Just as treating acute diseases has always been regarded as more dramatic and dazzling than preventing disease, studying or teaching in a school of public health has taken the back seat to doing the same in a medical school. One didn’t see the stars of TV’s Dr. Kildare, Marcus Welby. Ben Casey. ER or House M.D. being lauded for helping a patient to lose weight and exercise or get vaccinated against the flu, pneumonia or tetanus.
Even the Health Ministry paid almost no attention and allocated only meager budgets to promoting healthful lifestyles and preventing illness – until recently, when Minister Ya’acov Litzman began to urge people to eschew junk food and plan to label processed foods as being good or bad for you. Even so, it has totally omitted from its campaign the importance the exercise as a regular routine, perhaps because in the United Torah Judaism MK’s milieu, physical fitness is largely regarded as an ancient Greek idea of glorifying the body.
Prof. Ora Paltiel, the director of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine since last year, noted in an interview with The Jerusalem Post that “the glory in medicine has always been curative. The doctors who treat – especially surgeons – are regarded as the heroes. A patient has symptoms that have to be diagnosed, and an operation is so dramatic because it can immediately relieve the patient’s suffering.”
People, she said, “give more weight to alleviating suffering than to preserving health. It’s a mindset. I myself understand both sides, as I am a hematologist who continues to see patients in my clinic once a week, including those with lymphoma and other blood cancers. We use aggressive means to try to heal them. But I also appreciate the other side of promoting and preserving public health. Unfortunately, it’s not ‘sexy’ because you never see your successes; they never complain.”
PALTIEL, BORN in Canada to a family that originated in Romania and the Ukraine, was brought to Israel as a young child when her father did a doctorate in political science and her mother Freda received her master of public health degree in 1961 at the HU-Hadassah School of Public Health. “She was director of women’s health in Canada’s ministry of health for many years.” Then the family returned, and Ora grew up in Ottawa. At 17, Paltiel went to Toronto for a bachelor’s degree in physical anthropology, even though she “always knew she wanted to be a doctor.”
There she met and married Prof.Mark Clarfield, who received his MD degree from the University of Toronto and specialized first in family medicine, then community medicine and public health and finally in geriatrics. Until 1992, he was chief of geriatrics at the Jewish General Hospital as well as head of the McGill division of geriatric medicine and then reached the rank of professor.
In 1992 the Clarfield family he moved to Jerusalem, where he worked for seven years as head of geriatrics at the Health Ministry and then became in charge of geriatrics at Soroka University Medical Center and geriatrics professor at Ben-Gurion University. He subsequently was appointed head of BGU’s Medical School for International Health.
Her career has some parallels. She went to McGill Medical School and specialized in internal medicine and hematology and received a master’s degree in epidemiology and biostatistics . “I wanted to work with patients but also to be a researcher with an academic position. I worked for a while in a lab,” Paltiel recalled, but I wasn’t very good at it. I learned about clinical trials and wanted to do research on human beings. I worked for three years as a senior physician in hematology at McGill’s Montreal General Hospital.”
Then, after the first Gulf War took its toll on Israel, the two decided it was time to make aliya. They had two children, aged six and three (a third was born here); now, the couple have three grandchildren. Mark decided to volunteer during the war; Ora sent him to visit the Braun School in Jerusalem where she had previously made connections and, within a week, she was offered a job to develop the field of clinical epidemiology.
Since 1992, she has worked in public health and epidemiology while continuing to work as a hematologist at the Hadassah-University Medical Center.
he was for three years head of Braun’s international program before taking on the directorship of the Braun School. When she took over from Prof. Yehuda Neumark as head of the School (he is now head of its International Master’s of Public Health Program), she decided to pay special attention to health in the capital. “I had a vision that Jerusalem is our environment, and we at the school should work to improve the health of Jerusalemites. The Science, Technology and Space Ministry offered a NIS 1.3 million grant on promoting healthful lifestyles and technologies. Our school applied for it and won.”
Braun, under Paltiel, set up a Community Academic Partnership (CAP), and in the next three years “we want to map all programs involved in health promotion in the city, both in the western and eastern parts, by public and voluntary organizations. We will examine not only what and where they are but also the quality of their work according to evidence-based criteria. Then programs can be built and expanded based on what really succeeds.”
Paltiel pointed out that among the Arab population in eastern Jerusalem, especially women, are very overweight, because there are few sidewalks where they can walk or ride bicycles, no fitness or walking clubs. And Arab men are notorious for being the biggest smokers around the country PUBLIC HEALTH, she explained, is a multi-disciplinary field, blending a wide range of topics and areas including health and society, economics, policy and administration, heredity and environment. The breadth of public health research and practices spans from the molecular to the community level and from the local to the global level.
Students gain knowledge and expertise in public health and community medicine; acquire basic measurement tools (epidemiologic, statistical, behavioral and financial) related to public health; learn about planning, management and assessment of community, regional and national health services; quality control of medical services; and analyze community health data and developing a community health program.
