Reflecting on a decade of action: a review of select indicators for the Israel National Program for Active and Healthy Living-Efsharibari, 2011-2022.

backgroundSimilar to countries worldwide, Israel suffers from the effects of a modern lifestyle, with high rates of obesity, lack of healthy nutrition and insufficient physical activity. Global health organizations recommend national systemic programs to address this problem. The Israel National Program for Active and Healthy Living-Efsharibari was launched at the end of 2011 via government resolution, to reduce morbidity and mortality and improve quality of life for the diverse population. It is a collaborative effort of the Ministries of Health, Culture and Sport, and Education.

methodsDevelopment and monitoring of a comprehensive set of indicators to assess process, outputs and outcomes in relation to program objectives. Qualitative and quantitative retrospective review of legislation, standards and health-promoting environments. Review of national data and surveys related to key activity domains - policy, supportive environments and social marketing - and a study of related behavioral and morbidity indicators.

resultsOver a decade, notable changes were observed for indicators in key activity domains, aligning with the programs' initial objectives. Improvements were found for 13 of 18 planned nutrition policies and 7 of 8 physical-activity policies. Changes to the nutritional environment included enhanced nutritional labeling and reductions in the amounts of sodium, sugar and saturated fat in commercial food products. An increase in national and local health promotion infrastructures included adoption of the "healthy city" protocol in 77 local authorities and implementation of the "health-promoting school" plan in 1,698 schools across the country. Behavior and morbidity indicators display mixed findings: reported behaviors in the field of nutrition have improved and physical activity among adults 65 + has increased. However, fewer children, youth, and adults are achieving the global recommended levels of reported physical activity and there are negative trends in breastfeeding behaviors. In terms of morbidity, a decrease in mortality from heart disease and diabetes was found, along with modest fluctuations in obesity trends.

conclusionsConsistent and ongoing efforts of the national plan to promote health in all policies, enable healthy choices, and promote systematic change have impacted Israeli society over time. In spite of changes of government and a lack of funds, Efsharibari has allowed for continuous cooperation between policymakers, professionals and additional partners, including during the COVID-19 pandemic. Additional efforts are necessary to reduce health disparities, enhance healthy behaviors and improve morbidity indicators. Amidst ongoing international dialogue to improve and expand health promotion, Israel's practical experience, including both successes and challenges serves to inform the international community.