*Rediscovering America*

The Health Ministry, plagued for decades by rapid turnover of ministers not enamored of the job and senior officials who know they won’t get credit for what they do, needs an upgrade.

By
March 21, 2015 21:59
DR. RONIT ENDEVELT

DR. RONIT ENDEVELT. (photo credit: JUDY SIEGEL-ITZKOVICH)

 
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The Health Ministry, like numerous other government ministries over the past few decades, suffers from a number of ailments – chronic fatigue disorder, myopia about the need for long-term planning, periodic paralysis, the inability to think out of the box, repetitive motion disorders when new officials replace old ones and are unaware of what has already been done and stuttering when ministers and senior officials decide policies and try to explain them.

The fact that there have been 19 health ministers in the past three decades and that most of the occupants did not really want the job only complicates the matter. Yehoshua Matza, after serving as a Knesset member for 15 years, headed the Health Ministry for a whole three years, from 1996 to 1999. He openly told health reporters when he took office that he regarded the portfolio as a kind of consolation prize. “I really wanted to be tourism minister,” he confided, so he could see the world.

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As health minister, he spent an inordinate amount of time visiting other countries to examine their health systems and got his wish.

Shas Rabbi Shlomo Benizri served as health minister for exactly a year, until July 2000, and was later convicted of accepting bribes, breach of trust, conspiring to commit a crime and obstruction of justice, leading to a 2.5 years in prison.

And cigar-smoking former Jerusalem mayor and prime minister Ehud Olmert, who was health minister for two years in the early ‘90s, faces a six-year prison sentence and NIS 1.5 million fine (which he is appealing). He was convicted of accepting bribes in exchange for helping Holyland Park land developers and is liable to be punished for other allegedly shady involvements as well.

When United Torah Judaism MK Ya’acov Litzman ran the ministry as deputy health minister, he caused life-threatening and expensive delays in the construction of anti-missile fortification for medical facilities at Ashkelon’s Barzilai Medical Center, which was constantly fired at during wars of terror from Gaza. Litzman insisted pagan graves from the Byzantine era at the construction site were “Jewish” and could not be moved, despite conclusive evidence to the contrary from archeologists and historians.

And as health minister, Yesh Atid MK Yael German’s first decision was to prohibit fluoridation of the country’s drinking water, which has been practiced for many decades to reduce dental cavities and is endorsed by the vast majority of dentists and public health experts inside and outside her ministry; her decision, which ministry experts want to overturn but which requires the passage of a law is likely to create a generation of poor children with rotten teeth if not abrogated.

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The ministry was emotionally devastated when five of its officials were found by courts to have been negligent in the 2003 case in which three infants died and 23 others suffered severe, irreversible damage to their hearts and nervous systems.

The children had been fed exclusively with imported Remedia formula that was missing the key vitamin B1 (thiamine). A former food technologist for the formula company was sentenced to two-and-half years in prison for negligent homicide by the Petah Tikva Magistrate’s Court.

Remedia’s CEO, Gideon Landsberger, was acquitted of negligent homicide and convicted of violating the standards law.

Dr. Dorit Nitzan-Kaluski, a respected pediatrician and head of the ministry’s Food Service and nutrition department, was severely criticized for failing to be aware that the vitamin was absent. She and four ministry inspectors were indicted for negligence and required to do community service. Nitzan-Kaluski banished herself from the country and has since been working for the World Health Organization in Eastern Europe.

She was replaced as head of the nutrition department (which separated from the Food Service) by Dr.

Ziva Stahl, who after a few years was quietly shifted by management to a less senior nutrition job. Meanwhile, public health chief Prof. Itamar Grotto took over responsibility for the Food Service along with his other tasks.

With a tiny professional staff of clinical dietitians, the ministry outsourced its Program for an Active and Healthy Life (dubbed in Hebrew Efsharibari or “It’s Possible to Be Healthy”) to reduce salt, fat and sugar in processed foods, promote the consumption of whole-grained bread and more. The ministry’s health promotion unit was formally in charge, and it hired Prof. Danny Moran to run it. But he was dismissed after a short time in the post when ministry officials saw he was “not suitable.”

