Finally, a nod at public health

Jerusalem’s 10th Israel Medical Conference innovated by giving much time to health promotion and disease prevention.

It took a decade for the annual Israel Medical Conference to focus most of its discussions on preventing disease and promoting good health rather than just talking about hospitals and dealing with disease.
By chance or not, it coincided with the awakening at the Health Ministry – which has always devoted less than two percent of its budget to disease prevention – to the fact that much money can be saved this way. Minister MK Ya’acov Litzman has even made junk food public enemy number one.
Over 1,000 members of the general public attended the free, all-day event at Jerusalem’s International Convention Center 12 days ago. Sponsored by the Hadassah Medical Organization, Shaare Zedek Medical Center, Bnai Zion Medical Center and various public organizations and companies, the event’s theme was called “360 Degrees of Health.”
The event gave the sponsors the opportunity to raise subjects from nutrition to preventing infections in hospitals and allow their experts to speak on new medical advances.
Personages such as President Reuven Rivlin, Litzman and Jerusalem Mayor Nir Barkat greeted the audience.
Prof. Itamar Raz, head of the diabetes unit at Hadassah University Medical Center in Jerusalem’s Ein Kerem and of the Israel National Diabetes Council, noted that tobacco and sugar are the two most dangerous substances to which people are routinely exposed. Both, he said, are addictive.
“In, 1970, there was a recommendation to reduce the amount of fat in food, so companies replaced fat with sugar and salt. Twenty years later, the obesity epidemic began in the US. Today, many US states have populations with huge amounts of diabetes cases. The rate rose by 150% from 1970,” said Raz.
Sugar cannot be completely cut out from the diet, he continued, “but it shouldn’t be more than 10% of the daily diet. Yet, today, most people double that, mostly by consuming large amounts of soft drinks. We have to intervene so that children from infancy don’t become addicted to sugar.”
According to the Hadassah metabolism expert, the centers in the brain that react to cocaine are the same ones that react to sugar, which “makes us feel hungry so we want more. Artificial flavors in food make people more addicted to sugar, which is pushed by a strong industrial lobby. Very few people realize the dangers of sugar.”
Most “sugar poisoning” comes from industrialized food, not the amount added to a home-baked cake, said Raz.
“It is similar in Israel, and if we don’t make changes very soon, our obesity situation will be like that in the US. I am glad that the current health minister has raised the issue, but we are only at the beginning of change. We must raise public awareness of on the dangers of too much industrialized food, especially its sugar content.”
Including the natural sugar in fruit, children should consume no more than six or seven teaspoons, and adults eight or nine teaspoons of sugar a day, and all should eat less industrialized food. We should eat more vegetables and other natural things, Raz recommended. He bemoaned the fact that white bread – which is harmful to health – is subsidized and price controlled by the government, while whole wheat bread is expensive and not subsidized, even though both cost the same to make.
“Government policy causes us to poison the population,” he asserted.
Free refreshments at the conference included admirable amounts of cut vegetables and yogurt with granola, but there were also such mountains of baked goods made from trans fats – from rogelach to burekas – that some from the audience mentioned it when the subject of food was raised from the podium. Even the sandwiches sold for lunch were all made from white, not whole-wheat, flour.
ARIK SCHOR, a former director-general of Tnuva, said that when he ran the huge dairy company, he decided to cut the amount of salt and sugar in products.
“There used to be a large amount of salt in cottage cheese. We decided to cut it, but we couldn’t do it suddenly, in one effort. The taste has to be reasonable; if not, the public will go elsewhere or add salt or sugar to what we make. We had to do it slowly, every six months, so they’d get used to the taste.”
As 75% of food we eat comes readymade from companies, the responsibility for high amounts of salt and sugar in the diet is that of industry.
The excess salt does not come from the saltshaker on the table, said Schor.
The lack of food security for many low-income pregnant women and new mothers is very worrisome, said Yael Amad-Tulov of the International Fellowship of Christians and Jews, who is involved with giving grants to 5,000 such women around the country.
“Single-family women in fertile ages are poorer than men. It’s hard for them to pay for the costs during pregnancy. We can’t solve the problem, but we will start with those who live in poverty and are getting payments from the National Insurance Institute.”
Eating more fruits and vegetables offers significant protection against irritable bowel disease, including Crohn’s, said Prof. Dan Turner, an expert in gastro diseases in children at Shaare Zedek.
“The prevalence of such diseases is relatively high and rising. Jews have a higher risk due to genetics,” he told the audience. But the risk can be reduced by consuming more natural food.
“The US Food and Drug Administration allows companies to add 4,000 chemicals to the products they manufacture. The industry uses a lot of emulsifiers and other additives that raise the risk of irritable bowel.
A lot more is known today about these chemicals than when the FDA approved them. I recommend that you prefer foods without additives as much as possible, because we know their effects only on some people and conditions and not on others.
He noted that his department gives special natural formulas for weeks to Crohn’s patients that reduce inflammation more than if they took steroid drugs.
IN A roundtable discussion of nutrition from infancy to old age, Shaare Zedek sports medicine head Prof. Naama Constantini noted that obesity results not only from what one eats but also from how much energy one has expended.
