A new approach to determining healthcare priorities in Israel

What is the price of the rise in life expectancy?  With the rapid increase in life expectancy and population aging in Israel, consideration should be given not just to the number of years lived, but also to the quality of those years.

A new Taub Center study by Liora Bowers and Prof. Dov Chernichovsky examines the years of healthy life in terms of disease burden, a measure that takes into account both disability/poor functioning and death.  The study compares Israel to other developed countries, highlights the impact of different health conditions on the country’s overall disease burden and outlines the challenges ahead of us in this arena. 

Some major findings from the study:

  • A baby born in Israel today can expect to live 71.7 years in good health – a figure that is about a decade less than total life expectancy (82.1 years). Furthermore, healthy life expectancy is growing at a slower rate than total life expectancy. 
  • Disease burden from heart disease and lung cancer are notably lower than in other countries and the burden of heart disease and stroke have decreased by a remarkable 58% in the last 25 years.
  • On the other hand, obesity and high sugar consumption are larger risk factors in Israel than in other countries, particularly among children.
  • Diabetes is responsible for nearly 90% more disease burden in Israel than in Europe, and its prevalence among the poor is substantially higher than that among higher-income individuals.

Without major government regulations to promote healthy behaviors, particularly ensuring access to healthy foods and marketing of unhealthy foods – with a specific emphasis on younger populations – Israel is set to experience substantial increases in disease burden in the coming decades.

In 2015, the life expectancy in Israel stood at 82.1 years, placing Israel ninth globally.  This remained fairly stagnant over the last couple years and represents a fall from the country’s fifth place ranking in 2013.  Yet, although there has been a substantial increase in life expectancy over the last decades, this is no guarantee regarding quality of life.  According to a new study by the Taub Center, there has been a slower rise in the number of years lived in full health and functioning.

A baby born today in Israel is expected to live 71.7 years in good health, all told, about a decade less than the 82.1 years of total life expectancy.  Further, it appears that the rise in the number of healthy years lived in Israel is slightly lower than that of other countries known for their longevity.  The data indicate that Israel faces a problem, and it is no longer possible to consider good health only in the context of life and death.

Since 1995, Israel has provided universal healthcare coverage.  The Health Basket Committee annually convenes to select new medications and procedures to add to the public health basket per the allocation from the government budget.  The committee, as well as policymakers and the public, focuses primarily on technologies that prevent death, and devotes fewer resources to addressing the disease burden caused by non-fatal diseases such as orthopedic problems, depression, migraine, and hearing and vision problems.

Even though they do not directly lead to death, these conditions impose a large burden on many and exact a heavy price: from the patient, in terms of pain and decreased functioning and quality of life; from family members, who must care for the patient; and from society and the economy in terms of lost working days or reduced productivity.

A new Taub Center study by Liora Bowers and Prof. Dov Chernichovsky examines changes in disease burden between 1990 and 2015.  The study utilizes the Institute for Health Metrics and Evaluation (IHME) database, an international dataset collected over a number of years across all countries in the world. Poor health is measured in DALYs – Disability-Adjusted Life Years, which take into account years lost to both death and disability. Using this measure, the researchers compare the quality of life alongside total life expectancy in Israel, and identify the trends in Israel in comparison with those of European countries.

The researchers point to Israel’s comparative advantages alongside its shortcomings, and anticipate the challenges that the health system will face in light of the aging of the population over the next 20 years.

Back pain, diabetes and depression are among the main causes of disease burden in Israel today

Bowers and Chernichovsky examined the health conditions that take the greatest toll on Israel’s population today in terms of DALYs. Contrary to conventional wisdom, when considering the many people affected and the duration of suffering, the burden caused on society by back and neck pain is even higher than that of heart disease. The five conditions causing the greatest disease burden are neck and back pain, heart disease, diabetes, vision and hearing problems, and depression (in that order).

