Above: Third from left Prof. Richard Horton and in front of him Prof. Mark A. Clarfield (Credit: Pyotr Pliter)
Israel’s health system ensures that a basket
of health services is provided for its 8.68 million citizens, mostly free at
point of service, which has led to strong progress in the health of the Israeli
population, improving life expectancy and reducing infant mortality.
remain – for example, in addressing the health needs of an ageing society and
for women and children’s health. Important health inequalities between Israeli
Arabs and Israeli Jews and across different regions of the country also persist
and must be addressed, according to a
new Series in The
examining health in Israel, which began its official launch at
a special event in Tel Aviv on Monday.
Additionally, the Series
points to important examples of health care and scientific research crossing
political and religious divides, offering opportunities for collaboration in a
region of deep conflict.
Dr Richard Horton,
Editor in Chief of The Lancet,
says: “This Series was conceived in the aftermath of a tragic conflict in 2014
between Israel and Gaza, and following publication of a letter that divided
world medical opinion about that conflict. Through the generous and courageous
outreach of the authors of this Series, we have sought to show that medicine
and science can be a bridge to a better understanding of complex and seemingly
intractable geopolitical challenges. Our future commitment is to work
intensively with both our Palestinian and Israeli colleagues to provide the
foundations in one aspect of society for peace and justice.” (Background information)
The Series is part of
The Lancet’s programme of country analyses investigating progress towards
universal health coverage, and explores the unique aspects of health and health
care delivery in Israel. The papers, authored by academics and policy makers in
Israel, offer constructive recommendations for strengthening the country’s
health care system, improving health, and addressing health inequalities in
The Series was led by
BGU’s Prof. A. Mark Clarfield (the Series’ guest
editor), Israel National Institute for Health Policy and Services Research’s
Prof. Orly Manor and Rambam Health Care Campus’s Prof. Zaher Azzam and will be
launched at consecutive events in Tel-Aviv, Haifa, Nazareth, Beer Sheva, and
Jerusalem during 8-10 May, 2017.
Healthcare in Israel
Overall, life expectancy
has increased substantially and now stands at 80 years for men and 84 years for
women (compared with 75.3 and 79.1 years, respectively, in 1993). Over the same
period, infant mortality halved from 7.5 per 1000 live births to 3 per 1000.
Universal health care
insurance – via a landmark National Health Insurance Law - was enacted for all
Israeli citizens in 1995, ensuring access to a range of core health services.
Reviewed on an annual basis, these services initially included a more limited
repertoire of medications, procedures, and tests. But in the past decade, they
have expanded to include quality of life and preventive services.
spending on health has increased from 5% of GDP in 1960 to 7.6% in the 2000s,
the level of spending has remained relatively constant for the past 20 years.
The percentage of funding from public sources has slowly declined from 70% in
1995 to 60% today, with a parallel increase in household expenditure on health.
Professor A. Mark Clarfield,
director of the Medical School for International Health at Ben-Gurion
University of the Negev, Beer Sheva, Israel, says: “Israel has made strong
progress on health, but challenges remain. The slow, but increasing
privatisation of services, and stagnating national expenditure on health must
be addressed so as to ensure the country is able to continue providing good
quality health care for its citizens. Given that health care delivery and
representation in the health professions represent areas of the greatest
equality among population sectors in Israel, residual troublesome disparities
in health outcomes among population and regional groups reflect inequalities in
the socioeconomic underpinnings of health and well-being.”
consists of many groups – 74.8% Israeli Jews and 20.8% Israeli Arabs (including
Muslim, Druze, and Christian populations). Although there has been progress on
health, inequalities persist, often as a result of underlying socioeconomic differences.
For example, life expectancy is consistently higher among Israeli Jews compared
with Israeli Arabs (80.3 vs 78 for men and 84.1 vs 80.9 for women).
Smoking prevalence is
twice as high among Israeli Arab men (43.9%) compared with Israeli Jewish men
(22.1%), and lung cancer is much more common among Israeli Arabs, despite most
other cancers being similarly common across both groups. Rates of diabetes and
heart disease are also more common among Israeli Arabs. Disparities exist in
terms of healthcare too. For example, Israeli Arab women are more likely to be
diagnosed at a more advanced stage of breast cancer, and less likely to take
part in screening programmes.
Although progress has
been made on reducing infant mortality (now at 3.1 deaths per 1000 live
births), it remains twice as high among Israeli Arabs compared with Israeli
Jews. Bedouin-Arabs have the highest rates of infant mortality at 11.3 per 1000
live births, which has decreased from 16 per 1000 in 2004. Additionally, about
a third of children in Israel live in poverty, and rates are especially high
among ultra-Orthodox Jewish communities (67%) and Arab communities (63%),
compared with all other Israeli communities (15%).
Israel is a relatively
young country, but the proportion of people over 65 is predicted to rise from
11.1% in 2015 to 14.6% by 2035, putting pressure on health and social care. A
unique aspect of Israeli society is the high proportion of immigrants,
including from the former Soviet Union and Holocaust survivors who made up a
third of the population aged 70 years and older in 2013.
Dr. Khitam Muhsen, Tel
Aviv University, Israel, says: “Overall, health in Israel has improved steadily
over recent decades but disparities persist. Life expectancy has remained lower
for Israeli Arabs compared to Israeli Jews and this gap has recently widened.
Mortality from heart disease, stroke and diabetes remain higher for Israeli
Arabs, as does smoking and obesity. All government ministries should make
addressing health disparities between rich and poor and Israeli Arabs and
Israeli Jews a priority.”
improving health care in Israel
The authors make several
recommendations to improve health in Israel, including:
•Increasing spending in
the health sector from the current 7.8% of GDP to 9%, consistent with the OECD
funding for national health programmes aimed at reducing smoking, lowering
sugar and salt content, and encouraging physical activity, especially among
•Halting the shift from
public to private care, and ensuring the Ministry of Health focuses on
long-term planning and funding for health care services, and divests itself
from providing direct services or operating hospitals.
•Increasing funding for
home and community services to support an ageing population, including support
for informal care-givers, as well as increased funding for acute hospital beds.
leave from 14 weeks to 6 months, providing contraception under health insurance
plans, and introducing a formal government office or department in the Ministry
of Health focusing on gender and health.
through the creation of an Institute of Health Research, under the auspices of
the Israel Science Foundation, similar to the National Institutes of Health in
the United States or the Medical Research Council in the United Kingdom.
Collaboration in a
region of conflict
Finally, the Series
points to examples of collaboration in the fields of science and health care
across historical, demographic, ethnic, political and economic divides. While
diplomatic relationships are either non-existent or limited between Israel and
its neighbouring countries, shared public health issues such as disease,
pathogens or water sources require collaboration between Israel and its
neighbours, most especially the Palestinian population. For instance, regional
collaboration between Israeli, Jordanian, and Palestinian veterinary and public
health services helped contain the outbreak of influenza A H5N1.
accompanying paper details the medical effort in treating over 2,000 Syrian
patients who have made their way over the border and been treated in hospitals
in Israel, despite the countries being in a state of war.
Prof. Karl Skorecki,
Rambam Health Care Campus, Haifa, adds: “This Series shows that there is an
enormous opportunity to leverage the universally accepted principles of health
as a sanctuary against conflict and inequity, to achieve a brighter future for
a deeply troubled region of the world. It is especially in those areas of
greatest challenge where Israel has shown innovative leadership, that greater
mutual engagement in global health forums is most urgently needed.”