“Many Americans are obese, but statistics show they are not eating more than 20 years ago. The problem is that they just don’t move!” Only nine percent of Israelis carry out aerobic exercise daily and 20% do it three times a week. In the Arab sector, only six percent get that amount of exercise, said Constantini.
Dr. Ofer Bustan, deputy head of the sports administration in the Culture and Sports Ministry, added that there is a lack of sports and sports facilities in the schools, especially in the Arab community.
“Some 2,500 more sports facilities are needed nationwide in the schools.”
Dr. Nihaiya Daoud, a physician from Ben-Gurion University’s public health department, said that half of all Arab families around the country “live in food insecurity compared to only 14% in the Jewish sector, and that there is a much higher level of anemia due to poor diet among Arab children. This is at a time when huge amounts of good food – NIS 1.4 billion a year – are thrown out uneaten.”
HEALTH MINISTRY director-general Moshe Bar Siman Tov, a former Treasury budget official who has been promoting public health at the ministry since taking his new job less than a year ago, noted: “We are working on prevention because tens of thousands of Israelis die from sitting down, smoking and eating poor diets. One out of five first graders are overweight or obese; one of two adults is overweight. If we continue like this, we will reach obesity levels of countries whose example we don’t want to follow.”
There is a constant rise in the number of diabetics, especially in the socioeconomically deprived, he said.
“Israeli youth drink more soft drinks even than Americans. Our consumption of sugar and salt is very high. Schoolchildren get more than twice the maximum recommended amount of salt. People can have a normal body-mass index and not be overweight but consume too much sugar and salt.”
Bar Siman Tov explained that treating those who get sick due to improper nutrition “costs a lot of money.
We’ve changed our outlook from just dealing with disease. We don’t accuse the overweight for being too fat. It’s the environment in which we live.
“Part of the ministry’s plan to fight the phenomenon is to require clearer information on food labels. The language must be clearer, because even if the data is clear, people don’t understand their impact. Products will have to show graphic teaspoons to represent the amount of sugar in them. Unlike tobacco, that we urge people not to use, people have to eat. We are working with the food industry and introducing regulatory changes over time. We will restrict advertising of dangerous products to children. We want to change the contents of industrialized food for all of us. But it won’t be easy, as we Israelis have gotten used to eating too much salt and sugar.”
CONSIDERABLE AMOUNTS of time during the afternoon session was devoted to nosoconial infections – those contracted in hospitals by patients even though they entered the medical center without them.
Dr. Anat Zohar, the Health Ministry official in charge of quality, said that in 2013, all hospitals were required by legislation to collect and publish information on their quality indicators. The program was successful, causing most hospitals to make efforts to raise their ranking. Can the same thing be accomplished to reduce nosocomial infections? Zohar said it could, and when an organization went to court to require publication of comparative figures, the ministry took action.
Between 5% and 10% of all hospital patients contract infections inside hospitals – and an average of 6,000 Israelis die of them in an average year – much more than from terrorism, war and road accidents (but fewer than from smoking).
“We studied infection after colon surgery within a month of the operation, and some hospitals had only 8% while others had over 30%. Compared to OECD country rates, we have much higher rates of hospital infections than countries like England and Norway,” said Zohar.
Giving antibiotics to prevent infections and a high level of hygiene can reduce the rates, although antibiotics don’t always work.
“We have invested NIS 50 million in a program to reduce hospital infections. By next year, infections will have to be published by all the hospitals.”
Maj.-Gen. (res.) Orna Barbivai, who now heads the Fund for National Initiatives, said that a few months ago, it set up a project to reduce nosocomial infections.
“The problem is serious, and infections can be prevented. Israel is 10 to 15 years behind other countries in reducing them. We were shocked by the figures, so we made nosocomial infections our first project since being established,” Barbivai said.
“We hope to cut rates by 50% by the end of next year.”
Dr. Shmuel Benenson, in charge of preventing infections at Hadassah, said that one of the problems in preventing infections was that government hospitals have for a long time had maintenance workers who work for contractors. The cleaners are low paid, so many really don’t care and don’t know how to clean to prevent infections. In England, maintenance work in hospitals is a respected profession, he said.
AMONG THE medical innovations presented by speakers was the country’s first robotic pharmacy, presented by Meuhedet Health Services’ Dr. Yuval Weiss. The pharmacists on duty input the computer with prescriptions, and – miraculously – the medications with their barcodes emerge in seconds from seven holes in the wall.
“The system in our main Jerusalem pharmacy on Rehov Haturim is faster and with no mistakes,” said Weiss, who added that it cost NIS 1 million to import the system from Finland and set it up. More robot pharmacies are sure to follow.
Brig.-Gen. Dr. Ram Sagi of the Israel Defense Forces Medical Corps said that death rates on the battlefield were significantly lower in the last war in Gaza than in previous wars.
Protective equipment is better and the wounded are evacuated to hospitals faster. A balloon is inflated to press against injured limbs and reduce hemorrhaging, and a bracelet with all medical data is worn by wounded soldiers that help hospital personnel to treat him.
More exciting medical innovations are certain to be presented at the 11th Israel Medical Conference to be held in the summer of 2017.