Why Is Men's Life Expectancy in Israel So High?

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A new study by the Taub Center for Social Policy Studies in Israel finds a relationship between the longevity of men in Israel and army service, which contributes to Israeli men’s better physical fitness

Main findings:  In 2013, the average life expectancy for men in Israel was 81 years, in contrast to the OECD average of 77.7 and a world average of 68.8 years.  Considering other variables that influence longevity – including wealth and education levels, the health system and the country’s general demographic profile – the Israeli advantage is large and increasing.  An analysis based on a sample of more than 130 countries found that military service added more than three years to male life expectancy.  This conclusion is reinforced in data showing the differences in the average life expectancy of men and women in Israel and in the OECD. In the 34 OECD countries, women live an average of 5.5 years longer than men, but in Israel, where military service is shorter and in most cases less physically demanding for women, women's life expectancy is only 3 years longer.  While military service is an important component in public health, it has not yet been discussed in the academic literature on general health factors, nor has it been discussed in Israeli health literature. In 2013, life expectancy for men in Israel was 81 years. According to WHO data from that year, this ranks Israel in second place in the world out of 170 countries, alongside Iceland, Singapore and Switzerland, with only San Marino ranking higher. What explains this ranking? Prof. Alex Weinreb, a principal researcher at the Taub Center, examines the reasons for this high life expectancy and finds that one of the central variables is mandatory military service.

Israelis live longer than expected

The Taub Center was established in 1982 under the leadership and vision of Herbert M. Singer, Henry Taub, and the American Jewish Joint Distribution Committee. The Center is funded by a permanent endowment created by the Henry and Marilyn Taub Foundation, the Herbert M. and Nell Singer Foundation, Jane and John Colman, the Kolker-Saxon-Hallock Family Foundation, the Milton A. and Roslyn Z. Wolf Family Foundation, and the American Jewish Joint Distribution Committee. What influences life expectancy in a country? There are generally accepted criteria for estimating expected longevity in various countries. Some of the criteria are related to a country’s general level of development, like wealth, level of education and measures of inequality. A second group of criteria includes the amount of expenditure on health and the accessibility of health systems, while a third group examines demographic characteristics like population growth rate, crowding, and fertility rates. Prof. Weinreb’s analysis shows that together these criteria explain more than 80% of the variance in life expectancy among countries. More important from an Israeli perspective, the same model also shows that after accounting for differences in those criteria across countries, actual life expectancy in Israel is much higher than the predicted level: it is 6.3-7.2 years higher than its predicted level (depending on the model). When countries are ranked on “deviation” from predicted life expectancy, Israel is in second place globally (after Samoa), and it is top-ranked among all OECD countries. A secondary set of analyses shows that Israel’s better-than-predicted life expectancy has been consistent for at least 20 years, and has been increasing over time: the gap between predicted life expectancy and actual life expectancy for Israeli men was 3.8 years in 1990 and 5.85 years in 2000.

The sea breeze helps, but it is not enough Since the accepted criteria do not explain the observed longevity in Israel, additional variables known to influence life expectancy were taken into consideration, which required reducing the sample size to 133 countries. The first set of variables is related to geographic characteristics, and includes whether the country has a coastline. Countries located along the coast place high on the longevity scale, and there is some scientific documentation for the positive health effects of living by the sea. There is also evidence that living at a distance greater than 40 degrees from the equator lowers life expectancy, and so this variable was also added to the equation. The addition of these variables to the usual model explains approximately 2.1 years of Israel's higher than predicted life expectancy and decreases the deviation of Israel from

2 its predicted life expectancy to 5.4 years. Even after accounting for these factors, Israel remains it at the head of the OECD country ranking, although it drops to fourth place in the ranking among all 133 countries studied. A second set of variables added is related to religiosity. Many studies point to the positive relationship between religiosity and health, in both developed and developing countries. There are no data on average levels of religiosity in many countries, so the level was judged using proxy variables that looked at the strength of the relationship between religion and state worldwide (2007 to 2012). When these were inserted into the model, Israel’s deviation from its predicted life expectancy fell a further 1.8 years to 3.65 excess years, placing it in 4th place in the OECD ranking and 20th place among 133 countries. The indirect contribution of military service to Israel’s men

