Jerusalem poverty
An impoverished woman searches for vegetables in Jerusalem garbage. Photo by Olivier Fitoussi
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The gaps in health and health care enjoyed by the rich and the poor are widening, according to a recent study based on data from Israel's four health maintenance organizations.

While diabetes affects 4.7 percent of the entire population and 7.1 percent of Israelis aged 18 and above, it is 4.7 times more prevalent among those who qualify for state assistance in paying health insurance fees. The diabetes incidence in this group is 16.07 percent, compared to 3.43 percent among the rest of the population.

For the purposes of the study, "poor" is defined as people who receive a full or partial waiver of health tax payments, and includes 10.1 percent of the population. The report was carried out by the Israel National Institute for Health Policy and Health Services Research.

In 2009, the percentage of Israelis with diabetes whose blood sugar levels were not under control was 12.9, representing 39,514 individuals. Unbalanced blood glucose levels were more prevalent among men (13.4 percent ) than women (12.3 percent ), and among the poor (13.8 percent ) than among those in higher socioeconomic levels (12.3 percent ). Of those whose diabetes was not under control, 53.1 percent were receiving insulin.

The incidence of asthma was also far greater among those with the health tax waiver, affecting 2.36 percent of this population but only 0.93 percent of the rest of the population.

Increasing numbers of Israeli women are having mammograms for early detection of breast cancer. The percentage of women aged 51 to 74 receiving mammograms climbed 7 percent from 2006 to reach 68 percent in 2009, but among poor women the figure was just 64 percent.

In the past five years, 27 percent of Israelis between the ages of 50 and 74 carried out fecal occult blood tests, and an additional 20 percent had a colonoscopy. These tests are carried out for the early detection of colon cancer.

The percentage of Israelis for whom the annual influenza vaccination is recommended and who received the vaccine climbed 5 percent in the past three years. In 2009, 57 percent of all Israelis aged 65 and above were vaccinated. Vaccination rates were higher among those in higher socioeconomic groups (59.5 percent ) than in lower levels (51.8 percent ). Immunization rates rose among asthma sufferers and diabetes sufferers rose 11 and 8 percent, respectively, to reach 40 percent and 55 percent in 2009.

The proportion of babies being tested for blood hemoglobin levels, in an effort to spot anemia, rose by 7 percent in three years, to reach 73.5 percent of all infants aged 9 to 18 months. There was also a dramatic increase in the number of teens aged 14 to 18 whose height and weight was monitored by their HMOs, from just 28 percent in 2007 to 61 percent in 2009.

With regard to cardiovascular disease, the researchers did not find substantive differences in care between difference socioeconomic groups but they did find some interesting gender gaps. For example, despite a general assumption that women spend more on their health than men, female cardiac patients purchased less cholesterol-lowering medication than male cardiac patients. The study found that while 85.8 percent of all men in the 35-74 age group who had undergone a cardiac bypass purchased cholesterol busters in 2009, that figure was just 78.4 percent among women. For patients who underwent cardiac catheterization, the figures were 85.2 percent and 83.2 percent respectively. While 72 percent of all cardiac patients reduced their LDL "bad cholesterol" levels to below 100 mg/dL, as recommended by health specialists, more men reached the target than women, in both the post-bypass and post-catheterization groups.

Female cardiac patients did outdo their male cohorts in one respect: They were more likely to purchase ACE-1 and ARB drugs, which reduce stress on the heart, as well as beta blockers, used to prevent additional damage to heart muscle.

The study was carried out by the faculty of the Braun School of Public Health & Community Medicine Hebrew University - Hadassah, under Prof. Orly Manor. The monitoring project began in 2000, at Ben-Gurion University.

A month ago the Jerusalem District Court gave the Health Ministry until March 31, 2012, to publish a comparative analysis, among the four HMOs, of the data gathered for the report.