Jeremy D. Kark

Quotes

That [Community Health] survey established risk factor distributions. Even at that time the researchers involved, Sydney Kark, Joe Abramson, had this concept of a “community syndrome” of disturbed lipids, high cholesterol, hypertension, obesity, and diabetes. …Syndey registered this “community syndrome” in this population as a high priority because of the extremely high proportion of deaths due to cardiovascular disease at the the time. And it was something that was intervenable. (4)

The idea was to deliver health care to the community through a primary care mode and affect the health of the community and to assist it to survey it in kind of a circular mode where you first engage in community diagnosis, which was by the survey. The survey was the diagnosis. It had descriptive components and, if you will, the determinants of the ecological components, and then moving through to needs assessment, intervention, assessment of the intervention, and again, getting back to the cycle. So this is the way they conceptualized community-oriented primary health – COPC… (5-6)

The idea of a department of social medicine for a community in which it is working… was set up essentially in 1959 when Sydney [Kark] came here to Israel with a group of South Africans. And this group that came from Durban and Polela and had developed a COPC there, came to Israel in 1958-1959-1960…and came up through the WHO Program to develop a social medicine program, to develop an MPH. (8)

Let’s say, the interesting Israeli characteristics have determined to a large extent the research that I do. The structure of immigrant populations. We have a multi-variate culture, we’re multi-ethnic and extreme differences in socio-economic status that have increased. We used to have smaller disparities. These have increased. So relating to things like culture, we’ve looked at religiosity and health with very interesting findings. You see, we compared religious and secular kibbutz’s and found a striking excess of mortality in the secular as compared to the religious kibbutz for all causes of death, including cardiovascular. And for the multi-ethnic type of country, we looked at ethnic differences within Jews and also differences between Jews and Arabs. Found very interesting results showing that East Jerusalem Arabs have about twice the coronary fatality/mortality of the West Jerusalem Jews. As a result of that we developed a registry for the East Jerusalem Arabs and found they had an excess incidence, but most of the excess was in pre-hospital deaths. There was also an excess in in-hospital, say non-fatal MI. But the excess was largely pre-hospital death. So this has led us into our series of studies expanding on that, looking at the determinants of these differences. (10)

But I think that Israel’s contribution can really be in our special attributes. We have a multi-ethnic culture and stresses abound and we have unusual dietary intakes, unusual alcohol intake, unusual lipid levels, and I think that these can be… We might have unusual genes, but I don’t think we’ve demonstrated that our unusual patterns can be put down to unusual allelic distributions. It’s possible we’ll find some, but my guess is we’re talking about common alleles that others have too that are interacting with our special environment. (14)