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Why Israelis live so long and what they can teach the rest of us

Resilience and social connections are factors in Israeli's longevity, and a Mediterranean climate doesn't hurt

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The National Post has been celebrating the modern state of Israel ahead of its 75th anniversary on April 26, telling the remarkable story of its rebirth and resilience against all odds.

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Rachel Kafri, 102, likes to keep busy and on top of the news. She recently had a pacemaker implanted in her body.

The device keeps her heart beating normally. Before surgery, her cardiologist, Dr. Shaul Atar, head of cardiology at the Galilee Medical Centre in Nahariya, Israel’s northernmost coastal city, went over the risks, which weren’t all that high. He’s pleased the procedure went smoothly, he told The Jerusalem Post, and he wishes his patient “many more good years.”

Kafri, who’d been feeling dizzy and out of sorts, pre-pacemaker, but who tries to keep “my wits about me” when others are losing theirs, doesn’t know what all the fuss is about. “I don’t feel that old,” she told Israel’s Ynet News.

“Yes, indeed, Mrs. Kafri is a delightful person, one of the true founders of the state of Israel,” Atar wrote in an email to the National Post. Her family was one of the founding members of Nahalal, the first moshav, or agricultural settlement, in Israel. As remarkable as her surgery sounds, she isn’t the oldest Israeli recipient of a pacemaker. Over the last decade, Atar’s team has placed pacemakers inside the bodies of at least three others older than 100. The eldest was 107.

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“We, the physicians (in Israel), do not consider age as a barrier to procedures,” Atar wrote. There’s a certain readiness to break the rules, so to speak. Doctors judge according to biological age, and not chronological age, considering factors like a clear mind, lifestyle and diet, normal or low blood pressure, kidney function, the absence or not of diabetes.

“All are predictors of longevity,” said Atar, who estimates Mrs. Kafri — mother to five, grandmother to 14 and great-grandmother to 30 — is, biologically speaking, only 95.

May you live until 120

Traditional Jewish birthday blessing

“May you live until 120” is a traditional Jewish birthday blessing, and Israelis already enjoy one of the longest life expectancies in the world, especially men. The current, combined projected life expectancy for both sexes for 2023 is 83.49, according to Macrotrends — 81 for men and 86 for women — compared to 82.96 for Canada. Recently, Israel took tenth place in a Bloomberg ranking of the world’s healthiest countries in 2019, behind Spain, Italy, Iceland, Japan, Switzerland, Sweden, Australia, Singapore and Norway; Canada placed 16th. By the year 2040, Israelis are expected to be ranked seventh in the world in longevity, with an average life expectancy of 84.4.

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From the Mediterranean diet and Mediterranean weather — sunny, warm, no extremes — to religiosity, mandatory military service and optimism despite decades of near-constant conflicts. All have been cited as factors contributing to Israel’s longevity standing.

An ultra-Orthodox Jewish man sits on a swing and reads from a book as a youth swings next to him, in Jerusalem, Monday, Nov. 14, 2022.
An ultra-Orthodox Jewish man sits on a swing and reads from a book as a youth swings next to him, in Jerusalem, Monday, Nov. 14, 2022. Photo by AP Photo/Mahmoud Illean

Atar, the cardiologist, would also include “an excellent health system, with relatively high availability of medical services all over the country.”

Before the soaring tensions, strikes and mass demonstrations over the Netanyahu government’s judicial overhaul plan, Israel was crowned the fourth happiest country in the world, behind Finland, Denmark and Iceland, in the UN-sponsored World Happiness Report released in March. (Canada was among the top 20).

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Atar isn’t sure about the current days, but “for decades, Israelis considered themselves as ‘happy’ persons,” and studies have shown that how happy people are can have a powerful influence over how long they live.

Israel’s average household disposable income is lower than the OECD average of US$30,490 a year. However, Israel outperforms the average in health, life satisfaction and strong social connections — 95 per cent of people in Israel know someone they could rely on in a time of need, above the OECD average of 91 per cent.

Other theories for its above-average lifespans have been offered up. The country could be benefiting from genetic diversity. Most older Israelis immigrated to Israel, or the area that became the State of Israel, from 78 different countries around the world, sociologists wrote in the Gerontologist, and research suggests that increased genetic diversity in a population provides a survival advantage.

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An elderly Israeli lounges on the beach in Tel Aviv.
An elderly Israeli lounges on the beach in Tel Aviv. Photo by JACK GUEZ/AFP via Getty Images

Resilience has also been associated with exceptional longevity. Thirty per cent of the oldest Israelis are Holocaust survivors, and scientists have found that, “against all odds,” men who lived through the Holocaust as teenage boys or young men lived 18 months longer than those who didn’t experience the Holocaust, possibly owing to a “genetic, temperamental, physical or psychological make-up” that kept them alive.

But does greater resilience explain Israel’s longevity standing? A diet richer in fish than red meat? More doctors and nurses?

In fact, according to its most recent “State of the Nation Report” from the Taub Center for Social Policy Studies in Israel, Israel’s share of active doctors is slightly lower than the OECD average. It’s share of active nurses is lower, still. The country also ranks low, relative to other OECD nations, in MRI machines, CT machines and hospital beds. “During periods of pressure, like the flu season, hospitals and hospital wards are so full and it is likely to have a negative impact on the health of those in care,” the authors wrote. (Canada is the only OECD country with higher hospital bed occupancy rates than Israel).

