia who were exposed to radiation from the Chernobyl
nuclear plant melt-down in 1987.
According to the Ministry of Health yearbook for 2001, the life
expectancy for males (76.6) years) was topped only in Japan. Israeli
women live longer than men, but do not fare as well in international
statistical comparisons
What is public health?
Whereas medicine treats the health needs of an individual, public health
(a discipline also known as public medicine or social medicine) deals
with the health requirements of society as a whole. In fact, public
health was a more popular concept in the 19th century when physicians
realized that matters such as sewage amenities, cleanliness and a
balanced diet would improve the health of the population . But as
sanitary and dietary conditions improved and with such medical.
discoveries as penicillin in the 20th century, much less emphaisis was
placed on public health.
International community acknowledges importance of public health
Public health returned to the global agenda in 1975 at the WHO meeting
in Alma Ata, Kazakhstan, in the former Soviet Union. Leading health
officials from every country in the world signed a covenant proclaiming
that the health of the people and the provision of medical services must
be the responsibility of national governments. Only the United States
refused to sign the covenant, insisting that individuals rather than
their governments must be responsible for the provision of health
services for themselves and their families.
Of course most nations simply do not have the necessary resources to
offer their citizens adequate health services. Even in developed and
relatively affluent countries like Israel, the essential challenge
facing public health policy is effective distribution of limited
resources.
Israel emphasizes public health
The Zionist Movement in pre-state Israel, which combined the traditional
Jewish concern for all people with an emphasis on societal needs,
regarded public health as a top social, political and economic priority.
By the time Israel declared its independence in 1948, a national health
infrastructure was already in place. Mother-and-child care centers (Tipot
Halav) administered the necessary vaccinations to new-born babies and
advised parents on proper care of infants. Health insurance funds (Kupot
Holim) offered day-to-day consultations with doctors and specialists,
and insured members for hospitalization.
The National Health Insurance Law
Despite Israel's commitment to providing health services for all of its
citizens, by the early 90's some six percent of Israelis were not
insured through one of the four existing health funds - Kupat Holim
Clalit, Maccabi, Me'uhedet and Le'umit. In 1994, the National Health
Insurance Law was enacted and it was implemented the following year,
rectifying this situation. Since then, all citizens have their health
insurance paid by a tax on income (up to 4.8%) while their employer's
portion is collected by the National Insurance Institute, and passed on
to the health insurance fund of the individual's choice.
National expenditure
Israel's national expenditure on health is typical for a western
country. In 1999, the country spent 8.3% of its Gross Domestic Product
(GDP) on health, down from a peak of 8.8% in 1994; the United States
spent13.6% of its GDP on health care, Canada 9.5%, Japan 6.9% and the UK
7.6%. Of the Israeli expenditure, 41% was for hospitals and research,
39% for public clinics and preventive medicine and 9% for dental care.
Israel spent $1,555 per capita on medicine.
Public health as an academic discipline
The discipline of Public Health is responsible for promoting the health
of the population - by planned prevention of disease, by early diagnosis
of ill health and by provision of accessible health care for those in
need. This population orientation brings with it the requirement to
define health priorities and allocation of the appropriate, though
usually scarce, resources.
The academic study of the discipline of public health was spearheaded by
the Hebrew University-Hadassah Braun School of Public and Community
Medicine and its predecessor departments. The major framework is the
Master of Public Health (MPH) Course, which provides academic training
for public health practitioners and researchers. The School has
developed two MPH programs: one for Israeli students, whose graduates
form the cadre of public health professionals in the country; the second
is a unique international MPH program, which, since 1971, has graduated
over 600 students from 80 countries. They have become the mainstay of
health care systems in many parts of the developing world.
A central feature of the training program is planning health care for
the community, based on the assessed needs for primary health care
services. Known as Community Oriented Primary Care (COPC), its concepts
and practice have been taken to the corners of the world by the School's
faculty and graduates. It embodies a planned link between the clinical
responsibility for the individual patient with the public health
responsibility for the whole population.
Successes in Israel
University research results are put into practice by the public health
system, while the Israel Council for Public Health runs campaigns to
raise public awareness of relevant issues. In addition to increasing
longevity and reducing infant mortality, Israel has completely
eradicated a range of diseases, such as malaria, polio and diphtheria,
which had plagued the country in its formative years. Other diseases
such as tuberculosis have been virtually eliminated but sporadically
reappear, brought in by waves of new immigrants.
Successful educational campaigns have greatly reduced the level of
smoking and the incidence of skin cancer caused by the sun's rays.
Israel has the lowest percentage of new HIV positive victims in the
western world with just a few hundred new cases each year. This is
largely attributed to comprehensive sex education programs offered in
the country's high schools. Annual traffic accident fatalities have been
reduced from 750 in 1974 to 476 in 1999, despite the fact that there are
four times as many vehicles on the roads. As in most western countries,
heart disease and cancer are the biggest killers.
The country has also made significant strides in combating nutritional
deficiencies. Nowadays the diet of Israelis favors vitamin-rich fresh
fruit and vegetables. In the early years of the State, even the
country's agricultural infrastructure was, in part, planned in
conjunction with the Ministry of Health's nutritional recommendations.
