Tell me how many years of education you have and I can predict how long you are likely to live. In Israel, there’s a huge correlation between years of schooling and life expectancy, especially for men.
A man who didn’t finish high school and had fewer than 11 years of schooling has an average life expectancy of 76.6 years. A man with a postsecondary education or a college degree can expect to reach the age of 84.5 years on average – nearly eight additional years.
For an Israeli woman with less than a high school education, the average life expectancy is 81.9 years, compared with 87.9 years for a women with postsecondary schooling of some kind.
The figures were released by the Health Ministry this week ahead of a conference on how the health care system can address inequality. It has its work cut out for it. Despite the fact that the State Health Insurance Law covers all Israeli citizens and is supposed to provide care with “justice, equality and mutual assistance,” Israel suffers a yawning health gap.
The gaps exist not just between the educated and less educated but between Jews and Arabs, the rich and the poor and residents of the Negev and Galilee peripheries versus those in the center of the country.
The health care system is only part of the problem. The differences in life expectancy all spring from the same constellation of characteristics – the less educated tend to have lower incomes, live in the periphery where they have less access to health care and where the Arab population is concentrated.
The poor are less able to pay for drugs and medical services that are not covered by the state. Without a car, they may even have trouble reaching a hospital. Smoking rates are higher for people who earn less or are less educated. They exercise less and don’t have the money to pay for the healthiest foods, like fresh fruits and vegetables, whole-wheat bread and the like.
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A particular prominent example of this health gap is the growing prevalence of Type 2 diabetes, formerly called adult-onset diabetes. Treatment includes exercise and dietary changes, together with medication if needed.
Managing diabetes has a significant impact on reducing other complications that arise from it, such as cardiovascular disease, blindness and kidney failure. These complications not only seriously harm to the quality of patients’ lives, but to their length. A person with diabetes who doesn’t follow the protocol is likely to die at a younger age than one who does.
Maintaining balanced blood sugar levels for people with diabetes is a high priority for the country’s health maintenance organizations. A lot is invested in it.
It’s long been known that the risk of diabetes is higher among lower socioeconomic groups. This week’s Health Ministry report adds a new dimension to the problem by illustrating the life expectancy gaps among diabetes patients.
Ein Mahil, an Arab town in the Galilee, has the highest proportion in Israel of Type 2 diabetes patients whose blood sugar levels are not under control. Among adults aged 25 and above with the disease, the blood sugar levels of 41% of those 25 or older with the disease are imbalanced. Next on the list is the Negev Bedouin community of Tel Sheva, at 38%.
The mainly Jewish communities that rank highest in this regard are those with low to medium socioeconomic scores. At 25%, Kiryat Malakhi leade the list followed by Acre, Arad, Dimona and Migdal Ha’emek.
The communities with the lowest proportions of residents with Type 2 diabetes whose blood sugar levels are not balanced – not more than 10% – are Kiryat Ono, Binyamina-Giv’at Ada, Givat Shmuel, Tel Mond, Kadima-Tzoran, Mevasseret Zion and Ramat Hasharon.
Other gaps in life expectancy are related to the availability of doctors, as measured by the number of physicians, nurses and other medical personnel per capita.
In Greater Tel Aviv, for instance, there are 5.3 doctors for every 1,000 people, compared with just 2.1 in the northern and southern peripheries. In the south, the rate has even declined from 3.1 for 1,000 in 2013-15.
Insurance coverage also varies a lot between the richest and poorest as well as between Jews and Arabs. Jews are far more likely to take out supplementary coverage from the HMOs as well as private policies. Among the poor, those who do buy extra coverage are less likely to use it.
The Health Ministry can’t close these gaps by itself, but it can do a lot to improve access to health care to people and areas that lack them, by improving the health care infrastructure in the periphery and by spending more on education for healthy living and preventive medicine, and by adapting the system better to special populations.
A lot of that is already being done, but the figures show there’s still a long way to go.