3 years after open letter alleged Gaza ‘massacre,’ Lancet eyes Israeli health

Special issue of venerable British medical journal lauds medical services, highlights inequalities across country and between Jews and Arabs

Shoshanna Solomon is The Times of Israel's Startups and Business reporter

Illustrative photo of a nursery in a Jerusalem hospital's maternity ward. (Abir Sultan/Flash90)
Illustrative photo of a nursery in a Jerusalem hospital's maternity ward. (Abir Sultan/Flash90)

The British medical journal The Lancet published a special issue on health in Israel, outlining its achievements in striving for universal health coverage for its diverse population but also setting out the challenges that remain as conflict in the region persists.

The issue’s series of articles was conceived in 2014, after the editor in chief of The Lancet, Richard Horton, allowed publication of an open letter that accused Israel of a “massacre” in Gaza. Horton later wrote that he regretted the polarization caused by the publication of the letter, but did not retract it.

At the time Horton said that the journal had proposed new guidelines to deal with “submissions that lie at the difficult intersection of medicine and politics,” and called on editors to “pause, reflect, and consult before publishing any manuscript that might unnecessarily polarize, or foster or worsen political division.”

He also said that the journal would publish a series on Israel’s health and medical research system, after a visit to Israel and Rambam Health Care Campus in Haifa in which he was invited to see Jewish-Arab medical cooperation firsthand.

Richard Horton, editor of the British medical journal The Lancet. (screen capture: YouTube/World Health Summit)
Richard Horton, editor of the British medical journal The Lancet. (screen capture: YouTube/World Health Summit)

“Our collaboration began in the aftermath of the tragedy of war between Israel and the Hamas-controlled Gaza Strip in 2014. In July 2014, in the very midst of the conflict The Lancet published a letter that divided medical opinion worldwide,” Horton said in a statement announcing the publication of the series on Tuesday. “We have learned lessons from this unfortunate episode. Our collaboration seeks to undo the harm and tarnish of this episode by transforming those experiences into constructive practice.”

The series addresses how Israel’s health system ensures that a basket of health services is provided for its 8.68 million citizens, mostly free at point of service, which has led to strong progress in the health of the Israeli population, improving life expectancy and reducing infant mortality.

But the authors also look at the challenges that remain — how Israel addresses the health needs of an aging society and of women and children, and the health inequalities between Israeli Arabs and Israeli Jews and across different regions of the country.

Smoke rises from buildings following an Israeli air strike on Gaza City on August 20, 2014. (photo credit: AFP/MAHMUD HAMS)
Smoke rises from buildings following an Israeli airstrike on Gaza City on August 20, 2014. (photo credit: AFP/MAHMUD HAMS)

“The Lancet’s Israel Series could serve as a springboard for increasing not only health and health equity within Israel and between Israel and its closest neighbours, but also offer a platform for greater engagement of Israeli physicians and medical scientists in issues of national and global health,” Horton said.

The series aims to show “that medicine and science can be a bridge to a better understanding of complex and seemingly intractable geopolitical challenges,” he said.

The Israel Series is part of The Lancet’s program of country analyses investigating progress toward universal health coverage, and explores aspects of health and health care delivery in Israel. The papers, authored by academics and policy makers in Israel, offer recommendations for strengthening the country’s health care system, improving health, and addressing health inequalities, digital health, medical genetics, medical education and women and health among others.

The series of Israel articles was led by Ben-Gurion University of the Negev’s Prof. Mark Clarfield, Prof. Orly Manor of the Israel National Institute for Health Policy and Services Research, and Prof. Zaher Azzam of the Rambam Health Care Campus. The series will be launched at consecutive events in Tel Aviv, Haifa, Nazareth, Beersheba, and Jerusalem on Monday through Wednesday.

Life expectancy lower among Israeli Arabs

“Israel has made strong progress on health, but challenges remain,” said Clarfield in the statement. “The slow, but increasing privatization of services, and stagnating national expenditure on health must be addressed so as to ensure the country is able to continue providing good quality health care for its citizens. Given that health care delivery and representation in the health professions represent areas of the greatest equality among population sectors in Israel, residual troublesome disparities in health outcomes among population and regional groups reflect inequalities in the socioeconomic underpinnings of health and well-being.”

Life expectancy in Israel is consistently higher among Israeli Jews than Israeli Arabs (80.3 vs 78 for men and 84.1 vs 80.9 for women).

Smoking prevalence is twice as high among Israeli Arab men (43.9 percent) as Israeli Jewish men (22.1%), and lung cancer is much more common among Israeli Arabs, despite most other cancers occurring with roughly the same frequency across both groups. Rates of diabetes and heart disease are also more common among Israeli Arabs. Disparities exist in terms of healthcare too. For example, Israeli Arab women are more likely to be diagnosed at a more advanced stage of breast cancer, and less likely to take part in screening programs.

Among the recommendations made by the authors are increasing spending in the health sector from the current 7.8% of GDP to 9%, consistent with the OECD average; guaranteeing long-term funding for national health programs aimed at reducing smoking, lowering sugar and salt content, and encouraging physical activity, especially among disadvantaged groups; halting the shift from public to private care, and ensuring the Health Ministry focuses on long-term planning and funding for health care services; increasing funding for home and community services to support an aging population and increasing the number of acute hospital beds; extending maternity leave from 14 weeks to 6 months and providing contraception under health insurance plans.

The authors also urge regional collaborations on health issues across historical, demographic, ethnic, political and economic divides, even where diplomatic relations are nonexistent.

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