Liora Bowers noted that “the burden of heart disease and stroke decreased significantly (58 percent)  since 1990, as part of a known international phenomenon attributed to better detection and treatment, and the development of new medications effective at lowering cholesterol and blood pressure. On the other hand, an increase in body mass index (BMI) and in diabetes rates has had the opposite effect, and mitigated the reduction in heart disease that might have otherwise been seen.”

Diseases related to high blood pressure such as heart disease, kidney disease, stroke and diabetes are strongly affected by diet. Although the Mediterranean diet in Israel – which includes high consumption of vegetables, fruits and legumes – has proven health benefits, Israelis also tend to consume relatively high amounts of sugar, and not enough whole grains. Almost half of Israeli children drink sugar-sweetened beverages every day, rates that are even higher than in the United States.

High blood sugar levels are the most significant risk factor for disease burden in Israel and are responsible for about 61% more disease burden than in Europe, after taking into account differences in the population age structure. Obesity is also a major problem in Israel (particularly among the country’s children) and causes about 21% greater disease burden here than in Europe.

The Ministry of Health has taken a significant step in addressing this problem by prohibiting the sale of unhealthy food products in schools and recommending labeling unhealthy products with clear and prominent labels and limiting the marketing of unhealthy food for children. However, a major problem facing the public is the high cost of a healthy food basket that contains sufficient fruits, vegetables, nuts and healthy oils, which are unaffordable for many.  Furthermore, food price regulations in the country are currently based on economic and agricultural considerations, with no input from the Ministry of Health regarding nutritional considerations.

Compared to Europeans, Israelis today suffer more from diabetes, kidney disease, anemia, birth defects, and depression, and the health system is poised to face higher burden from cancer, heart disease and stroke, dementia and mental illness

The Taub Center study shows that Israel has a significantly lower death rate caused by lung cancer, heart disease, stroke, and liver disease, even after controlling for Israel’s younger population. One key reason for this finding is the lower rates of tobacco smoking and alcohol consumption. However, despite overall declines in smoking rates in Israel over time, 20% of Israeli tenth graders report having smoked a cigarette compared to 17% of their European counterparts, and the age of smoking initiation is earlier than in the past.

The disease burden from diabetes is nearly 90% higher in Israel than in Europe (age-adjusted), and kidney-related disease, which requires dialysis treatment or a transplant, also causes nearly double the burden. Israel also suffers a higher burden from anemia, birth defects and depression.

Anemia affects many women during pregnancy, causes fatigue and weakness, and may lead to premature labor or a low birthweight baby. In addition, it is very common among young children and has been linked to cognitive, motor, and language delays. This can be solved through effective iron fortification of food, as has been done in other countries, and increasing public awareness.

Bowers and Chernichovsky also studied the causes of disease burden in Israel in comparison to Europe, whose population is older, on a non-age adjusted basis.  The goal here was to better understand which health problems are likely to affect Israel in the coming decades as its population ages. The effect of the age distribution on a society’s health is clear. An examination of disability-adjusted life years shows that the impact of neck and back pain, heart disease, stroke, Alzheimer’s, lung cancer, falls and anxiety is higher in Europe, mainly, though not only, due to the fact that it is an older population.

In conclusion, Bowers states, “The common link across many of the leading health problems is lifestyle.  By promoting better nutrition and physical activity, through food regulations and through designing healthy school and living environments, policymakers in Israel can proactively lengthen the years of healthy life.  Ranging from back pain to diabetes to depression, the main way to ensure a healthier aging population down the road is to focus on prevention efforts, particularly on the young and those of lower socioeconomic status.”

The Taub Center for Social Policy Studies in Israel is an independent, non-partisan socioeconomic research institute. The Center provides decision makers and the public with research and findings on some of the most critical issues facing Israel in the areas of education, health, welfare, labor markets and economic policy in order to impact the decision-making process in Israel and to advance the well-being of all Israelis.