For the last seven decades, the Central Bureau of Statistics (CBS) has been taking the temperature, so to speak, of Israel and its residents. Almost any factor that can be measured in numbers and depicted on a chart has been collected and analyzed to understand where the country is going.
But only for the last three years has the CBS issued a report on indicators relating to its “Quality of life, Sustainability and National Resilience.” The third report, recently unveiled at a special session for statisticians, government officials and journalists (including The Jerusalem Post) and others at the bureau’s Jerusalem headquarters, included quite a lot about the health of the population, both physically and emotionally.
Just 7.4% of Israel’s Gross Domestic Product (GDP) goes to health expenditures, compared to 18% of the GDP in the US, a figure that is expected by 2025 to rise to an incredible one-fifth of the US economy.
US per-capital healthcare spending is more than double the average of other developed countries. The Institute of Medicine has estimated that “30% of total healthcare spending in the US goes to unnecessary, ineffective, overpriced and wasteful services. That $765 billion in waste alone per year.
But Israel’s life expectancy at birth is number eight among the world’s 183 countries – at 82.5 years for both genders, compared to only 31 in the US (79.3). Israeli women’s life expectancy is 84.2 and men 80.7, compared to 81.6 years for women and 76.9 years for men.
Surprisingly, when measured by the number of cigarettes smoked per year by residents over the age of 15, Israel is 44th, with an average of 1,346 cigarettes, while the US is 23rd, with 1,687 cigarettes – even though there are more smokers per-capita here than in the US (and it is rising here thanks to government inaction but falling in most of the world).
PROF. DANNY Pfeffermann, the national statistician and director-general of the CBS, told the audience of 60 people that the bureau’s aim is to help government, local authorities and others to reach decisions that will improve the population’s quality of life.
“I hope it will not be left in the drawer but used for this purpose.”
The UN is constantly producing new quality-of-life and other indicators, said Pfefferman.
Israel 11th happiest country in the world according to 2018 UN happiness report
“The development of new ones in Israel requires new methodology. The statistics we collect are meant to help the central government and local authorities, among others, to reach decisions on how to improve the quality of life of residents.”
Prof. Avi Simhon, head of the National Economics Council, said statisticians used to check the country’s quality of life solely from the level of the gross domestic product, but this is far from ideal for assessing reality and getting decision makers to invest effort and resources in a problem.
“If we can show them that there is a problem, they are more likely to realize that they have to deal with it. It also helps the citizenly to better assess government performance,” he added.
There are regular media reports on the long queues in hospital emergency rooms.
“I have gone through this myself. So when we go to the health authorities, they say we have the eighth-highest life expectancy figures in the world even though we spend much less on health. So the authorities they will say leave it alone. But others feel there is a very big problem. What indicator do I show? If you present figures on satisfaction with medical services, it is usually very high, so the emergency room problem doesn’t show up.”
Simhon added that there have been many news reports of late on traffic jams, and in fact, Israeli public transport and roads were found to be the worst among those in all OECD countries.
“So what do you make of the news reports? That the newspaper publishers don’t like the transport ministry? There are Treasury officials who have a lot of influence, but there are politicians who put pressure on these officials. How do I tell decision makers what is correct and what isn’t? But if our indicators can show the reality, it will help. The criteria for choosing new indicators is that if you show results to people in charge, it can lead to improvements. So the CBS not only documents reality; it can also change it.”
He noted that the CBS also has a YouTube channel to present information to the public and not just its regular statistical reports.
ACCORDING TO the CBS, infant mortality per 1,000 live births is 3.1 here, and 25.1% of Israelis die of cancer compared to 14.4% from cardiovascular diseases. We think we’re quite healthy, with 83.7% of those of us over the age of 20 reporting that their health was good or very good. Yet 16.6% of those over 21 suffer from obesity, and just 29.5% adults reported that they exercise.
Israel has only 1.8 general hospital beds per 1,000 residents, a low figure, and just 3.3 working physicians and 4.8 working nurses per 1,000 residents, which are also inadequate.
Of a total of 61 indicators, CBS statisticians reported, there was an improvement in 29 of them since 2015, a decline in eight of them and no change in the rest. The CBS developed 14 new indicators for the 2016 report regarding the national quality of life. These included not only the number of healthy years but also trust in the health system, healthful behaviors by the population (such as eating vegetables and fruits, exercising and not smoking) and new cases of malignancies. Indicators that were monitored from previous years included life expectancy, infant mortality, body mass index, self-assessment of health and self-assessment of depression.
Although Israelis seem to enjoy complaining, the CBS quality of life report found that 88.3% are satisfied with their lives; 87.1% are satisfied by their work and 58.8% by their salaries; 59.8% are happy even with their economic situation; and 83% don’t complain about where they live. But only 53.3% are satisfied by the cleanliness in their neighborhoods, 21% feel constant or frequent stress; 6.3% feel lonely; and 33.9% had difficulty making ends meet. Almost a fifth would like to change jobs; a fifth complain that it takes too long to get to work; 51.7% reach their place of employment using public transportation; 20.2% fear that their workplace endangers their health or safety; 46.4% often or sometimes feel tension and emotional pressure while working; and 41.3% are not happy with the balance between their work and home life (perhaps the new government-mandated cut in weekly work hours from 43 to 42 will help a bit).
