Israeli Public Health Project Takes Aim at Diabetes

Arabs, Haredim more likely to get disease; founder of Finnish program on which Israel's version is modeled speaks with Health Ministry officials on visit to the country.

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An ad campaign encouraging Ashdod residents to drink water is part of a nationwide public health project that, according to the founder of the Finnish program on which the Israeli one is modeled, is potentially capable of reducing obesity rates among the segment of society most affected by resulting diseases such as diabetes: the poor.

Like other chronic illnesses, diabetes is more common among people from lower socioeconomic classes, said Jaakko Tuomilehto, the University of Helsinki professor of public health who created a successful national plan to battle diabetes in Finland. But, he said, the data prove that obesity rates can be lowered in all classes of society.

Tuomilehto spoke to Israeli Health Ministry officials about the program during a visit to the country late last year for a convention held by the Israel Forum for a Healthy Lifestyle, which is running the anti-diabetes program in this country.

Though the differential rate of disease may be primarily an economic issue in Finland, in Israel there is an ethnic dimension to varying diabetes rates. The Forum for a Healthy Lifestyle has found that 16 percent of Israeli Arabs and ultra-Orthodox Jews get diabetes, 4 percentage points higher than among Israeli adults in general over age 35.

Compared to Finland, Israel has a more heterogeneous population," the Finnish expert said, adding that cultural adjustments are needed in order to guarantee the project's success."

The Israeli program is due to be expanded to Bnei Brak and Nazareth (as well as Eilat)next year, in an effort to lower the diabetes rate among the ultra-Orthodox and Arab populations found in those cities.

"There are gaps within Israeli society regarding the treatment of diabetes," said Dr. Itamar Raz, who heads the diabetes unit at Jerusalem's Hadassah University Hospital, Ein Karem, as well as the healthy lifestyle forum and the National Diabetes Council. "I believe that the quality of treatment in the Arab community is lower than among the Jewish population. The same can be said about southern Israel. Despite the existence of better hospitals, is seems the population has less access to the diabetes clinics, since we can see that fewer people are seeking treatment for diabetes-related foot problems."

The Israeli plan is based on close cooperation with mayors and heads of local councils.

"We reached the conclusion that national programs fail," said Raz. "In

Western countries such as the U.S. and Britain, huge sums were invested in national prevention programs, but, ultimately, they all failed. Apart from government initiatives, we decided to begin from below, from the grass roots, implementing small steps on the ground."

In Israel, the Ashdod program includes a weekly family sports day with the mayor of the southern city, Yehiel Lasri, as well as regulations mandating that city institutions serve only healthy snacks and a plan to build 60 water fountains throughout the city.

The Israeli plan includes three main strategies: improving diet and increasing physical activity;identifying patients at risk and instituting preventive steps; and treating patients diagnosed with diabetes.

"I believe that we will start seeing results within five years," said Raz.

In Finland, the program entails improving nutrition at workplace cafeterias, including an increase in low-sodium and high-protein foods; building more public sports centers and increasing health education.

Israel isn't the first country to adopt some of Tuomilehto's principles.  Variations of the model have been used in several countries, including the United States, Britain, Sweden and Japan.

Diabetes is increasingly spreading in the West, with a 2004 study predicting that more than half of Europe's population would be afflicted with adult-onset, or type 2, diabetes.

The forecasts for Israel aren't optimistic: 51 percent of the population is overweight, there are presently 600,000 diabetes patients, and by 2030 some 2 million Israelis are expected to suffer from the disease. Every third child is expected to develop symptoms by the age of 40, unless medical policies change radically.

A report of the Israel National Institute for Health Policy Research, based on data from all four health maintenance organizations, concluded that 355,326 patients – nearly 5 percent of the population – received diabetes medication in 2010, with the rate rising steadily, by 0.25 percent annually.

In Finland, Tuomilehto achieved worldwide acclaim after conceiving and implementing his plan to deal with diabetes. A decade ago there were some 200,000 diagnosed diabetes patients there, and it was estimated that 50,000 more were suffering from the disease but had not been diagnosed.

After data showed that 23 percent of the population was suffering from extreme obesity, the Finnish government called on Tuomilehto, and his efforts led to a steady drop in the number of diabetes patients.

Finland is not among the Western states that has taxed unhealthy food in recent years, a policy now being examined in Israel as well.

Speaking to Haaretz, Tuomilehto said Finland, whose population is about the same size as that of Israel, had no choice but to fight the disease.

He and his colleagues identified the rise in the number of patients, and decided to try to prevent it, he said.

The first step was to promote a healthy diet, a move that Tuomilehto says prevented a staggering 58 percent of diabetes cases within two years. Further research carried out in the United States showed similar results.

Tuomilehto's project managed not just to halt obesity in Finland but also to decrease it. When he started off, there was a 25 percent rate of obesity, which dropped toward the 20 percent mark, he said.

One of the ways Tuomilehto identifies people at risk is through a questionnaire consisting of eight questions to determine basic parameters such as age, weight, waist size, personal and family history of diabetes, blood pressure, eating habits and physical activity.

Israelis are often skeptical about efforts to promote a healthier lifestyle, but Tuomilehto says that in Finland, too, it took a lot of persuading to get people to heed the recommendations promoted by the project.

Many individuals reacted positively to the recommendations, but some of them simply didn't have the time to implement them, he said, adding that while the program can offer the information, it is helpless when it comes to finding time for people to engage in physical activity.

Another problem, in Finland as in many other Western countries, is the junk food habit. Tuomilehto said his program contacted the food industry and called on manufacturers to enrich food with dietary fibers, while decreasing salt and fat.

There is one factor that might count in Israel's favor: the relatively warm climate.

The climate in Finland encourages diabetes, since it's cold outside for many months, said Tuomilehto, making eating more appealing than exercising.

Surgery in an Israeli hospital (illustrative photo).Credit: Kobi Kalmanovitz

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