A third set of additional variables that stand at the center of this study are related to compulsory military service. In three of the four countries with the highest life expectancy in the world for men there is compulsory military service, and among the five leading OECD countries, only one, Japan, has not had some type of compulsory service in the past 30 years. In order to reflect the potential influence of compulsory service on men’s life expectancy, four related variables were measured. In each case, calculations were based on military service data from 1990, since one of the main hypotheses was that the likely health benefits of compulsory service—operating through high levels of physical activity—are most pronounced in the long term, as men reach their 40s. The Taub Center study first distinguished between countries with some sort of compulsory service in 1990 and those without. After that, levels of defense expenditure out of GDP were added to the calculations. The analyses that included these two variables show that in countries with compulsory service in 1990, the life expectancy of men in 2013 was higher by about 1.5 years than in countries without compulsory service. Considering this factor lowers Israel’s deviation from the predicted level of life expectancy to 2.9 years, explaining approximately six months of Israel's higher than predicted life expectancy. This places it in 5th place in the OECD ranking and 21st place among 133 countries that were examined. The final model that was tested takes into consideration the interaction between military spending as a percent of GDP and length of military service, treating this as a measure of the overall societal investment in terms of time and financial resources. This measure had the largest effect on life expectancy. It lowered Israel’s deviation from predicted life expectancy by more than 3.5 years, to only 0.07 years above the predicted level. It moved Israel from 4th place among OECD countries in terms of its deviation from expected life expectancy to 22nd place, and to 70th place among the 133

3 countries examined (versus 20th place in the model based on the basic variables, demographic characteristics and the level of religiosity). This is a highly significant effect. This variable alone (the interaction between military spending as a percent of GDP and length of military service) essentially explains Israeli men’s longevity over and above the effect of other variables that were tested. In other words, if Israel did not have the compulsory military service and spending that it currently has, male life expectancy in Israel would probably be much lower. The Taub Center's Prof. Weinreb notes, “even if a contribution to public health is not a goal of compulsory military service, it has important bearing on future policy decisions. It is possible to influence health through investment in institutions that are not directly related to health care, and, in Israel, the army is one of the agencies with a particular status that allows it to impact public health.” At ease: How exactly does military service contribute to longevity?

Compulsory army service is not a cure all, but there is some evidence supporting its positive influence on public health. One of the characteristics of military service is physical training, and, according to data from the “Global Disease Burden” project, in Israel, there is a relatively low mortality rate from diseases that are influenced by physical exercise, like heart disease (cardiovascular and cerebrovascular) and certain types of cancer. The mortality patterns among Arabs and Jews in Israel also support the relation between military service and health. For the most part, Arab Israelis do not serve in the military, and, according to data from the Ministry of Health, the rates of diagnosis of heart and vascular diseases among them are higher than among the Jewish population. Additional support for the study’s findings is provided by the gap in life expectancy between men and women. In the 34 OECD countries, women live an average of 5.5 years more than men. If compulsory service has a positive impact on public health, and primarily on men (whose service is longer than women’s and is characterized by a much more rigorous physical regiment), then the expected gap between men and women would be less. Indeed, the gap in Israel is only three years. The complete study on life expectancy of men in Israel will appear in the State of the Nation Report 2016 which will be published at the end of December.

The Taub Center for Social Policy Studies in Israel is an independent, non-partisan socioeconomic research institute. The Center provides decision makers and the public with research and findings on some of the most critical issues facing Israel in the areas of education, health, welfare, labor markets and economic policy in order to impact the decision-making process in Israel and to advance the well-being of all Israelis.

For details, or to arrange an interview, please contact Itay Matityahu, Director of Marketing and Communications at the Taub Center for Social Policy Studies in Israel: 052-290-4678.