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However, unlike smoking — 21 per cent of its adult population smokes — Israelis drink less alcohol than most of the OECD. The country has fewer suicides per year, and its fertility rate is the highest, with three births per woman compared to Canada’s lower-than-replacement fertility rate of 1.4.

While diet is almost certainly a factor in Israel’s higher-than-expected life expectancy, when Israelis aren’t eating a diet high in vegetables and fruits, they tend toward one heavy on animal fats, proteins and salt, “none of which are associated with longevity,” Taub’s research director, Alex Weinreb, has noted.

“We also have a large population, 20-per-cent-plus is Arab, where the rates of diabetes are very high,” Weinreb said in an interview with the National Post. Still, the high life expectancy persists despite the diabetes rates.

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We don’t have people who die from cold, and there are very few people who die from excess heat

Living in a nice climate helps. “We don’t have people who die from cold, and there are very few people who die from excess heat,” Weinreb said from his office at the Taub Center in the middle of Jerusalem.

His team recently published a paper breaking down the causes of death in Israel, ranking the country relative to OECD countries on each of the major causes.

Where Israel does phenomenally well is on cerebrovascular disease. It has the lowest rates of death from strokes. “We’re third lowest on heart disease,” Weinreb said. The rates are surprisingly good for a country with as mixed a population’s as Israel, and one that isn’t super-wealthy, though its GDP per capita has climbed sharply over the last 20 years.

Those factors “point to things like early successful intervention — heart problems being caught in people’s 50s, not 70s — and fairly effective treatment,” said Weinreb.

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Alex Weinreb, research director at the Taub Center, is looking into factors such as physical fitness to explain Israeli’s high life-expectancy.
Alex Weinreb, research director at the Taub Center, is looking into factors such as physical fitness to explain Israeli’s high life-expectancy.

Israel does worse, however, on breast and prostate cancer, the two leading forms of cancer. “There you get into the differences within Israel’s population,” Weinreb said. Israel’s ultra-Orthodox Jewish population isn’t big on medical testing, especially for breast cancer. And Ashkenazi Jewish women are much more likely to carry the BRCA gene mutation that predisposes them to higher rates of breast cancer. “So, that’s a particular problem there.”

The Israeli-Arab population now is also following the same health trends as Arab populations in other wealthy Arab states, leading to major problems with obesity and diabetes, especially among women and children, Weinreb said. “Those are problems which we’ll confront as a society in terms of health consequences in 10, 20 years,” when a large bulge of people hit their 40s.

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But Israel is also an exceptionally family-centred society, and social connections are important to mental health, and human survival.

People live with, or close to, family. Israel has low levels of loneliness, Weinreb said. It’s reflected in all the international happiness surveys, “where, despite all its problems, and it has many, people in Israel always claim to be happy.” Even in areas where poverty levels are high, life expectancy is much higher than expected.

People feel that their life has meaning

“People feel that their life has meaning,” Weinreb said. “There’s a lot of volunteering, a lot of inter-generational contact.” Israel also tends to have lower rates of dementia. There’s “ongoing cognitive engagement” with the world around them.

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But none of this fully explains the longevity edge for Weinreb. He wondered why there are such particularly good outcomes when it comes to heart disease, or stroke, both of which are known to be associated with physical fitness.

The State of Israel requires every citizen over age 18 to serve in the Israel Defense Forces, although Arab citizens are exempted if they so wish. Men are expected to serve a minimum of 32 months, and women 24 months (until quite recently, women didn’t serve in the same combat roles, so their training was not as physically demanding).

When Weinreb, an expert in demography, put together a dataset involving 130 countries, he found that, even after controlling for all sorts of variables, military service added more than three years to male life expectancy.

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How to explain that? It may come down to a phenomenon known as the “healthy soldier effect.” At an age when, in most wealthy countries, people stop doing intensive physical stuff, in Israel, you have a large share of people in their 20s carrying 30-kilogram packs uphill for five days, first during their mandatory service, and then during annual reserve duty.

The ‘healthy soldier effect’ of mandatory conscription may be a factor in Israeli longevity.
The ‘healthy soldier effect’ of mandatory conscription may be a factor in Israeli longevity.

Army training potentially sets a precedent for maintaining physical fitness throughout one’s life, Weinreb said.

“No one in public health wants to say there’s anything good about the military. It may be a necessary evil, but to have mandatory conscription is counter to the Anglo-Saxon political ideology of this era.” It runs counter to the norms of liberalism, he said, and people are loathe to admit that there could be a positive health benefit.

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Easier to embrace are the health benefits of a sea breeze. People who live close to the sea report better sleep, less mental distress and have more optimal levels of vitamin D.

Israel, ironically, also has low rates of violence. The murder rate is also quite low, “though those two have been climbing. We’re unfortunately converging to more standard norms for wealthy countries,” Weinreb said.

Serious things are happening in Israel, he said. The normally optimistic are relatively unnerved. “Right now, no one is feeling good,” he said. “But it’s quite possible by the end of the year enough of the population will be feeling good that the mean is going to pick up again.”

Rachel Kafri is also following the protests over judicial overhaul. She makes sure to read the “Saturday papers.” She credits genetics and having worked almost her entire life for her centenarian status. She’s reached a “fair old age,” she told Israeli journalists, is in relatively good shape and still has more to accomplish.

“I am probably not ready to say goodbye to the world yet.”

National Post

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