We got to experience a number of interesting and important presentations from Yehuda Neumark on Community Oriented Primary Care, Ted Tulchinsky on Changing Concepts and the New Public Health and finally Milka Donchin on Health Promotion in Israel. The most meaningful part for me was the lecture by Dr. Tulchinsky where as part of the new public health, he notes that health system management is a core competency for effective public health particularly in an era of chronic disease, enhanced community health and resource constraints. His book by the same name was released in its second edition last year. The afternoon took all us to Bethlehem where we visited the Church of the Nativity. Traveling in the Palestinian Territorities was an eye-opener for me.
During lunch, we had a lively discussion around a question in which we again sought to compare and contrast the health care delivery systems of both countries. Granted that Israel has but 7.1 million people in a geographic area the size of New Jersey and the United States has over 300 million in a much larger geographic area with a much more heterogeneous population. That said, in 1995, Israel made the political, social and economic decision to craft a national health plan that provided a basket of services to each and every citizen regardless of religious affiliation. While there are additional details mentioned on Day 2, the question is why Israel and not the United States. The one thing that keeps coming up over and over again is social solidarity which I think about as a pre-condition for social capital. There is a sense that people care about one another and will sacrifice a little so that everyone has the essentials. I have a hard time imagining people in the United States agreeing to a basic basket of health services that would be paid by individual taxes. The more I listen to people at the Braun School of Public Health as well as regular Israeli's, the more I am convinced I am that legislation alone will not be enough to create and sustain a universal health plan in the US. What is needed is a change of mind set and perspective that says it is important that we take care of each other and not just maximize our own personal economic and social benefit. How we will get there, I don't know but the journey must begin now.