Public health – disease prevention and health promotion – has long been a stepchild of the Health Ministry, with less than two percent of its budget going to this purpose and the huge bulk invested in services to treat diseases. On the top of that, public health in most of the country’s periphery has taken a back seat compared to institutions in the center.
But now there is some good news. The Ashkelon Academic College will this month open the country’s first Department of Public Health giving bachelor’s degrees; all the rest – at the Hebrew University of Jerusalem, Tel Aviv University, the University of Haifa and Ben-Gurion University of the Negev in Beersheba – are master’s-degree programs for those who already have BAs.
As the southern, coastal city has been fortunate in enjoying local initiatives for public health, the new school on campus will mean a significant boost. Young people just contemplating careers will consider working in the public health field, and professionals who are already employed in health-related jobs, for example as a clinic manager of a health fund, will consider upgrading themselves for a BA at the college.
“The college was established by Bar-Ilan University in Ramat Gan in 1965,” its president since 2013, Prof. Shlomo Grossman, told The Jerusalem Post in an interview. “We have 4,000 students in a variety of fields for a bachelor’s degree, plus 1,000 more for non-degree certificates.” These include a School of Economics, School of Social Work and departments of sociology, social sciences, politics and government, psychology and exact sciences. “We will in future also award a master’s degree in criminology studies,” he added.
Grossman added that he was proud his college is the first to have a department of public health, which will share the building of the nursing school. The two fields are now part of the college’s School of Health Sciences, which also hopes to add studies in nutrition, speech therapy and occupational therapy.
“It is unfortunate that the ministry doesn’t spend more money on prevention and promotion.
We recognize that primary prevention, not just treatment, is very important.
When our students graduate, I’m sure there will be jobs for them.” Health education should be taught in elementary and high school to all pupils, continued Grossman. “It can build all kinds of positive health behaviors and prevent disorders that are costly to treat. But it isn’t, and the School Health Service, which was privatized, doesn’t educate about health in the schools.”
The college president noted with satisfaction that his institution of higher learning was not hit directly by Hamas rockets during Operation Protective Edge, but it had to close down summer classes because of the danger to students and faculty. “It affected us emotionally and really disrupted exams and registration. But we have overcome it. We added an additional round of opportunities for exams, and the students did well,” he said.
Before joining the Ashkelon College, Grossman served as a leading biochemist and molecular biologist and performed important research on fats and antioxidants.
Between 2003 to 2009, he was chairman of the Council for Higher Education’s powerful Planning and Budget Committee. At Bar- Ilan, he served in senior positions in the university’s academic administration, including that of vice president of research. For many years, he was also active in the Israel Science Foundation and is today a member of the European Academy of Sciences and Arts. As a part of these organizations, he has worked to promote excellence in academic instruction and research, the advancement of research-and-development programs and the cultivation of partnerships between Israeli academia and leading research institutions in Europe and the US.
THUS IT was natural that he gave his backing to the establishment of the new department of public health in the School of Health Sciences, both of them headed by Prof. Ted Tulchinsky. He has had an impressive public health career, spanning decades, that led in 1973, to his being appointed deputy minister of the Canadian province of Manitoba department of health and social development in Winnipeg, Canada.
He and his wife Joan and three children made aliya in 1976 “for Zionist reasons. It wasn’t an easy decision, but I have no regrets.” One son returned to the US, where he is chief of anesthesia at Beth Israel-Deaconess Medical Center in Boston; a second son is doing a nursing course at Hadassah, while his daughter is a student in Ashkelon.
Since moving here, Tulchinsky has had long careers as a senior administrator in the Health Ministry and also served as a faculty member of Jerusalem’s Hebrew University- Hadassah Braun School of Public Health and Community Medicine. Now, with his retirement from Hadassah (but he continues to teach two courses in its International Master of Public Health program for foreign physicians), and he is deputy editor of a Paris- based international journal called Public Health Reviews.
Tulchinsky is now focusing his efforts on promoting health from Ashkelon. “In 2001, I had retired from the Health Ministry, and my wife retired as a nurse at Hadassah, Tulchinsky recalled. “In 2004, she wanted a house by the sea and a garden, so she wanted to settle in Netanya, but as I taught at Jerusalem’s School of Public Health, we compromised and moved to the Afridar neighborhood in Ashkelon. When our three children grew up and moved out, we decided to buy an apartment instead, and with ‘good timing,’ we moved into our penthouse in the Barnea quarter of Ashkelon in the middle of the war with Gaza..”
The Hamas rockets and Red Alert sirens occurred about 10 times a day, in Ashkelon.
“One landed not far from us. We were invited to relatives’ homes in Jerusalem, but we like to stick to our routines, so we just stayed.”
Tulchinsky comes from a very Zionist family.
In fact, his parents gave him he name Theodore Herzl Tulchinsky (but he calls himself Ted). “My father escaped from Russia in 1921 went to Romania after the Russian Revolution.
Then he received a visa to Canada and arrived with nothing in his pockets. He married my mother, who was born in Canada and they opened a ‘ladies’ wear’ store.. They lived in Brantford in the Canadian province of Ontario , a city adjacent to an Indian reservation. Brantford was a community of 60,000 people, and there were 60 Jewish families, with an Orthodox synagogue.”
