The Taub Center Annual Herbert M. Singer International Conference was held this year for the 12th time under the title Inequality in Health: Defining Challenges, Developing Solutions. The conference began with brief opening remarks by Mr. Nir Kaidar, Director General of the Taub Center, Prof. Avi Weiss, Taub Center President, and Steven Taub, President of the Henry and Marilyn Taub Foundation. Following opening remarks, Prof. Sir Michael Marmot delivered the opening lecture, Inequality in the Health System from an International Perspective.
Prof. Sir Michael Marmot from University College London talked about his book The Health Gap, in which he focuses not only on treating patients but on the conditions that make people sick. His lecture dealt with the importance of measuring over time which provides a perspective on the actions taken and affords an understanding to lead in the right direction. Prof. Marmot referred to the life expectancy data in Israel and cited as an example the gap between the life expectancy of Palestinian men and that of Jewish men: “Israel’s life expectancy is excellent, but the main challenge, as in all countries, is inequality.” (Download the slideshow).
After that, the first session began: The Report on Health Inequality in Israel – Challenges and Potential Solutions. The session was chaired by Prof. Nadav Davidovitch, Principal Researcher and head of the Taub Center Health Policy Program. Session participants were Ms. Ayelet Grinbaum-Arizon, Senior Deputy Director for Strategic and Economic Planning at the Ministry of Health, Prof. Nachman Ash, Director General of the Ministry of Health, Ms. Ayala Meir, Senior Manager of the Family, Children and Youth in the Community Division at the Ministry of Welfare and Social Affairs, and Prof. Orly Manor, Chairwoman of the Executive Committee of the Israel National Institute for Health Policy Research.
Prof. Davidovitch spoke about the work being done in recent years at the Ministry of Health to address inequality, which is expressed, for example, in bigoted attitudes of patients towards healthcare workers, and vice versa. He expanded on the Decade Committee, established by the Ministry of Health, and its overarching goal: formulating a plan to eradicate health inequalities by 2032. The committee’s main recommendations for the 2023–2024 budget are setting goals and measurement mechanisms for eradicating health inequality in the coming decade; the institutionalization of the health sector in the local government; the development of unique and multi-system solutions for people living in poverty and expanding the services provided to them, assistance in uptake of rights and increasing representation; and strengthening the governance of the Ministry of Health in order to reduce inequality in general and inequality in the first years of life in particular. He concluded his remarks by referring to the importance of the conference: “This conference excites me very much, it is an important decision to put the issue of inequality at the center of a conference on health. I think that the issue is very much connected to the worldview of the Taub Center in the sense that it examines inequality in health not only from a narrow medical point of view, but also from a broader point of view, at the national and international level.”
Ms. Ayelet Grinbaum-Arizon spoke about the Ministry of Health’s strategic plans and noted that one of the main tasks is to build a work plan to reduce health inequalities. She emphasized the importance that the Ministry of Health attaches to long-term planning in order to optimize the processes. Prof. Nachman Ash stated that the issue of inequality has intensified in recent years, especially during the COVID-19 epidemic. The main challenges in reducing inequality are the need to identify the sectors and populations that suffer from it and the critical need to establish measurement mechanisms and goals on the subject. Ms. Ayala Meir spoke about disparities in health and inequality from the perspective of the Ministry of Welfare and Social Affairs. She stated that the health problem is particularly acute among populations living in poverty, and that they face more complex barriers in exercising their rights. “Poverty is on the table of the Ministry of Welfare. We have established an array in local authorities that have a high poverty rate, and I am happy to say that we are also working in cooperation with the Ministry of Health, which has adopted our paradigms in the field (Download the slideshow, in Hebrew).” Prof. Orly Manor spoke about the committee she chairs, which deals with infrastructure and metrics. One of the committee’s recommendations is to expand the reporting obligation of the health funds to include, for example, detailed reports on a geographic basis to ensure that health funds in the periphery make appropriate use of the funds transferred to them. Another recommendation concerns the need to share data between government ministries. As an example, Prof. Manor cited the COVID-19 period, when health system workers were not given data from the welfare agencies, even though we know the great importance of understanding the make-up of the population when targeting health promotion programs for reducing disparities. At the end of her lecture she said, “I call from here, as a researcher of disparities for many years, not to overturn the law on the taxation of sugary drinks; this is an important tool in the fight against diabetes and the issue of inequality.”
