The public health nurses' struggle against the transfer of school health services to a manpower company can of course be described - as Finance Ministry officials are doing - as a battle over employment conditions. Not that that's so terrible: After all, there seems to be some logic in a person's desire to preserve job security. But in the case of the nurses, who in recent years began working under a private association and are not civil servants in any case - that is not the main thing. At the heart of the attempt to minimize the blow to these services lies a much more important struggle - against the sweeping privatization of the health services.

The case of the schools exposes privatization's failure in preventive medicine in particular, and in the health services in general. Preventive medicine is the mainstay of a developed society. It is not by chance that the OECD countries decided preventive medicine is a condition for growth, and defined it as a threshold requirement for joining the organization. A World Bank paper states, "In places in the world where preventive medicine services have been transferred to competitive bodies, there has been a decline in immunization coverage and an increase in the extent of illnesses requiring immunization."

Nobody in the treasury can claim not to know these things. What is also known is the simple calculation that shows, in black and white, that when hearing or vision problems, eating disorders, depression - or even abuse - of children are not diagnosed in time, these children soon become a heavy burden on the education, health and welfare systems. Even if they drop out of - or are dropped by - all the systems and fall ill or disabled, or turn to crime, they will cost society and the government much more than a nurse's salary or pension.

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But for years the treasury has been waging a stubborn and systemic war of attrition against the health services, a war whose most blatant symptom is the blow to preventive medicine. Every few months a focus of privatization erupts into public awareness. There was the transfer of the well-baby clinics to the health services organizations, thus eliminating - for reasons of economic feasibility - preventive treatment for remote, weak populations: small peripheral communities, the Bedouin, foreign workers without residence permits, et al. There was the plan to privatize the hospitals for the mentally ill, and now there are the school health services.

In all these cases, the direct victims are those who cannot afford the increasingly expensive health services, and worse, anyone who is unable - due to economic or geographic reasons, or simply due to a lack of awareness - to arrange diagnostic tests for himself and his children. Israel is justifiably proud of its hospital system, which in spite of overcrowding and budgetary problems entitles everyone to emergency treatments and complex operations. But these treatments are the last (and most expensive) stage, and should be rendered superfluous by preventive medicine, including diagnoses, inoculations and counseling.

Economically speaking, this is a big mistake. A comparison between Israel, where the health care privatization process is still moving slowly, and the United States, which has fulfilled the dream - reveals the infant mortality rate there is higher than here, and life expectancy is lower, despite the fact that the U.S. government spends far more on health care per person than the Israeli government. In every other respect - social, humanitarian, civil-democratic - this is a matter of dangerous neglect.

The percentage of children per capita in Israel is the highest in the western world. (38 percent of the population is 18 and under). Since 1997 the number of students in Israel has grown by 33 percent, whereas the budget for school health services (which in 1997 was transferred from the Education Ministry to the Health Ministry, by dint of a government health law) has declined steadily. Public health nurses visit not only the state schools but also churches and mosques where children study. The treasury, which is pleased about erasing expenditure items, may not be interested in who replaces them. They should know: In every Arab community where the state avoids its civic duties, it is replaced by charities of the Islamic Movement, which distances its members from the state and leads them to political radicalism.

The Arab periphery is only the most extreme example of the folly. A society where only the children of the rich receive inoculations and diagnostic tests, whose public health nurses - once the clear symbol of the system's responsible, professional and human touch - speedily leaf through the files of thousands of children at record pace, while being tyrannized and exploited by manpower companies (see: security and caregiving firms) - is a society conducting its expenditure accounts blindly and obtusely, because it has apparently given up on tomorrow.