Moving from identifying inequities to creating a new community-based precision-medicine platform in Israel's social geographic northern periphery

Background: Israel’s northern region, the Galilee, is a social geographic periphery. Seventeen percent of the country’s population reside in this region. It is predominantly Arab, poor, and has the lowest rate of physicians per residents in the country. This region is also marked by a significant higher prevalence of chronic diseases and a 4-year difference in lifespan compared to the center of the country. Over 14% of the population suffers from type 2 diabetes, in comparison to 10% in the center of the country. A significant percentage of these patients have poor control of their diabetes, leading to the highest markers of diabetes complications in Israel including lower limb amputations, blindness and kidney failure resulting in dialysis.

Approach: In November 2021, the Azrieli Faculty of Medicine, located in the Galilee, launched SPHERE – Social Precision Medicine Health Equity Research Endeavor – A 10-year initiative, the first of its kind in Israel. The aims of SPHERE are to be socially accountable to our partner communities in the Galilee; develop and implement innovative models to reduce diabetes and obesity related health inequities; and improve Galilee residents’ health outcomes. To do so we developed the Municipal Engine for Social Health (MESH) platform for interventions. MESH supports implementation of interventions with healthcare providers, implementation of new municipal health units, as well as creating a new integrated eco-system in which healthcare providers and municipalities work together to reduce inequities.

Results: Today, SPHERE is already running over 60 interventions. We began with 5 pilot towns in 2021 and are now working with 23 cities and towns, with SPHERE’s unique MESH platform adopted as the national model by Israel’s Ministry of Health. Health units have been set up, a comprehensive in-depth mapping of each town was conducted to identify the network using social network analysis and the extent to which an infrastructure of health policy and interventions exists among different eco-system partners, including the education sector, health, municipal departments, local NGOs etc. Towns showed disperse networks with minimal policies and action regarding issues such as physical activity or healthy nutrition. Following these data, a comprehensive strategic plan tailored to each town was written together with the partner communities. These plans are now being implemented. Additionally, to overcome the disparities in access to diabetes and obesity specialists, we created programs such as diabetologist and obesity training for family physicians from these towns (n=50 trained), as well as a professional support network (n=170 health professionals). Interventions to improve the standard of care are implemented with these providers and are already showing impressive outcomes. For example, a pilot intervention to increase identification and delivery of standard of care for pre-diabetic patients (n=514) led to halving the percentage of patients who transition from pre-diabetes to diabetes. This is now being implemented at scale.

Implications: In northern Israel SPHERE is implementing a unique platform that expands knowledge, provides tools, and creates unique community based integrated interventions to improve the health of Galilee residents.