The program’s publicity campaign was run by Pnina Shalev, German’s personal spokeswoman, who has her own public relations company, to which she devoted half of her time and the rest to working for the minister.

While food companies have gradually reduced salt in their products, nothing substantive has been done to encourage the public to eat whole grains or make them cheaper than white bread, rice and pasta.

A professional cadre of tenured ministry professionals is often hard-working and dedicated, but some political appointees linger on until retirement without making significant contributions. The professionals are often furious when, as with German’s prohibition of fluoridation decision, ministerial decisions fly in the face of policies taken for granted in the Western world.

An example of misplaced ministry policies is its failure to mandate the iodization of salt, fortification of flour with folic acid and vitamin B complex,and adding vitamin D to all milk and other products. Even the Palestinian Authority has managed to accomplish most of that, like all the countries in North and South America. Yet, the ministry fails to implement it. Another is that while bemoaning the local authorities’ failure to adequately enforce no-smoking laws, the ministry has done almost nothing to goad them into action.

Unfortunately, due to the frequent Knesset elections that constantly bring in new health ministers – each of whom chooses his own director- general – instability is the rule. As ministers and directors-general know they will not last long enough to get credit for fundamental changes – and that their policies may even be rolled back – they tend not to grapple with controversial and difficult changes.

Why bother on a long-term project if their successors will get the credit? Sometimes, the new arrivals are even unaware of activity that already exists and “rediscover America.”

CURIOUS AS to what was going on now in the ministry’s nutrition department, I asked to interview the new director, Dr. Ronit Endevelt, who has been in the post for eight months. She sits in the ministry’s high-rise headquarters in Jerusalem’s Yirmiyahu Street.

The department, she said, focuses on nutrition in both the healthy population and that of populations that suffer from various diseases and who need special nutrition. It does so in cooperation with other bodies in the ministry and outside out it. The department aims at “protecting the authenticity and mandatory standards of food, collecting and disseminating information on Israeli food and the population’s nutrition condition, as well as locating populations at risk and with special needs. It also is a resource for developing training, expertise and setting manpower slots to improve the population’s nutrition and creates regulation and legislation for medical institutions.”

The nutrition department, with the Central Bureau of Statistics, periodically conducts surveys on the nutrition status of various age groups and publishes them in print and on the ministry’s website. The department is also supposed to provide information and responses to the written and broadcast press, professionals in the field and ordinary citizens.

Born in Tel Aviv, Endevelt earned degrees in nutrition, continuing medical education and health management.

She built and managed the nutrition department at Maccabi Health Services and ran health promotion at the ministry. Last July, she was named head of its nutrition department.

“We have seven dietitians who focus on geriatrics, mental health, hospitals (including private ones), public complaints and research. We receive many queries from the public and handle public complaints. We also conduct MABAT surveys of various age groups – personal interviews that are the base for our nutritional policy. We have a database on nutrition and many voluntary professional committees, including experts in child nutrition and pediatrics. But we lack dietitians for minorities in the hospitals and the health funds and in some local offices due to lack of budget.”

The US Food and Drug Administration is a huge, multi-billion-dollar world authority on food and medications.

But although the ministry has occasionally discussed the need for such an objective authority here, it hasn’t even contemplated adopting such a model due to the costs.

“It would require opening a huge central lab to concentrate all tests of food and a large staff. It would be much more objective,” said Endevelt.

“Instead, we test some of food ourselves or send other samples to labs abroad. We want to do mapping of what exists.”

Endevelt said she is planning on launching a program in ultra-Orthodox schools, as many families eat food that is not nutritious.

“One can see haredi parents on the eve of Shabbat buying cheap junk food as “treats” for the holy day and for going to synagogue. Stores in haredi neighborhoods sell cheap, blue and green (artificially colored) soft drinks, and cotton candy and other nutritionally worthless sweets are common. The families need to provide more nutritious food; it doesn’t necessarily have to be expensive.”

