Unacceptable Differences in Mortality Rates

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The infant mortality rate per 1,000 births in south Tel Aviv-Jaffa is three times higher than in north and central Tel Aviv. The data was collected over three years, 2000-2002, for a research project in the Tel Aviv District Health Office, which for the first time examined the connection between the mortality rate for infants and their socioeconomic status.

According to preliminary data, there's no connection between the mortality rate and ethnic origin (the research study did not cover foreign workers and the few Arab babies in Jaffa), nor to the differences in attitudes between secular and Haredim toward abortions (there was no gap in the data between north and south Tel Aviv regarding congenital defects), nor to differing levels of medical care at the various hospitals in the Tel Aviv area.

The research does not point to the reasons for the differences in mortality rates (those differences will be examined in the project's later stages), but the researchers assume they result from the effects of poverty on mortality and illness, the different levels of exposure to risk by a fetus as a result of the mother's lifestyle (smoking, diet), and the accessibility of treatment and checkups by doctors.

Dr. Svetlana Mariash's comments to the local weekly Tel Aviv on Friday were also indicative of the damaging effects on medical care resulting from the worsening poverty in the country. Mariash, who runs a Clalit HMO clinic in Jaffa's Dalet neighborhoods, says she see many cases of patients who forgo checkups and vital medicine because of lack of funds, parents who don't have their babies vaccinated, and those who cannot afford to pay for necessary medicine for their children.

Among the health system's top officials and its researchers, there is practically no dispute about the connection between the socioeconomic conditions and illness and mortality rates, and the connection between the widening economic gaps and the quality and availability of medical treatment.

In that context, it should be noted that there has been a large increase in private spending on health by residents of the country (including participation in payments for medical treatments) compared to public-government spending (from 26 percent in 1995 to some 32 percent in 2001). The health system has also long known that wealthier populations, as in north Tel Aviv, have more access and financing capabilities for private medicine, and that is most evident in checkups and follow-ups during and after pregnancy.

At a Health Ministry conference this week on public health, senior ministry officials reiterated that the economic, social-welfare and educational systems have no less an effect on the population's health than the influence of the medical system itself.

The worrisome findings of the research study require Health Minister Danny Naveh to order ministry officials to research the health gap among all populations in the country, and to lead urgent, significant steps, in cooperation with the HMOs and ministries of finance, education and social affairs, to narrow the terrible gaps in sickness and mortality rates between the poor and rich in Israel.