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Photo by: Courtesy Health Ministry
It’s possible to be healthy
By JUDY SIEGEL-ITZKOVICH
26/10/2013
The Health Ministry has finally realized that it’s better to prevent chronic disease, accidents than to treat the sick and injured.
 
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 regularly.

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 prevention.

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 Lev.

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 recommendations.

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 Sport Ministry.

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 vital.”

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 John F.

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.

PROF. 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 said.

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 isn’t easy.

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 cooperation.”

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 population.

“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 it.”

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.

Since 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 surveys.

“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 program.

“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 things.”

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 lifestyles.
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