Country Profile

Israel

Nutrition Promotion and Education in Israel

by Dr. Yitzhak Weinstein, Sports Medicine and Research, Wingate Institute, Israel and Dr. Dorit Nitzan-Kaluski, Department of Nutrition, Ministry of Health, Jerusalem, Israel

 

Background

Established in 1948, Israel is a melting pot for Jews, Arabs, Druz, Cherqusean and others. Its population rose from 1.2 million in 1949 to 6.1 million in 1999. During this time, rapid technological, economic, and health advances took place. Food production, healthcare, and life expectancy increased while infant mortality decreased.

Much has been done in the past 20 years to achieve nutritional goals, yet many issues remain unaddressed. Developing strategies and prioritizing a comprehensive plan for nutrition education are recommended. The need for political support at all levels is particularly stressed. Insufficient budgets for nutrition education often impair well-planned project design.

The sustainability and effectiveness of nutrition education programs can be enhanced by the commitment of political leaders and policymakers. Seeking such commitment is an important step in the planning and launching of an effective nutrition education strategy.

In January 1995, Israel adopted a new healthcare system. Health services are organized through the Ministry of Health, which is responsible for health legislation, financing and formulation of general policy goals. The Ministry of Health has executed health education programs, in cooperation with other government offices.

 

Health education and promotion

Disease prevention and health promotion is often divided into three strategies: mass (the entire population), target groups (various sub-groups of the population: schoolchildren, infants, immigrants, minorities), and high-risk groups.

The main nutritional problems in Israel are: malnutrition and anemia, especially in young children; a rapid decrease in breastfeeding; high rates of obesity; and eating disorders (especially among teenage girls).

The evolution of Israel's nutrition education reflects major strides by the Public Health Services. The programs are a product of four major integrated elements: nutritional problems, target groups, setting, and methods.

1. Nutritional problems- Identification of the problems is particularly relevant to sub-groups. This is accomplished via data on dietary intake and nutritional status. Data is obtained by local monitoring projects like questionnaires, environmental and psychosocial health indicators, and the sub-groups' own perceptions of their needs and abilities. (Such sub-groups include specific ethnic communities, new immigrants, the disabled, etc.)

2. Target groups- assessment of the issues of sub-groups leads to identification of appropriated primary target groups. The life-cycle approach is the most commonly used method. The specific needs of sub-groups are identified and targeted.

3. Settings- The use of key settings that are not traditionally viewed as the domain of nutrition education programs can enable sub-groups to be reached at their activity worksites. It enables precise targeting to be carried out, provides for positive links to occur across disciplines and sectors, and encourages greater community involvement.

Such settings include: primary healthcare services, schools, workplaces, social organizations, cultural or sports groups, and retail settings like supermarkets.

Educational institutions such as colleges present an important setup to improve the teaching capabilities of trainers. Thus, nutrition education curriculum programs are becoming an integral part of the education curriculum, with built-in evaluation techniques.

4. Methods- Myriad methods (e.g. personal interviews, use of the media and participatory methods) are considered in the development, implementation and evaluation of the program to ensure changes in individuals and organizations, as well as economics and environment.

"Education is a basic human right and a key element to bring about the political, economic and social changes needed to make health a possibility for all", reads the 1991 Sundsvall statement on supportive environments for health from WHO.

In this spirit, multidisciplinary work teams were assembled in the 18 regional headquarters of the Ministry of Health. Each team has a public health physician, a nutritionist, a nurse, a food technologist, an environmental engineer and a elegate from the community. The team identifies and prioritizes nutrition problems, develops community-based plans, and acts to assure that plans are carried out appropriately. Community outreach programs have been successful in bringing about positive changes in some of the most vulnerable groups, as shown by local studies and assessments.

Public health nutritionists focus?on teaching and training 'agents of health' who help to facilitate coordination and distribution of nutrition education material in schools, child care centers, health-clubs, etc. To ensure effective interventions, the teams' knowledge and skills are frequently updated. This enables the public-health service to employ professional nutritionists to share their knowledge with a large group of 'secondary messengers'.

The 'family health stations' located in the communities serve as the first line of nutrition guidance for parents and children. A follow-up of pregnant women, newborns and children is carried out in these stations. These include anthropometric measurements, blood tests, and assessment of nutritional habits, after which they are provided with guidelines for healthy nutrition.

The Ministry of Health is also involved in implementing and assessing such programs. Large-scale multi-media campaigns, planned to communicate a single concept, have been operating in Israel for the past decade. Scientific and applied information is given to journalists to produce "edu-tainment", some of whom turned into food and nutrition "specialists".

Recently, several un-related events occurred, resulting in the possible push for better nutrition. The Public Health Services placed nutrition as a high-priority issue during 1997-1998, the Israeli Center for Disease Control (ICDC) was established and the Department of Nutrition was reorganized.

These events created an opportunity for disease prevention, control over health expenses, and development of nutrition policy. In 1998, the Department of Nutrition, ICDC, Central Bureau of Statistics, and several academic institutes initiated a National Nutrition Survey.

This survey is intended to provide information and a database for public policy decisions, such as developing nutrition education and public health nutrition programs, and evaluating their long-term effectiveness.

The nationwide survey will be concluded by February 2000.

A Survey of Physical Activity Trend in Israel

Summary of Talk delivered at the 2nd IIHP Congress. Mauritius, 12-15 Oct. 1997 by Itzik Weinstein, Ph. D.

 

From the national bureau of statistics we learn that $ 4,7 billion were spent by Israelis on Health, only $ 0,4 billion on Sport (1994). Can we lower the Health expenses by increasing the investment in physical activity? is there a link to health promotion?
The purpose of the survey (carried out by "Modern Ezrahi", a freelance company in Febr. 1996) was to learn about public opinion on physical activity and the frequency and type of activity Israelis are engaged in.
 
Methods: Personal interviews were conducted with 1,145 interviewees at random, aged 21 years and older.
 
Results: About 28% reported that they are regularly active, usually between 1-3 times per week. 42% of the responders reported that they were never engaged in any type of physical activity, and 27% reported that in the past they were casually active. the most "popular" activity consists of home drills and organized drills of various types. These are more common among divorced women and widows. Swimming is more common among Israelis of Western origin (North America and Europe), ball games among 24-35 year old males, and walking - among 55-64 years old. Most (68%) prefer non-organized activity.
 
95% of the responders acknowledge that regular physical activity contribute to health and to well-being, 90% support a campaign for physical activity as an effective vehicle for health promotion.
 
Dr. Yitzak Weinstein is head of the Wingate Institute for Physical Education and Sports. He may be reached at: Wingate Post Office Netanya, Israel 42902, Tel: (972)-89639400, Fax: (972)-89639412, e-mail: itzw@mofet.macam98.ac.il.
 
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