Teaching Israel’s socioeconomically disadvantaged to avoid diabetes

When it comes to educating people to improve their health and avoid chronic diseases, one starts from zero in the general population but at -100 for those who live in the periphery who are at much higher risk of obesity, type-2 diabetes, hypertension, and other diseases. 

So says Dr. Sivan Spitzer, who for the last three years has been intensively involved in an innovative project to promote better health among Jews and Arabs of all types through education and active projects. 

The project was initiated by the Russell Berrie Galilee Diabetes SPHERE (Social-Precision-Medicine Health Equity Research) of the Bar-Ilan University Azrieli Faculty of Medicine in Safed. 

“We have a catchment area of 660,000 people and are currently working in cooperation with the Ministry of Health in 23 Arab and Jewish local authorities in the North,” Spitzer noted in an interview with The Jerusalem Post. 

“It’s not new that physical activity, following a proper diet with little processed food and sweets, can prevent diabetes and other diseases,” she added. 

“What is new is that people at high risk for these disorders can be taught to avoid prediabetes converting to fully fledged diabetes. About one million Israelis are prediabetic. Each year, four percent to eight percent of them become diabetic. 

“This is the first time that a joint in-depth process has been conducted with the local authorities in Israel that helps the authority to build a solid foundation and make health a part of its DNA,” Spitzer emphasized. 

Her interests lie in the study of health inequities and in identifying, designing, and evaluating organizational strategies aimed at reducing healthcare inequities through the prism of organizational change and implementation science. 

Inequities in access and provision of care exist for many disadvantaged groups, including minorities, persons of low socioeconomic status, the elderly, and the disabled – in many countries as well as in Israel.

After three years, data from Maccabi Healthcare Services (the second-largest health fund) and with the cooperation of Clalit Healthcare Services (the largest public health insurer) reveal a significant decrease in diabetes diagnoses thanks to the SPHERE prevention program initiated by Spitzer. 

The Berrie Foundation donated $20 million for the 10-year project, and the Azrieli Faculty matched the amount. 

What is Sphere?

SPHERE was launched three years ago by the Azrieli Faculty to reduce health disparities and improve the harsh reality of diabetes and obesity in the northern peripheries of Israel through research, education, and healthcare delivery.

Russell Berrie, who founded a toy and gift company in New Jersey, established a philanthropic foundation that donated large sums to Israel and elsewhere. When he died prematurely at the age of 69 in 2002, his wife Angelica took over the foundation. 

Berrie and Angelica approached philanthropy as a social investment, seeking out energetic leaders with a sense of urgency around their missions and infusing the foundation with an entrepreneurial spirit that continues to inspire its work. 

“We identify visionaries, institutions, and unsung heroes doing groundbreaking work, and we amplify their impact by providing financial and strategic support. We invest in areas that reflect our founder’s passions and perspective, including diabetes care and research, Israel’s cultural and economic vitality, interfaith bridge-building, elevating the profession of sales, and strengthening community in New Jersey.”

SPHERE is directed by endocrinologist Prof. Naim Shehadeh, a Christian Arab from Kafr Yasif, located 11 kilometers northeast of Acre, who is also the director of the Institute of Diabetes, Endocrinology, and Metabolism at Haifa’s Rambam Health Care Campus. 

“Initial data from our project reveal a 40% decrease in the transition from prediabetes to diabetes. This is the result of a simple intervention of adopting a healthful lifestyle, losing weight, or taking the commonly prescribed diabetes drug Metformin for prevention.” 

Spitzer, who is SPHERE’s deputy director, and Shehadeh, work closely together. Half of their team is Arabic-speaking. Obesity is very common in the north of the Arab sector, as it is among Jews and other ethnic groups, including haredi (ultra-Orthodox) Jews. 

“Diabetes used to be a disease of the rich,” said Spitzer, “but now it is much more a disorder of the poor and socioeconomically disadvantaged with less education. The Central Bureau of Statistics shows a 12% increase in our area since 2019, compared to just 2.5% in Jerusalem that has many haredim and Arabs, but they are a much younger population and are at a lower risk for contracting diabetes at this age.” 

“When people here are treated for diabetes, there is poor control and a higher risk of complications, including amputation of legs, kidney failure, and blindness. The disease is an amazing marker for health inequity,” she continued. 

Their paid team of 25 people are all residents of the Galilee but have different professional backgrounds, including health promotion, those who work with municipal government, town planners, and, of course, physicians. 

“To intervene, they create an impact. Many universities don’t do real-world interventions. Our medical faculty feels an obligation to change things and have a role in the community and not just to train doctors,” said SHERE’s deputy director. 

“About 80% of factors that cause the disease are related to where people live, and only 20% [are] due to lack of healthcare facilities there,” Spitzer explained. 

“Israel has a generous basket of health services, and there are many new drugs for treating diabetes, but here, family physicians prescribe fewer of them – so we have to teach them about these drugs. We have established an application to present them with the latest clinical data.”

She added that “we have to create an ecosystem in each town and work with the health funds in the area. We work mostly with the two largest, Clalit and Maccabi, but we hope to involve the two others – Meuhedet and Leumit – as well.” 

As a leading scientific body, SPHERE brings to this joint venture a groundbreaking model for reducing disparities in obesity and morbidity in diabetes in the most complex local councils in Israel. 

Its implementation in the local authorities has created an ecosystem including health, local government, and the community that has never existed before and should be adopted in Israel’s social and southern peripheries.