In terms of overall health, Israel ranks among the world's leaders. But there are significant gaps between health indicators for men and for women. For many years, IWN's Health Forum worked to place women's health issues at the forefront of the public agenda, as part of our struggle for equality and justice for all Israeli women.

IWN published a compelling book on women's health in Israel: Women's Health in Israel, 1999: A Data Book. This comprehensive study is the first of its kind ever to be published in Israel. It reveals disturbing data on the status of women's health in Israel and points to many crucial questions that remain unmet. For example, while men's life expectancy ranked 5th among 25 developed countries, women's life expectancy ranked 20th.

The conclusions presented here address major health care issues:

Cancer

Cancer is the second leading cause of death in women, and some researchers predict that it is likely to become the leading cause of death in industrialized countries in t21st century. Cancer in women requires investment of resources in both research and health care. Because of its heterogeneous, Immigrant population, and the large differences in cancer incidence between Arabs and Jews, Israel is a natural laboratory for studying the epidemiology of different cancers.

The relatively high incidence of cancer in Israeli women in contrast to the lower incidence in men, when compared with other countries, requires explanation. Are Israeli Jewish women at increased risk because of genetic factors? The relatively young age at which native Israelis are diagnosed with breast cancer should be addressed.

Despite the higher incidence of colorectal cancer in Jewish women, case fatality is higher in Arab women. The reasons for the discrepancy between much higher incidence ratio (3 to 1) between Jews and Arabs and the narrow mortality ratio (1.8 to 1) need to be investigated.

The most obvious finding that distinguishes Israel from other countries is the relatively high incidence of mutations in the BRCA1 and BRCA2 genes. The high carrier rate among Ashkenazi (and other) Jews means that many Israeli women are at especially high risk for breast and ovarian cancer. The controversial question of genetic testing will need to be confronted, since it is likely to become an increasingly important issue.

Although the incidence of cervical cancer is very low in Israeli women, relative to women in other countries, between 1985-1995 increased by almost 40%. However, 50% of women in Israel have never had a Pap smear. Pap smears are perpetually in danger of being eliminated from the basic list of services provided within the National Health Insurance Law, because of low cost-effectiveness. Since survival rates for this cancer are high when treated in its early stages, clear guidelines should be established for screening high-risk populations.

Heart Disease

Heart disease is the leading cause of death in Israeli women. Despite this fact, it is likely that in Israel, as in the U.S., both women and their physicians think of heart disease as a man’s disease. Since it affects older women, usually out of the public eye, heart disease does not get the headlines that breast cancer often commands. Although coronary heart disease (CHD) mortality has declined among women, it may be reduced further by attention to possible gender biases in attitudes and in the provision of care to women with the disease.

What is striking is the fact that, while rates of CHD mortality are lower in women than men, Israeli women have the smallest CHD mortality advantage over men, relative to other western countries. As in other countries, mortality rates after myocardial infarction and after coronary artery bypass grafting were found to be higher in women than men in Israel.

Mental Health

Although mental illness is a common and disabling disorder in terms of public health, it has often been a stepchild with regard to research, policy and service provision and funding. Women with emotional illness are not a vocal lobbying group, partly because of stigma attached to these disorders. It should be stressed that the long-term impact of violence on women’s health, apart from physical injury, is on their emotional well-being.

Reproductive Health

Israel has one of the highest rates of assisted fertility facilities per population. In Israel’s prenatal climate, reproductive health priorities are often set without serious public debate, and some feel that an inequitable proportion of resources and services are devoted to fertility promotion.

Chronic Illness and Disability

Women suffer from chronic illness and disability more than men’ and constitute the majority of nursing home residents. The crippling conditions that can make women’s longer life expectancy a burden rather than a gift for many women need to be addressed.

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The two-year study was made possible by Hadassah, the Women's Zionist Organization of America. It was produced by IWN in cooperation with the Israeli Center for Disease Control of the Ministry of Health and Hadassah-Israel. Funding was also provided by the American Physicians' Fellowship for Medicine in Israel. The Hebrew translation was supported by a grant from the Jewish Federation of Greater Monmouth County, New Jersey. Anneke Ifrah coordinated the study and publication for IWN. She was assisted by Suzanne Brown, Diane Flescher, Manfred S. Green and Chana Kurtzman, as well as a steering committee and numerous other individuals.