Healthy Israel 2020

How a Plan for Improving the Health of a Population Produced Dramatic Improvement in Chronic Health Outcomes

Dr Ronit Almog with child (1)

You Get What You Plan For: Healthy Israel 2020 Initiative

The Healthy Israel 2020 (HI2020) initiative was launched by Israel’s Ministry of Health in 2005 in an ambitious effort to ensure continued improvement in the provision of healthcare and the health of the nation. Given Israel already had impressive results both in terms of its healthcare system and in the main health indicators of its population, this initiative reveals a highly progressive attitude towards health. Most significantly, it was among the most pioneering efforts to date in any country to prevent illness, promote wellbeing, and improve quality of life.

Back in 2005, the main focus was on treatment quality and outcomes, whereas prevention of illness and promotion of wellbeing was comparatively weak. Recognition of this as a major hindrance to further progress in maintaining the health of the nation led to launching the Healthy Israel 2020 Initiative. The Initiative was based on similar initiatives in the USA and elsewhere and built on its existing successful programs of illness prevention and health promotion in Israel, such as Israel’s well-baby clinics and community-oriented primary care system. However, until then the main focus had been on treatment rather than prevention, with only 0.6 percent of Israel’s health expenditure going to prevention and public health services. Although a great deal of further progress is still possible, much has since been achieved. In 2011, vaccination rates of children ranged from 93 percent (Hib3) to 99 percent (HepB). Among those of pension age, 57 percent received the annual vaccination against influenza. In 2010, 68 percent of eligible women were screened for breast cancer with mammography, and 47 percent of those eligible were screened for colon cancer. This represents consistent improvement.

HI2020 was a blueprint and a call to arms for addressing the modern health hazards that face a more advanced economy. Promoting a healthy lifestyle assumed the same priority that eradicating communicable diseases was in the early days of the state. The initiative adopted a broad sweep in addressing health and wellbeing, addressing a whole range of health determinants. Very significantly, the plan involved not only preparing detailed reports and recommendations, but also generating objectives and targets to be reached by 2020. Importantly, in formulating HI2020 plans, the scientific literature was assiduously reviewed so as to develop recommendations supported by proven strategies and evidence-based interventions.

A steering committee composed of leaders in the health field from both government and nongovernmental organizations was formed to oversee the entire process. To implement the initiative, twenty committees and subcommittees were formed to focus on such areas as health behaviors, occupational health, infectious diseases, oral health, accident prevention, maternal and child health, and healthcare for seniors. An international board of consultants from a variety of countries was recruited to assist each committee. All told, over 300 committee members and roughly 50 consultants were recruited.

As is to be expected when committees are involved, difficulties around leadership, definitions, and priorities were not lacking. Nevertheless, significant progress occurred, and by 2009 several action plans had been drawn up, including on obesity control, enhancing physical activity, and healthful nutrition. This progress provided the foundation for a major spinoff: The National Program for the Promotion of an Active and Healthy Lifestyle. HI2020 has been a key factor in the development of tobacco control legislation, alcohol control efforts, pediatric injury reduction, skin cancer prevention, and intervention programs to mitigate chronic disease in the disabled. The highest profile and most productive outcome of the Healthy Israel initiative was in relation to health behaviors.

For example, tobacco cessation medication and group counseling are now available at no cost, and proactive hypertension and diabetes management is prioritized in primary care.

Another creative program that resulted from HI2020 was “Stepping Stone,” a health promotion and safety enhancement program for the disabled, managed by the Myers-JDC-Brookdale Institute. Other preventive initiatives have also been developed and launched over recent years, including a national program for alcohol control developed several years ago by the Israel Anti-Drug Authority, and driver fatigue prevention programs developed by the Ministry of Transportation and the
National Road Safety Authority.

HI2020 has established itself as a key feature in the Israeli health landscape, bringing health promotion and disease prevention into sharper focus than ever before. This has been achieved
through its publications, internet site content, conferences, and incorporation into the curriculum of university health promotion degree courses and medical residency syllabi. Its science-based, cutting edge content has been recognized by a series of international bodies. In November 2011, the First WHO European Conference on the New European Policy for Health-2020 was held in Jerusalem, recognizing Israel’s pioneering work in health targeting.

Despite impressive progress, gaps exist between various parts of society. For example, diabetes is much higher among the Arab population, while cancer rates are higher among the Jewish population – although these gaps are shrinking through such measures as improved cancer screening and lifestyle education. There are many reasons why HI2020 proved to be successful, including strong national leadership, cooperation between government ministries and agencies, and widespread public support. These are features to be prioritized by any government seeking to drive forward significant health improvement of its people, addressing legislative, educational, clinical, and interventional programs in schools, workplaces, primary care clinics, and in the community at large.

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