He went to the University of Toronto to do his medical degree, followed by internship at the Montreal Jewish General Hospital. He also served in the Royal Canadian Navy as a doctor (after his aliya, he spent five years as a reserve medical officer in the Israel Defense Forces). After specializing in cardiology and internal medicine, he worked as a general practitioner in Saskatchewan, Canada.
Following five years as a senior health official in Manitoba, where he was responsible for managing a department of over 3,000 employees and various institutions, he and his family moved to Jerusalem. There he he served for two years as director of the Health Ministry’s public health service, responsible for managing the preventive health system operated through district health offices; sanitary supervision, maternal and child health services at 600 tipat halav centers, immunization policy and more.
From there, Tulchinsky was named by the ministry as coordinator of health services in Judea, Samaria and Gaza and for 13 years was involved immunization policy, nutrition and child growth monitoring and other issues, including a village health worker project in Hebron, high risk pregnancy care, prevention of anemia, hospital discharge information systems and preparation of annual reports for the World Health Organization. When the Palestinian Authority took over responsibility for health services, Tulchinsky continued as coordinator for health with the PA until 1979, when he was named director of the ministry’s personal and community preventive health services and responsible for a large number of public health matters from vitamin and mineral enrichment of basic foods, asbestos-related disease and exposed-worker followup to thalassemia, waterborne disease, child growth monitoring and nutrition. He retired from the ministry after 25 years of service but continued teaching international students at Jerusalem’s school of public health.
“In summing up experience of 40 years in public health, I have published with a Russian colleague, The New Public Health: an Introduction for the 21st Century, a textbook of 882 pages for Russian schools of medicine, nursing and other health disciplines,” he related with pride. “It brings together, a broad overview of modern public health, including infectious diseases, family health and chronic disease, as well as health management, organization of public health services and evaluation of health services. It is studied in medical and nursing schools and libraries throughout the former Soviet Union and was translated into many languages including Russian, Bulgarian, Mongolian and Georgian.
THREE YEARS ago, Tulchinsky wrote a letter to the then-president of the academic college, Prof. Moshe Many, a former president of Tel Aviv University who retired and went to head the Ashkelon college. “I suggested that his school create a BA track in public health.
Prof. Many approved it in principle. Then Prof. Grossman came, and we worked on it together. Now I head it,” he said. This program is so important to strengthen health manpower development in the south and provide learning and teaching opportunities and jobs for young Israeli academics in public health-related fields.”
Ben-Gurion University, Tulchinsky continued, “has a school of public health that awards master’s degrees, but our own threeyear degree program focuses on the BA level to make possible opportunities not only for young college students starting out but also for those already in the field. The Council for Higher Education gave its formal approval seven months ago. The government subsidizes us, and tuition is the same as in any university or public college. There is also a lot of financial assistance to students.”
The Ashkelon campus has six buildings for teaching plus dormitories and owns apartments that students share. The student body is varied, with Jews and Arabs, including Beduin. Tulchinsky expects a public health department class of 15 to 20 students. “There will be a new public hospital in Ashdod, so it will need a lot of trained public health employees. There will also be an expansion of Soroka University Medical Center and a planned new hospital in Beersheba.”
The college’s nursing school, which will have a new four-year curriculum for an academic agree, incorporates Barzilai Medical Center’s nursing school, where students studied for three years and earned only a diploma, not an academic degree. “With the new program, we had such an influx that we had to stop accepting new students,” Grossman related.
Ashkelon, surprisingly for a city in the periphery, “has a long tradition of health promotion and disease prevention,” said the dean. “Back in the 1970s, there were programs to control blood pressure. This became a national program of the health funds and helped to dramatically reduce deaths from stroke in Israel.”
But while there has been progress in public health, there have also been reversals. As an example, school health services have been privatized, with the private nurses not having time to teach pupils about smoking, drugs, eating disorders, posture and other important matters.
Health Minister Yael German’s recent decision to prohibit the fluoridation of drinking water infuriated Tulchinsky and many colleagues at Hadassah, the pediatric and dental communities in the country because it is a sfe inexpensive way to improve health of children and adults and banning it by the minister will harm the peripheral communities and the poor people in the country.. They are trying to reverse her decision by appealing to the High Court of Justice.
“And the ministry still hasn’t done what is done around the world – the fortification of salt with iodine to minimize harm to newborns by thyroid deficincy; of folic acid in flour to further reduce neural tube defects in fetuses or vitamin D in most milk for a large variety of health benefits. We will invite Minister German to our department to make her more aware.”
Tulchinsky has been gratified to receive numerous applications from would-be teachers in his new department. “We have core group of four people representing a variety of fields including basic sciences, epidemiology and health management. Most of them are young but have done research and produced many journal articles. We also have good relations with the district health offices in Beersheva and Ashkelon and with Barzilai.”
The department is already working on establishing a joint project with the school of public health in Lausanne, Switzerland on managing diabetes during the early stages in patients.
Although it is a relatively small college and not part of a university, Tulchinsky’s public health department will promote research.
“We aren’t required to, but it supports high quality. In their third year, all students will have to conduct small research projects at workplaces, tipat halav, health funds or hospitals under our faculty’s supervision,” Tulchinsky concluded.