Only 16.1% of Israelis over the age of 21 said they observed a healthful way of life – eating five or more portions of vegetables or fruits daily, exercising regularly and not smoking. There were 30,524 new cases of cancer, at a rate of 371.5 per 100,000 people, in one year
. Of these, 16,591 were in women and 13,933 in men.
Israeli men live more of their lives in good health than women (who apparently take care of the men’s health more than they worry about their own); Arabs are more satisfied with the public health system than Jews.
The number of healthy years from birth that Israeli women can expect to live is 65.1, a bit lower than men, who can look forward to 65.4 years in good health. Thus women can expect to live 77% of their lives with health good enough that does not interfere with their functioning, compared to 81% of men’s lives.
Arabs are significantly more satisfied (84% ) with the public health system than the Jews (73%). But there were major differences depending on social status, education and place of residence.
Other factors in quality of life include leisure, culture and community; environmental quality; social and personal wellbeing; education; civil involvement and trust in government; housing and infrastructure; employment; personal safety; and information technology.
AMIT YAGUR-KROLL, who is in charge of the quality-of-life group at the CBS, said that the 2012 decision to start a quality-of-life index was to focus on the social and personal wellbeing of individuals and families – the quality of employment, technology of data, leisure, culture, community, material quality of life, the environment and involvement in civil life, including differences among the various sectors in the population.
“It’s a balance between the objective and subjective.”
The report makes use of green and red arrows to show desirable trends and where the statistics are actually going – up or down.
About 55% of those whose parents have higher education also have gone to college or university. If one parent has a higher-education degree, said the statistician, his offspring are five times more likely to get an MD degree than someone who doesn’t.
“The least successful index is civilian involvement and faith in government. While 72.3% vote in elections, only 38.8% trust the government, compared to 54.6% who have trust in the judicial system. Even worse is the statistic about having the feeling that they can influence government policy – just 13.2% agreed with that statement. Arabs were lower than average in feeling they had influence, which is not surprising, but even fewer ultra-Orthodox Jews (haredim)– whose political parties have proven very powerful in their impact on the current government – agreed with this statement.
When asked about discrimination according to one’s ethnic background and sexual preferences, Arabs complain more than Jews. Modern Orthodox and secular Jews have a higher index of how much they trust other Israelis than haredim.
More than half of Israelis are worried about road accidents and complained that they were personally affected by “violent threats on the road,” 19% of them on a daily basis. The Arab sector suffers from murders at double the rate of the Jewish sector.
Naama Rotem, who is the head of health statistics at the CBS, said that 75% of Israelis aged 21 and over had faith in country’s health system, with Arabs more satisfied than Jews and men more satisfied than women.
Comparing quality-of-life indices, as judged by residents of the various cities, Muriel Shafir of the CBS said that Rehovot takes the top prize, followed by Ramat Gan, Rishon Lezion, Bnei Brak, Petah Tikva, Holon, Tel Aviv/Jaffa, Ashdod, Ashkelon, Haifa, Netanya and Beersheba, with (poor) Jerusalem and Bat Yam at the bottom. Life expectancy is longest in Ramat Gan and the lowest in Beersheba (surely because of Beduin residents in the area). Satisfaction with public transport was highest in Bat Yam and lowest in Beersheba. Civil involvement and trust in government was highest in Netanya and lowest in Jerusalem (where the Knesset, Prime Minister’s Office and most state offices are located). But residents of Petah Tikva and Jerusalem were most satisfied with their economic situation and Bat Yam residents the least happy.
HEALTH MINISTRY associate director-general Prof. Itamar Grotto said that the four public health funds’ community clinics are the basis for daily healthcare in the country. Many other countries’ healthcare at the grass roots level is less than satisfactory. Some Eastern Europeans, he said, have none. If you have good community clinic health care, it can prevent patients from having to be hospitalized.
While hepatitis A infections used to spread like wildfire in day-care centers and kindergartens, after Israel became one of the first countries to vaccinate against it, there are today only a handful of cases. “Sanitation was bad, but we had the money to give kids the shots,” he explained.
Israel is a world leader in water recycling, at a rate of 80%, so the water is reused for agriculture; in the US, only 5% of water is recycled, probably because most locations have plenty.
Grotto’s biggest worry is the rapid aging of the population, which threatens to overwhelm medical institutions.
“We must change the paradigm and shift more healthcare to the patient’s home. Already in development are devices that will be able to monitor glucose levels in the blood using the cellphone (maybe even without taking a blood sample but just putting a finger over the camera), digital electrocardiograms and electronic medicine cabinets.
“They won’t replace doctors but they can help.”
Artificial intelligence will require doctors to redefine what they do.
“This is a challenge, as computer systems can analyze x-rays better than physicians.”
The fact that medical files can be shared by the health funds, the IDF and the various hospital networks streamlines health care without sacrificing privacy, as the data disappear as soon as they are displayed. Most important, the health authorities will put more emphasis on preventing disease and promoting good health rather than just treating it, concluded Grotto.
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