Israel's prevention programs and screening policies for cardiovascular disease.

For all four broad ethnic groups in Israel, mortality rates declined over the last decade for both ischemic heart disease (IHD) and cerebrovascular disease (CVD), the first and third most important causes of death in the country. The four broad ethnic groups consist of persons born in Israel, Asia, North Africa, and Europe. Mortality data also indicate a low male to female ratio in mortality from IHD, a definite female predominance in mortality from CVD, and high mortality rates for IHD and CVD in males and females born in North Africa. Morbidity data, especially incidence, are scarce for CVD in both sexes and IHD in females. The feasibility of preventive intervention needs to be tested under the specific conditions of Israel. Although a multiple risk factor trial in Jerusalem showed that such a program can be conducted in a primary care framework, it clearly still needs to be tested in clinics rather than in a model teaching institution. The best place for intervention would seem to be the primary health care system, which has almost complete access to the country's population. Kupat Holim (the Health Insurance Institute of the General Federation of Labour) is attempting systematically to identify and manage hypertension patients. To date, management of acute coronary disease has been emphasized in Israel. Although additional resources are needed for primary prevention services, other options are suggested for obtaining those services.