Afterwards, Dr. Joreintje Mackenbach from the University Medical Center of Amsterdam delivered the keynote address, Inequality in Health at a Local Level – the Role of Neighborhood Environments. According to her, residence and neighborhood patterns can have a positive or negative effect on health inequality, so sustainable neighborhoods must be established in which a healthy environment can be created through maintenance and planning. She spoke about the environment in her place of residence, and noted, for example, the connection between the good public transportation in her city and the high life expectancy. She also talked about her research, which dealt with the food environment that has changed over time and showed that the biggest change is evident in the decrease of fresh food stores such as greengrocers and butchers. (Download the slideshow).
The second session, Health Inequality: The Intersection of Geography, Poverty, Education, Ethnicity and Gender, was moderated by Dr. Sagit Arbel-Alon, Chief Physician and Director of the Health Services System at the Ministry of Welfare and Social Affairs. Participants in the session were Ms. Sigal Regev, CEO of Meuhedet Health Services, Ms. Yael Sherer, Founder and Director of the Lobby Against Sexual Violence, Prof. Sarab Abu Rabia-Queder, Vice President for Diversity and Inclusion at Ben-Gurion University of the Negev, and Mr. Idan Grinbaum, head of the Emek HaYarden Regional Council.
Dr. Sagit Arbel-Alon spoke about the cooperation between the Ministry of Welfare and Social Affairs and the Ministry of Health. The Ministry of Welfare has responsibilities in the field of health. For example, it is responsible for hostels for people with disabilities. Health workers within the Ministry of Welfare and Social Affairs are also responsible for shelters for women who are victims of violence and emergency centers for children, monitoring dual diagnoses, and even dental services. Dr. Arbel-Alon focused her lecture on people with disabilities and the inequality they suffer from within the field of health in order to raise awareness and bring about change. “We don’t receive training in accessing people with disabilities and how to treat them,” she complained, revealing another problem: “The system is not accessible to people with disabilities.” According to her, it is necessary to make diagnosis and treatment accessible to people with disabilities and women. For example, there should be provisions to provide a mammogram for a woman in a wheelchair or a dental CT scan while lying down.
Ms. Sigal Regev stated that inequality is not just related to geographic location or areas in the periphery of Israel, but to many other factors such as poverty rates, socio economic status and education, all of which affect health awareness health maintenance, awareness of possible treatments and the ability access healthcare. Ms. Yael Sherer spoke about the importance of knowledge regarding the development of diseases such as heart disease in women who have been sexually assaulted and the reluctance of women to take care of their bodies and their health following a sexual assault. Ms. Sherer added that there is not enough awareness of the issue and said that she met with the Minister of Health and asked to assign units to deal with the issue. “The most invisible population is the population of victims of sexual violence.” However, she said, the health funds are already starting to formulate plans for customized healthcare, and although this issue is still in its infancy – both in Israel and in the world – the interest in it is increasing.
Prof. Sarab Abu Rabia-Queder spoke about her latest research that dealt with discrimination against professional women and in particular in the Bedouin society in the Negev – for example, female social workers, researchers, psychologists, pharmacists, and more. She said that the research showed that despite their education and professionalism, they experience multidimensional discrimination both from their employers and from the public they come into contact with as part of their work. Mr. Idan Greenbaum’s talk focused on the lack of accessibility to health fund clinics and the lack of medical teams in the periphery. He also talked about the change in his accessibility to health services following the relocation of his residence from Tel Aviv to Emek HaYarden. Even a very basic thing like buying a prescription drug at the pharmacy, he said, is problematic, because the working hours of the pharmacy do not coincide with the working hours of the clinic. “To buy the prescription medicine I have to travel to Tiberias – a journey by public transport that requires two buses. The geographic periphery definitely plays a significant role in terms of inequality in healthcare, even in terms of accessibility to transportation and to medical services.”