The ministry department is responsible for fighting the baby formula companies’ constant pushes to promote their products at the expense of breastfeeding; the ministry is bound to do this after signing years ago a World Health Organization framework agreement. But some formula companies make exaggerated claims in advertisements and try to unduly influence the media with press releases.

The department’s inadequate supervision of formula companies was sharply criticized by Prof. Francis Mimouni, chief of neonatology at Jerusalem’s Shaare Zedek Medical Center, who after seeing recent advertising by one company said: “In my opinion, this advertisement is contrary to the policy of the Health Ministry, which signed the charter for the promotion of breastfeeding; it should be prohibited.”

Endevelt disclosed that a “new” project she was launching was the “mapping of what food is served to preschool children in afternoon frameworks that take care of them until parents return from work” (called tzaharonim). “Legislation and guidelines on nutrition are needed there. We will work on this with the local authorities and the Finance Ministry.”

But the nutrition department head was totally unaware of the years of intensive and successful work that former deputy Jerusalem mayor Rachel Azaria – who left to run on the Koolanu list for the Knesset – did in this field. She didn’t even know who Azaria was. The former deputy mayor was hurt and angry when she learned that Endevelt was in the dark about her intensive activity to ensure more nutritious hot meals in nursery and kindergartens and in after-class frameworks in elementary schools.

Working with a parent groups called Aruhat 10, the Jerusalem Education Authority and others, “We have changed menus in 450 Jerusalem kindergartens,” said Azaria.

“The menus have reduced amounts of fat, salt and sugar and are based on whole grains, unprocessed meat and poultry, pulses, vegetables and fruits.”

In addition, kindergartens in socioeconomically disadvantaged neighborhoods have joined the Jerusalem Municipality pilot for healthful but tasty nutrition that Azaria created last year. Beginning in 15 kindergartens around the capital, it was warmly welcomed by parents, some of whom have begun to change the foodstuffs they themselves serve at home to create more nutritious meals. Azaria noted that when children are served nutritious foods at a very young age, they accept them as tasty and prefer them through adulthood.

Kindergarten assistants have attended lectures on nutrition from clinical dietitians and tips on serving such meals. The Jerusalem Municipality has committed itself to expand these programs to additional kindergartens, Azaria said proudly.

“We have managed to turn Jerusalem into the pioneer in healthy food for young children. It all began with parents who raised the issue a few years ago.”

When this reporter mentioned the stickers produced by the United Hatzalah president and founder Eli Beer to prevent young children from being asphyxiated in locked cars, Endevelt said she was unaware of the name and of where UH was headquartered. But just a look out her office window could have told her that Beer’s organization is located across the street from the Health Ministry and that his fleet of ambucycles is parked at the corner.

Endevelt also said she was starting to work on the idea of a breast milk bank to provide donations from healthy lactating women to new mothers with premature babies and others who need mother’s milk. But the idea, first implemented independently by haredi women decades ago, has been known in the ministry for years.

Since taking office, Endevelt said, “We have made a good start, and we are busy working on regulations in various spheres. Since I [took office], my department has organized professional meetings, supervision by nutritionists in hospitals and courses for training dietitians. We are doing research with the National Insurance Institute on nutritional status in lower socioeconomic population.

We helped build better nutritional value in the food basket given to poor people. We recommend that there be dietitians in schools. We want to work on a basic healthy food basket for low-socioeconomic groups.”

Much of the department’s work involves the preparation of regulations rather than promoting actual change in the public by teaching health promotion. Thirty years ago, the head of a major pasta company rejected the idea that noodles could be marketed without the artificial coloring of tartrazine, which is suspected of being a carcinogen.

“Women would never serve noodles that aren’t yellow because they think the color means they contain eggs,” he said then.

But thanks to articles and programs in the media, the public have rejected yellow noodles containing artificial coloring. There remains much to do, however, about the harmful use of caramel and burnt grain as artificial coloring.

The nutrition department seems to be mired in creating new rules too often ignored in the field. Instead, teaching the public what is nutritious would cause individuals to bring about change by demanding change and voting with their wallets.

Endevelt agreed that “educating the public about nutrition is, in the long run, much more effective that creating guidelines and laws.”

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