One of the world’s leading medical journals, the Lancet, has devoted its entire latest issue to the Israeli healthcare system.
The issue, titled “Health in Israel,” was published Monday. It contains 10 English-language articles written by Israeli doctors and researchers, plus summaries of them in both Hebrew and Arabic.
Prof. Richard Horton, the journal’s editor in chief, termed the edition the most comprehensive independent survey of Israel’s health system ever published anywhere. He was speaking in Tel Aviv at the annual conference of the Israel National Institute for Health Policy Research.
The idea for issue emerged under inauspicious circumstances. In July 2014, at the height of that summer’s war between Hamas and Israel in the Gaza Strip, the Lancet published an “Open Letter to the People of Gaza,” signed by doctors from several countries. In this letter, they accused Israel of committing massacres and war crimes in Gaza and then lying to justify its conduct.
The letter ignited a storm of protest, both from Israel’s medical community and overseas, and Horton came under heavy fire. As he said on Monday, he was accused of anti-Semitism, his picture was posted together with that of Nazis in uniform, his wife was verbally attacked and his daughter was told by classmates that her father was an anti-Semite. It was, he said, a very difficult time both personally and professionally.
As this storm was raging Prof. Rafael Beyar ,CEO and Director General at Rambam Medical Center in Haifa, invited Horton to come to Israel and see for himself. And in August 2014, Horton duly arrived on his first ever visit to Israel. Until then, he said, he had only passed through on his way to the Palestinian Authority. But the visit changed his relationship with Israel’s medical community, and since then, he has been back several times.
The issue’s opening article, coauthored by Horton and Prof. Karl Skorecki, Director, Medical & Research Development, discusses various problems in Israel’s health system, including the privatization of medical services, gender inequality, health gaps between different regions of the country and different population groups, a critical shortage of medical professionals and hospital beds, and a failure to adapt to the needs of a growing, aging population. It also discussed the enormous health gaps between Israel and the Palestinian Authority, adding that medical cooperation with the PA is limited and does not provide an answer to Palestinian aspirations for an independent health system.
The issue also makes various recommendations for improving the health system, including increasing government spending on health care, drafting and funding a long-term plan for preventive care, ending the drift from public to private health care, increasing the number of hospital beds, extending maternity leave from 14 weeks to six months and providing free contraceptives as part of the national health insurance program.
For anyone familiar with Israel’s health system, there is little new or surprising in the issue. But it does provide Israel’s healthcare system with impressive global exposure. Very few countries have had an entire issue of the Lancet devoted to them; among them are Japan, the United States, Mexico, India, France, Brazil and the Palestinian Authority. Researchers and doctors say that being featured in such an issue has an impact far beyond the realm of medicine and academia.
The issue also highlights several achievements of Israel’s health system, including the steady rise in life expectancy. Since 1993, life expectancy has risen from 75.3 to 80 years for men and from 79.1 to 84 years for women. Consequently, Israel now ranks fourth in the world for life expectancy among men and 11th for life expectancy among women. Yet at the same time, life expectancy is much lower in certain subsets of the Israeli population, first and foremost the Arab community, and the gap has actually grown in recent years.
Another achievement is low infant mortality. Since 1993, infant mortality has dropped by over 50 percent, from 7.5 deaths per 1,000 births to just three, and today, Israel has the lowest infant mortality rate of all 35 countries in the OECD.
Yet at the same time, Israel has the highest child poverty rate in the OECD, with 35 percent of children living in poverty. Poverty is especially widespread in the ultra-Orthodox and Arab communities, with 67 percent of ultra-Orthodox children and 63 percent of Arab children living in poverty, compared to just 15 percent of other Israeli children.
The issue also devoted an entire article to women’s health in Israel. It found that incidence of death due to strokes, heart disease and cervical cancer is lower for Israeli women than the OECD average. But incidence of breast cancer is higher, with 80 cases per 100,000 women, compared to an OECD average of 74. Israel also has the fifth-highest rate of death from breast cancer in the OECD, and its rate of sexual harassment and violence against women is 10 percent higher than in other OECD countries.