Israel: health and beyond

Lancet. 2017 Jun 24;389(10088):2551-2562. doi: 10.1016/S0140-6736(17)30877-2. Epub 2017 May 8.


The principle that global human identity and dignity supersede other values is a broadly accepted conviction that guides practice and policies in the realm of human health in most of the world. An assessment of the level of success that Israel has achieved in health, in the face of formidable challenges, including rapid population growth, diverse and often divided ethnic affiliations, and existential security threats, leads us to propose that extension of this principle of global human identity and dignity, together with the objective of a decent society, as overriding values beyond health to other domains of human endeavour within Israel and in its relations with neighbouring peoples, represents an entirely achievable imperative. The result will be to further advance Israel's aspiration to serve as a model for societal decency with wide international acceptance and engagement. We have identified several determinants of Israel's advancement in health, including: articulation of a clear vision, national purpose, and long-term commitment that seeks to take the health of its citizens seriously; a multi-ethnic population that brings diversity and energy to national progress; a political democracy, which is characterised by robust debate and discussion about the nation's future; national legislation governing cardinal health-care processes; cultural and religious histories that respect and revere scholarship, learning, research, and charitable donation; an expanding economy, with recent but increasing appreciation of the economic, social, and political underpinnings of health and health inequalities; a strong base of international support from the Diaspora Jewish community; and a strong desire for acceptance by the international community in key arenas, especially science and health. As a result, despite the fewer than seven decades since its establishment, Israel has achieved important milestones in health. Nevertheless, this trajectory of achievement is threatened by several serious challenges, including the capacity to sustain high-quality universal health coverage, especially for an ageing population living with multiple comorbidities in the face of a stagnant level of the percentage of treasury funding to health care at a level that is well below the average of the Organisation for Economic Co-operation and Development; ever-increasing transfer of services and care covered by the mandatory public health services basket to private programmes; insufficient progress in resolving health disparities among and between communities, populations, and regions of the country congruent with disparities in income and employment; gender inequities; a looming increase in the already alarming shortfall in health-care professionals; and failure to match inpatient and acute care facilities to manage growing needs. These challenges within Israel are magnified in the context of health disparities with the neighbouring Palestinian population, a situation in which ongoing-but fragile and limited-health cooperation and training arrangements cannot stand in for a solution that will address Palestinian national aspirations. We come away from this Series with a great sense of optimism, but with specific recommendations that are based on the foregoing challenges. We believe that by increasing the investment in the health sector, which includes investing in the societal, political, educational, and environmental underpinnings of health, far more can be achieved to move Israel to a model international leadership position in health care, education, and research, and turn health into an engine for economic wellbeing and development. Religious leadership in Israel, with its formidable political influence, can be harnessed to promote health initiatives in areas ranging from smoking cessation and healthy diet to organ transplantation, and most of all condemnation of hostility and its replacement by peaceful resolution of even the deepest conflicts. Most of all, this Series showed that there is an enormous opportunity, which Israel can lead, to leverage the universally accepted principles of health as a sanctuary against conflict and inequity, to achieve a brighter future for a deeply troubled region of the world.

Publication types

  • Review

MeSH terms

  • Conservation of Natural Resources / trends
  • Delivery of Health Care / trends*
  • Health Policy / trends
  • Health Status
  • Humans
  • International Cooperation
  • Israel
  • Population Growth