Food security Prof’ Ronit Endevelt PhD, RD Prof’ Pierre Singer MD, Josefa Kachal RD, MPH Nutrition Department, Public Health Services, Ministry of Health, Israel The Israeli progress in the ONCA program 2016 Warsaw

 About 8.5 million inhabitants  Area 20,770 km²  National health insurance law- all citizens are insured in 4 HMO’s Main health challenges: 1.Obesity 2.Non communicable diseases 3.Food insecurity 4.Malnutrition Some facts about Israel

% of population 65+: -Currently 10% - projected in 2050 – 17% Israel The Demographic Transition challenge: Iris Rasooly MD MPH, Geriatric Division, Israel MOH

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Iris Rasooly MD MPH, Geriatric Division, Israel MOH

Our Department’s Goal “ All people at all times should have access to sufficient, safe, nutritious food to maintain a healthy and active life”. World Food Summit of 1996 Elderly Infancy Childhood Maturity Adolescence

The Vision of the Nutrition Department - Healthy Diet for the Entire Population 1.As the higher professional authority, to serve as a basis for determining the dietary and nutrition policy for the transition of Israel to sustainable nutrition, development and implementation of health promotion programs, reducing disparities and inequalities 2.To serve as a resource for the development of training, expertise and staffing levels of personnel to improve the nutritional status of the population. 3.To create regulations and legislation of medical nutrition for institutions through the development of procedures, standards, and quality indicators based on surveys and inspections in hospitals and HMO’s. 4.To serve as a professional resource on food and nutrition, nutritional assessment coverage and (for) the general population and professionals. 5.To serve as a focal point to promote nutrition by creating a network of partnerships between academia, various government agencies, organizations, associations, medical institutions, local authorities and others.

The department's main goal is to promote optimal nutrition in the ecosystem in which we all operate

From Vision to Practice: Key issues on the table in our department

Optimal nutritional care for all Education Public health Implementation Undergrad Postgrad Nutrition Day Hospital ICU Oncology Care home Public awareness National nutrition plan Hospital Care home Community Trained Staff Stakeholder groups Multi-stakeholder PEN Ger Medicine Paediatricians Patients Dietitians Nurses Pharmacists General practice Hospital Health insurance Industry Politicians Media Policy and standards Screening policy Standards/ quality indicators Audit Discharge management Hospital Care home Community Guidelines Screening Hospital Care home Community Intervention Dietitians Medics Nurses Pharmacists Economic data Cost DRM Value of intervention Presence Engagement Prevalence DRM Hospital Care home Community Reimbursement Hospital Care home Community Malnutrition Services ONS Tube PN Israel / 8.5 million / Date 12/5/16 Discharge management Screening Care plan Medical nutrition Discharge management

Achievements in the last half year and measuring progress, key topics: Public private partnership: Including all medical foods used in tube feeding to all the children in the 0-19 age range and ALS patients in the list of subsidized medical technologies. Addressing a request for 2017 to widen the criteria for adults in the health basket Involvement MoH and industry A national program for optimal nutrition care for all including the social and welfare ministry for people with special needs and mental illnesses Patient groups participation A research on public awareness, A study of participatories from sick self help non- profit organization, association Developing a tool for self monitoring malnutrition New country developments and other topics A united national computerized file for all the nutrition care in all the hospital A discharge letter with nutritional status and instructions to the community A national committee led by the general manager of the ministry of health on nutrition regulation A committee for regulation of food fortifications and nutritional biomarkers A regulation on TPN in the hospital and community Nutrition day in 9 hospital, 261 people – (175 complete) 28% did not eat at all compared to 12 % in the general survey Education for the detection of malnutrition to dietitians (nutrition focused physical test)

Future plans 1.Economic model for cost benefit of intervention to eliminate,malnutrition. 2.A request for finance support for a national program from the health ministry- with 2 million Euro for expanding the program nationwide Thank You