The third and final session, Food Insecurity, was dedicated to the memory of the late Prof. Dov Chernichovsky. The outgoing Minister of Welfare and Social Affairs, Mr. Meir Cohen, came and spoke about his work of many years both as mayor of Dimona and as a member of the Knesset with Prof. Chernichovsky. Minister Cohen said that Prof. Chernichovsky was an enterprising person who opened his eyes to many issues, and together they established and promoted a medical center in Dimona that is open 24 hours a day. “He told me: I’ll bring you ideas, you bring the money.” On the subject of food insecurity, the Minister said that there are indeed hungry children, and offered to tour the Bedouin diaspora to understand what poverty is. He said that the distribution of food stamps to needy families is on the agenda today, although according to him there is a certain problem with this solution. He ended his talk with a call to the future government. “In 2012, they held a conference and asked who wanted to be Minister of Welfare, me and Bougie (Isaac Herzog) came; if they were to hold a conference now, it is likely that no one will come. But I really appeal to all the good politicians who will replace us: let’s be trailblazers and open our eyes to the question of food security. It is as important as ever.”
The third session was moderated by Prof. Hagai Levine, Chairman of the Israeli Association of Public Health Physicians. Participants in the session were Prof. Roni Strier, Head of the National Committee for Food Security and Founder and Head of the Interdisciplinary Center for the Study of Poverty and Social Exclusion at the University of Haifa, Dr. Amy Lazarus Yaroch from the Gretchen Swanson Center for Nutrition, and Mr. Gidi Kroch, CEO of Leket Israel.
Prof. Roni Strier spoke about the role of the National Committee for Food Security, which advises the government in planning policy to ensure food security for the population in Israel, and presented data from the latest report of the National Insurance Institute. Among other things, the report shows that almost 17% of families in Israel experience food insecurity and almost a million people in Israel live in a state of food insecurity. He emphasized that there is missing data, since the report does not include data on the Arab sector and the Bedouin population, and therefore the scope of the phenomenon is even greater. After that, Prof. Strier insisted on the lack of awareness of the issue and warned: “The relationship between economic status and health status is known, but there is also a relationship between food and health: food insecurity leads to heart disease.” (Download the slideshow)
Dr. Amy Lazarus Yaroch spoke about a large program she is involved in in the United States, “Supplemental Nutrition Aid,” under which households in need receive a budget of approximately $1,700 per month provided in vouchers, benefits, and basic groceries. Another program she works on helps with food for low-income women raising children ages birth to five. Through the program they receive a monthly benefit of about $67 a month. “Every American citizen should have access to healthy food to take care of their health,” she emphasized. (Download the slidshow)
Mr. Gidi Kroch began by speaking in memory of the late Prof. Dov Chernichovsky, who “was a great man, a gentleman, and I learned a lot from him.” He spoke about the Leket Israel organization and its important role in providing nutritious food to three quarters of a million people every week based on donations alone: “Nutrition is very important to Leket Israel, it is at the top of our agenda. We provide food to 8,000 people a day”. He talked about the various programs that have been developed in the organization and changes over the years. In one of them, for example, soups and salads are prepared from surpluses, which are real meals for the needy elderly who receive them: “It’s amazing how out of our need to know what to do with all these surpluses, a solution came to all those people to whom we distribute food.” (Download the slideshow).
Prof. Hagai Levine concluded the third session by talking about the complexity of the food and nutrition system and the real food crisis that the world has fallen into – not only because of the COVID-19 pandemic but because of climate change that has affected the global food system. He pointed out that, as in many places in the world, there is poverty and hunger in Israel, and here there is also an important role for non-profit organizations and third sector organizations. “Every crisis is also an opportunity. This conference shows us that inequality in health is an opportunity to raise this important issue on the public agenda.”
Watch the conference with live translation to English: