Researchers: Shlomit Avni¹, Nehami Baum², Roei Ben Moshe³, Tali Kenig⁴, Emma Averbuch¹, Yishai Kom³

Background: Poverty is known to be a key factor in determining health. This means that economic inequality is associated with gaps in health services and in disease.

Objectives: How senior managers in the Health Funds, the MOH, the Ministries of Social Affairs and Education and local authorities in Israel, assess the effects of poverty on health; Is there a "pro-poor" policy, and how is it expressed in programs; recommendations for policies alongside the barriers preventing implementation.

Method: In-depth, semi-structured interviews were carried out with 43 senior positions in the health-care system. Conceptual trends and categories were identified by four different investigators.

Findings: Organizations do not have policies focused on poverty, rather- only as part of general health inequity programs; Interviewees mentioned individual solutions of three main types- economic-exceptions committees, actions to relieve bureaucracy and a psychosocial registrar; interviewees emphasized the need to develop programs to help people navigate within the health system and healthy lifestyle workshops; Many described the need to raise awareness among health teams about the effects of poverty and a number pointed to the need for dedicated teams that specialize in health and poverty; Interviewees described the need for collaborations within and between the organizations, government ministries and municipalities; They expressed frustration from the lack of resources for the task, lack of methodical information systems and lack of cooperation between agents, especially health and welfare organizations; they emphasized legal and regulatory restrictions that prevent the organizations from providing differential service to disadvantaged populations.

Conclusions: There is a need to develop poverty-aware policies within the health system, at national and organizational levels. Policies can include differential investment in people living in poverty, dedicated functionaries, training for staff and multi-professional cross-sectoral cooperation.

Research end date: 05/2019