Reducing Health Inequality and Health Inequity in Israel: Towards a National Policy and Action Program – Summary Report

The overall objective of this study was to explore the significance and place of health inequalities in the thinking and action of leaders of the Israeli health system and related social systems, and to identify policies and actions that could reduce health inequality in Israel. As such, the study sought to promote the development of policy and action in Israel’s health care system.

While the existence of health inequality has been recognized in developed countries for over 150 years, it is only in the past three decades that countries have given serious attention to its social and economic implications, as well as to its implications for population health. Many attempts have been made to develop policies and subsequently take action to combat it.  Nonetheless, in Israel as elsewhere, extensive inequality continues to exist in many measures of health care delivery, health status and health outcomes. Moreover, in Israel the extent of overall inequality is growing, which is also reflected in the growth in some measures of health inequalities (such as education gaps in life expectancy).

It is generally accepted that social factors, such as inequalities in income, housing, education and employment, account for the bulk of health disparities. It is also generally accepted that although inequalities in health care are not the main cause of health inequality, the health care system can contribute significantly to their reduction.

The study had two major components:

  • Face-to-face interviews with over 100 policymakers, managers and professionals in the health system and related social systems. Respondents were asked about issues such as who is responsible for reducing health inequality, what has been done to date, what additional policies and actions could be undertaken, and what barriers to change need to be overcome.
  • A review of the relevant professional literature and national efforts to reduce health inequality in the UK, the US, The Netherlands and Sweden.

The study found that many in Israel were interested in doing more to reduce health inequality, by both setting national policy and implementing programs in the field. In addition, on the basis of the interviews and international experience, the study team identified 11 concrete measures, which could be incorporated into a comprehensive plan of action in Israel.  Many of Israel’s leading health care organizations have asked the study team to make presentations to their top managements and explore together what their organization can do to reduce health inequalities.

This study was funded by grants from Andrea and Michael Dubroff, Massachusetts, USA; the Israel National Institute for Health Policy and Health Services Research; and an anonymous donor.

Citations in the professional and academic literature

Shadmi, E., Admi, H., Ungar, L., Naveh, N., Muller, E., Kaffman, M., … & Reis, S. (2010). Cancer care at the hospital–community interface: Perspectives of patients from different cultural and ethnic groups. Patient Education and Counseling79(1), 106-111.

Horev, T., & Avni, S. (2016). Strengthening the capacities of a national health authority in the effort to mitigate health inequity—the Israeli model. Israel journal of health policy research5(1), 19.

Yariv, H. (2015). The case of pharmacist prescribing policy in Israel. Israel journal of health policy research4(1), 49.

Shmueli, A. (2014). Income-related inequalities in health and health services use in Israel. Israel journal of health policy research3(1), 37.

Levin-Zamir, D., Keret, S., Yaakovson, O., Lev, B., Kay, C., Verber, G., & Lieberman, N. (2011). Refuah Shlema: a cross-cultural programme for promoting communication and health among Ethiopian immigrants in the primary health care setting in Israel: Evidence and lessons learned from over a decade of implementation. Global health promotion18(1), 51-54.

Deutsch, J., Lazar, A., & Silber, J. (2013). Becoming poor and the cutback in the demand for health services in Israel. Israel journal of health policy research2(1), 49.

Baum, N., Shalit, H., Kum, Y., & Tal, M. (2016). Social workers’ role in tempering inequality in healthcare in hospitals and clinics: a study in Israel. Health & social care in the community24(5), 605-613.

Spitzer-Shohat, S., Shadmi, E., Goldfracht, M., Kay, C., Hoshen, M., & Balicer, R. D. (2016). Reducing inequity in primary care clinics treating low socioeconomic Jewish and Arab populations in Israel. Journal of Public Health39(2), 395-402.

Chinitz, D., Rosen, B., Israeli, A., & Shortell, S. (2012). Legends of health policy and management. Accountability and Responsibility in Health Care: Issues in Addressing an Emerging Global Challenge277, 295.

Baum, N. (2013). Jewish Israeli Social Workers’ Responses to Ethnic Health Inequality. Qualitative health research23(4), 507-516.

Epstein, L. Health and Health Care Implications of Cultural and Social Diversity: The Israel Reality. Culturally Appropriate Health Care by Culturally Competent Health Professionals.

Chinitz, D., & Meislin, R. (2009). Israel: Partial Health Care Reform as Laboratory of Ongoing Change. Six Countries, Six Reform Models: The Healthcare Reform: Experience of Israel, the Netherlands, New Zealand, Singapore, Switzerland and Taiwan: Healthcare Reforms” under the Radar Screen”, 25.

McKee, M. (2012). Solidarity in a Changing World. Accountability and Responsibility in Health Care: Issues in Addressing an Emerging Global Challenge1, 297.