Through the decades, the Health Ministry hasn’t had a sterling record when it
comes to disease prevention and health promotion.
Its budget for these is
less than two percent of all public money spent on healthcare; hospitals,
primary care and treating disease have always been considered much more “sexy”
than getting people to eat right, avoid smoking, lose weight and exercise
The ministry regularly says it has “no budget” for public
service announcements on TV to teach the public about prevention; only when the
polio virus spread through sewage did the ministry invest millions in TV and
radio campaigns to get children vaccinated.
Over the decades, ministry
directors-general have worked in hospital administration and dealing with
disease before taking up the post. None have come from schools of public health.
When Prof. Ronni Gamzu, the current director-general, who previously ran Ichilov
Hospital of the Tel Aviv Sourasky Medical Center, made his first public
appearance, public health awareness was not on the agenda.
He spoke for
an hour on hospitals and nurses’ strikes at a conference at the Dead Sea,
followed by another hour to health journalists, without once mentioning subjects
from tobacco use to obesity and others related to health promotion and disease
But five years into the job, he has learned his lesson,
according to his subordinates. It became obvious to him that the ministry, and
the government, will go bankrupt if nothing is done to slow the rates of
preventable chronic disease and accidents. It costs a lot more to treat and
hospitalize than to prevent.
AROUND A decade ago, when the 21st century
was young and 2020 seemed a long time away, a program for health promotion was
conceived by the current and veteran associate director-general, Dr. Boaz
A keen sportsman who came to the ministry from medical positions in
the Israel Defense Forces, Lev starts the day early by running five to eight
kilometers, whatever the weather. People in and outside the ministry who care
about public health sat on committees, wrote reports and made
In the past year, the ministry has devoted much thought
and – for a change – hired a few new staffers and allocated funds for a new
National Program to Promote Active and Healthy Lifestyles. Headed by the Health
Ministry, it is going to be run with the Education Ministry and the Culture and
Named (in Hebrew only) Efshari-bari (“It’s Possible to be
Healthy”), the program focuses on encouraging Israelis to change their
lifestyles – to eat right and exercise regularly. It is the first Israeli health
promotion program conducted on a national scale.
Affiliated with the
health promotion department headed by Ruthie Weinstein, it does not at this
point include smoking prevention and cessation, accident prevention and other
aspects of public health.
The program was formally launched during the
intermediate days of Succot at Beit Hanassi, where President Shimon Peres – a
nonagenarian who exercises daily and enjoys good health – told the audience at
his succa’s open house that “peace is essential, but healthy living is
Israelis, he said, have been preoccupied for years with the
issues of peace and security.
Economic success has been the mantra for
the past two decades. Like the US, Israeli society is dealing with an obesity
crisis and unhealthy lifestyles – eating junk food and sitting all day in front
of a computer screen.
In the large courtyard of the president’s residence
were numerous educational activities for parents and children, all on the theme
of active and healthy living. They included theater and pantomime acts for
children with tips for a healthy lifestyle, games, performances, sports
activities, fruit and vegetable sculpting demonstrations, and chefs teaching
simple and healthy cooking.
But yes, although its obesity rates are lower
than in the US, Israel is way behind.
Back in the early 1960s, President
Kennedy established a Presidential Council on Fitness to
accomplish the same thing, and since her husband’s first term, US first lady
Michelle Obama has promoted a similar program called Let’s Move.
DANI Moran, a physiologist by training from Sheba Medical Center who worked at
the institute of military physiology at IDF’s Heller Institute of Medical
Research (affiliated with Tel Aviv University’s Sackler School of Medicine),
became head of Efshari-bari, which he began planning over two years ago. He also
teaches at Ariel University.
In addition, Prof. Nurit Guttman, chairman
of TAU’s communications department, was selected by the project to conduct
“social marketing” for the national program, together with a small team of
university personnel and students. In addition, Pnina Shalev – who has her own
Tel Aviv public relations firm and has since become half-time personal adviser
and spokeswoman of Health Minister Yael German – was commissioned to do
Efsharibari’s publicity campaign.
The government has allocated some NIS
26 million a year for the program, NIS 7 million of it for the social marketing
part and the rest for educational projects, sports infrastructure including
bicycle and running paths, and other projects Moran told The Jerusalem Post in
an interview that instead of just directives from the Health Ministry’s
director-general (which can easily be overlooked), those involved in the program
will push through legislation to prohibit junk food from being served in those
schools that provide hot meals, or even sold in school kiosks, for example.
“There will finally be “teeth” for enforcement.