Braun’s International Program for Master’s in Public Health currently has 21 students – all with donated scholarships – nine of them from Africa – Ethiopia, Sierra Leone, Kenya, Zimbabwe, Ghana, Nigeria and Cameroon. These will be added to the 850 graduates from 92 countries in the world. Usually, the Program also hosts students from North America and Europe, but none this year. “Our IMPH students study five days a week in English. The students are physicians or worked in their countries in other health professions, but they wanted to know more. We take them on tours all over the country and celebrate the Jewish holidays with them,” Paltiel said. She took a break from the interview to make an appearance at their Purim party in which the African students dressed up as Ahasuerus and Queen Esther and sampled hamentaschen.
One student, a Muslim physician from Sierra Leone, said he gave up a scholarship at the London School of Tropical Medicine to come and study in Jerusalem, where he learned that Jews are not the “evil people” that he was told they were in his native country.
Paltiel said that some of the graduates have become so impressed with Israel and its people then when they return home and marry, they have named their children “David,” “Hadassah” or “Israel.”
Braun’s graduate school for Israelis meets once a week for two years in Hebrew (so students can work at their regular jobs as well). “We have 100 students, including 33 doing their doctorates and the rest doing master’s of public health, masters in health administration (MHA) or MSc degrees. They include physicians, nurses, physiotherapists, pharmacists and others, and there are over 1200 graduates in key positions in the health system in Israel.”
“Ours was the first school of public health in the country, established first as a program in 1961 and as a fully fledged school in 1980. Now there are schools of public health at Tel Aviv University, Ben-Gurion University and the University of Haifa and MHA programs in the local colleges.
So we have a lot of competition and need to attract students with more programs while maintaining high standards,” Paltiel stressed.
The Braun School has 15 tenured faculty from the Hadassah-University Medical Center, the Hebrew University and Clalit Health Services.
It also has adjunct teachers from the Health Ministry who teach part time.
“The school is struggling vis-a-vis the Hadassah Medical Organization and its continued support, as are the other academic institutions affiliated with Hadassah. It is determined to maintain and improve its rightful place in HMO. It’s ironic, because the school is the embodiment of the original mission of the Hadassah Women’s Zionist Organization of America, which sent nurses to Jerusalem to treat poor and sick children and established the idea of tipat halav (well-baby clinics). HWZOA’s mission was thus involved in public health before its involvement in curative medicine,” Paltiel continued.
“HMO has to feel the school is precious to it, just as we at the school feel Hadassah is precious to us.”
Paltiel added that she is very proud of the fact that through the school’s small faculty the medical students on the Ein Kerem campus hear hundreds of hours of lectures on public health, research methods, biostatistics and health administration during their studies – more input than almost any medical school in the world. “Physicians who are also public health specialists and non-physician epidemiologists and statisticians mean better public health, but doctors trained in these disciplines will also be better physicians to their patients” said Paltiel.”
Braun also established the first Masters of Veterinary Public Health program in Israel. This program arose out a growing need to deepen knowledge and strengthen the relationships between veterinarians, public health practitioners, the public health system and the health of the population, she said. It’s a joint degree program of the Braun School, HU’s Koret School of Veterinary Medicine, the School of Nutritional Sciences and the department of agricultural economics and management in the agriculture faculty “The program comes from the very modern holistic concept of ‘One Health.’ We all live on Earth – plants, animals and humans, and we can’t be separated. There is bird flu, swine flu, HIV. Humans and animals share diseases. Individual veterinarians approached us some time ago for joint programs. A handful of them spend a whole year here learning the principles of epidemiology and public health. It’s a ‘boutique program.’ The first year we had 12 students.
It will never be large but it is one of the handful of such programs in the world.”
But Braun is nevertheless little known to Israel’s general population.
The spokesmen of the HMO and HU even failed officially to announce her appointment to the media or release much on the school all through the years. Although individual physicians there – such as Prof. Eli Richter on road accidents for many years and today Dr. Hagai Levine and Prof. Amnon Lahad on a variety of topics, including tobacco – have spoken out publically, the Braun School has rarely made public statements or fought for causes.
“There is tension in schools of public health around the world about how activist an academic institution should be. It remains an unresolved issue in Jerusalem as well. For Eli Richter, there was no question that we must be activist and not just remain in our ivory tower, doing research and teaching. But the jury is still out.”
Asked about Litzman’s plans to require manufacturers and importers of processed foods to label their products according to the amount of sugar, salt and fat in them, Paltiel commented: “People have a way of ignoring labels. It is built in in our psyche. I think labels are much less likely to be effective than education, making healthful foods cheaper and setting ‘sugar taxes’ [that the health minister strongly opposes, probably because it would cost a lot more for ultra-Orthodox families who are his constituency]. More serious steps are needed.”