Benefiting the developing world
In the late 1950's, Israel, a small and still developing country, made
it a policy to share its developmental experience, including the field
of public health, with other developing nations in Asia, Africa and
Latin America. In many areas, such as mother and child health, the
reduction of infant mortality, the prevention and reduction of
communicable diseases and the eradication of endemic diseases like
malaria, Israel shared its achievements and solutions with newly
developing countries.
MASHAV - The Center for International Cooperation
Israel's main conduit for sharing its public health successes and
experiences with health care workers around the world is MASHAV - the
Center for International Cooperation of the Ministry of Foreign Affairs.
Professionals from every continent, especially the developing world,
receive training from MASHAV to enable them to deal more effectively
with public health problems in their own countries.
Israel and the PA have been working together in Public Health since the
signing of the Declaration of Principles in 1993. Jordan, too, has
bilateral ties with Israel in this field, and a proposal for a
Multilateral Regional Program on Medicine and Public Health, which has
been on hold because of the security situation, is expected to be
renewed.
Good public health decision-making is imperative if nations are to use
the full potential of their medical resources. The International Masters
of Public Health Program (MPH) of the Hebrew University-Hadassah Braun
School of Public and Community Medicine, under the auspices of MASHAV,
is now being held for the 27th time, and has played a key role in
helping medical professionals in the developing world to tackle the
enormous problems facing their countries.
Moreover, students who have graduated from MPH have made significant
contributions in many countries and have had an enormous impact
worldwide. Many graduates have become senior administrators and in
several cases even Ministers of Health in their countries and have
played a pivotal role in formulating public health policies.
At the same time, MASHAV runs shorter public health courses for an
average of 250 professionals each year and teaches on-the-spot public
health courses in 12 countries.
Advising From Experience
Israeli experts in a wide variety of fields are able to share their
professional knowledge and experience through short-term consultancies.
Examples include: a delegation to the island of Zanzibar off the eastern
coast of Africa which was able to draw from Israel's experience of
draining the Hula swamp (formerly infested with malaria-carrying
mosquitoes); and experts who set up community health services for nomads
in Eritrea, replicating the type of services designed for the Bedouin in
Israel's Negev desert.
Contemporary trends
Israeli experts have identified two contemporary trends, which
substantially affect public health. The first trend is the aging of the
population and the second is the steeply rising cost of equipment now
available to health services.
The Aging of the Population
This phenomenon is placing much strain on health services worldwide. In
Israel people aged 65 and over represent 10%, while those aged 75 and
over represent 4.3% of the country's population (compared to 8.8% and
3.5% respectively a decade ago). By the year 2003, Health Ministry
officials forecast that the proportion of Israelis over 65 will rise to
11% and those over 75 will reach 4.5%.
Still, Israel is a young country by western standards. Children up to
the age of 14 comprise 29% of the total population. Despite the aging of
the population in Israel, the dependency ratio (which compares the
proportion of children under age 14 and senior citizens over 65 to the
population as a whole), has decreased from 70% to 64% over the past
decade, due to falling birth rates. However, the percentage of senior
citizens could rise to over 25% in the first half of the coming century,
both in Israel and in other western countries.
Israeli researchers have noted that the dependency ratio in the
developing world is increasing due to decreased infant mortality (but
not falling birth rates) and increased longevity. At the same time, to
some extent communities in developing nations, where the extended family
remains intact, are better suited to cope with aging because the elderly
are cared for by the family. In developed countries, where the extended
family and community structure have often disappeared, health services
must cope with fundamental welfare problems such as loneliness, as well
as the illnesses associated with old age.
In Israel, public health efforts in geriatrics encompass both the
sociological aspects - attempting to preserve extended family and
community structures - as well as the need to combat geriatric-related
illnesses such as Alzheimer's and senile dementia.
The Cost of Medical Technology
The introduction of increasingly expensive equipment for diagnosis and
treatment as well as costly innovative medications, poses one of the
greatest challenges to public health policy. Doctors and health
officials are finding that they must now choose between life and death
for population groups suffering from various diseases. The economics of
health care are further complicated by the fact that research and
development of such equipment and medication are inordinately expensive.
Thus health care professionals must choose between allocating funds for
short term medical needs, or for investing in R&D for long term
benefits.
Public health research and policy can help optimize ways to lengthen
life and alleviate suffering. Israel is pioneering a reduction in
hospital beds as a result of research showing that patients recover more
quickly when treated as out-patients. New surgical techniques such as
laparoscopy have also helped shorten hospital stays. The hospitalization
rate has fallen 24%, from 1,037 days annually per thousand people in
1975 to 785 days, and the average stay over that period has been halved
(from 8.7 days to 4.3 days
In the new millennium
At the beginning of the new millennium, Israel's public health policy
confidently faces the many challenges that lie ahead including
improvement of the quality of life for an aging population as medical
expenses seem to increase on a par with medical advances.
From:
http://www.jewishvirtuallibrary.org/jsource/Health/public.html
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