The first topic Moran
wants to tackle is the amount of salt in prepared foods. Excessive salt intake
raises blood pressure, which can lead to heart attack and strokes. But since
Israelis are used to a lot of sodium in canned foods such as soup, bread,
salads, sausage and other processed foods, the amount has to be reduced slowly –
even over three to five years – or customers will avoid buying them, Moran
The same tactic is necessary for reducing sugar and unnecessary and
“empty” calories in prepared foods. “We are working with industry to change
things,” Moran said.
Moran said his ministry wants to promote the sale
and consumption of whole-grained food – which is much more healthful, fights
weight gain and obesity and introduces necessary fiber into the diet. But it
Whole-grained flour, rice, baked goods and other products are
significantly more expensive than highly processed “white” foods, because their
prices are not supervised or limited by the government. To make them less
expensive than refined flour, rice and other products requires putting them
under state supervision.
Popular unpackaged whole-grained rolls, for
example, are not required by the government to be on display in baskets or
containers stating their contents. Thus, one doesn’t know whether unpackaged
breads or rolls contain whole-grained flour at all or if so, what percentage.
Many rolls and breads and rolls that are brown in color are in fact made to look
like they are whole-grain by adding caramel – burnt sugar, which some people
(such as diabetics) should not eat.
Although asked by the Post numerous
times over several months why whole-grained unpackaged breads are not required
to be identified and the percent of dark flour listed nearby, there was no
response. In addition, the Gidron company – Supersol’s baking goods subsidiary –
failed to answer queries on the subject.
“There is no reason why
full-grain products should be more expensive than their highly processed
counterparts. They are not even the same prices, even though they are cheaper to
make,” Moran said. “Companies have noticed that more people want to eat more
nutritious foods so they charge more for them. I hope that now there will be
WHILE THERE is not much yet in the field to see, Moran says
that Efshari-bari has already signed up 15 municipalities and local authorities
in the general, Arab and haredi communities – from Ashdod to Lakiya and Elad,
with a steering committee in each, to promote the health of the
“We have a focused plan to change policies and implement
them. All kindergarten teachers and their assistants will attend workshops on
food and exercise. They’ll look at the food parents send to class with their
children and discourage them from including cola, unhealthy snacks and chocolate
spread on their bread.
“Children will be encouraged to grow vegetables
outside their schools and eat them in class. If this pilot works, we will expand
In local pre-schools, birthdays are a symbolic event often
associated with and abundance of candies and sweet drinks. Some people
mistakenly think it impossible to have a healthier birthday, and among these
beliefs are that “parents will object” or “why not, once a year” or that “kids
won’t like it”.
But all these assumptions are false. Parents of young
children will also be encouraged to organize healthy birthday parties in class
with nutritious snacks such as fruit cut into various shapes instead of cakes
and candies with empty calories.
GUTTMAN SAID that her department’s
“participatory social marketing program received a two-year grant to conduct a
large theory- based applied research project and to apply its findings in
communication activities to people from diverse social backgrounds.
TV public service ads are terribly expensive and the government hasn’t required
networks to broadcast them for free, she decided to inform people of diverse
social backgrounds almost totally via social marketing – specifically through
Facebook and other social networks – and not by the general media. TV-quality
videoclips on nutrition and exercise will be produced, but they will mostly be
disseminated via Facebook, You- Tube and the like.
“We will provide
people with information, suggestions and tips to discuss healthier options and
how to adopt a healthier lifestyle for themselves, their families and
communities,” said Guttman, who concedes that the elderly who use the social
media much less than younger people will be targeted later.
There will be
personal and focus group interviews and Internet and national
“The uniqueness of the social marketing is that it focuses on
specific issues that come from members of the community and the tips and
suggestions mainly come from them as well,” she continued. “Informational
materials, for example, are being prepared in Amharic for Ethiopian Jews, based
on their own suggestions.”
AS FOR the exercise part, employees – both in
the government and private employers – Efshari-bari intends to go to workplaces
and encourage them to install places to shower after biking or walking to work
and exercising during breaks.
“By law, every state employee has the right
to do one hour of physical activity on the job per week. Very few take advantage
of it,” Moran concedes. Health fund primary physicians will be trained to tell
patients that “exercise, too, is medicine.”
Liri Findling, who previously
worked for the National Center for Child Safety and Health (Beterem) joined the
Health Ministry to be responsible for Efshari-bari policy in the health
promotion department. She is setting up indicators for testing success of the
“The Health Ministry has the knowhow and is heading it, but the
Education and Culture and Sport Ministries are largely implementing it in the
field,” she said. “I am interested in being part of sustainable
It’s better late than never for the Health Ministry to get
involved in health promotion and disease prevention; it will probably take a few
years to assess the program to find out whether the social marketing and
grassroots approach works.
When you notice people buying less junk food
at the supermarket checkout, fewer obese children and adults and more people
walking and running outdoors, you will know that they have changed their