Environmental Health in Israel 2020 Environment and Health Fund Ministry of Health Rivka 11, Jerusalem, Israel 9346117 Yirmiyahu 39, Jerusalem, Israel 9101002 Website: www.ehf.org.il/en Website: https://www.gov.il/en/departments/ministry_of_health Material from this report may be reproduced on condition that it is cited as: Environment and Health Fund and Ministry of Health (2020). Environmental Health in Israel 2020. A digital copy of this report can be found on the: Environment and Health Fund website Ministry of Health website www.ehf.org.il/en https://www.gov.il/en/departments/ministry_of_health About the Environment and Health Fund The Environment and Health Fund (EHF) is committed to expanding expertise in and knowledge about environmental health in Israel. EHF builds capacity and capabilities by supporting inter-disciplinary research, in-service professional training, and workshops and conferences. EHF helps connect Israeli scientists and policy makers to a network of international experts in environmental health research and policy. EHF works with scientists and professionals, government and the private sector to broaden stakeholder involvement in reducing exposure to environmental hazards and improving public health. Cover photo: Udi Katzman Environmental Health in Israel 2020 Environmental Health in Israel 2020 Editor-in-chief Authors Dr. Sari Rosen Dr. Tamar Berman Environment and Health Fund Department of Environmental Health, Ministry of Health Editing and production Dr. Zohar Barnett-Itzhaki Maya Popper Department of Environmental Health, Ministry of Health Advisor Additional authors (by order of chapters) Dr. Ruth Ostrin Dr. Isabella Karakis Environment and Health Fund Department of Environmental Epidemiology, Ministry of Health Research assistant Dr. Ziva Hamama Einav Horev National Food Service, Ministry of Health Environment and Health Fund Dr. Shay Reicher National Food Service, Ministry of Health Translation Ira Moskowitz Hadas Vagman The Israeli National Information Center for Non-Ionizing Language editing Radiation (“TNUDA”), Gertner Institute for Epidemiology Naftali Greenwood and Health Policy Research Dr. Tali Berman Graphic design Mimshak Fellow, Ministry of Health Navi Katzman Noam Hirsh Department of Environmental Health, Ministry of Health Ilana Taler Department of Environmental Health, Ministry of Health - 2 - Table of Contents Preface Dr. Ruth Ostrin 4 Introduction Prof. Itamar Grotto 6 Chapter 1 Ambient Air Quality 9 Chapter 2 Indoor Air Quality 27 Chapter 3 Environmental Tobacco Smoke 35 Chapter 4 Chemical Parameters in Drinking Water 43 Chapter 5 Reclaimed Wastewater 53 Chapter 6 Pesticides 59 Chapter 7 Chemical Food Contaminants 71 Chapter 8 Chemicals in Consumer Products 77 Chapter 9 Human Biomonitoring 85 Chapter 10 Non-Ionizing Radiation 95 Chapter 11 Climate Change 105 Chapter 12 Planning 119 Chapter 13 Vulnerable Populations 129 Chapter 14 Environmental Health Indicators and Trends 137 Conclusions and Recommendations Dr. Linda S. Birnbaum 151 Appendix 1 Progress Since 2017 and Future Challenges 158 Appendix 2 Environmental Health and COVID-19 165 Acknowledgments 168 - 3 - Environmental Health in Israel 2020 Preface Writing the preface to the third edition of Environmental Health in Israel is both an honor and a challenge. The report is the fruit of a continuing and extremely productive collaboration, more than a decade long, between the Environment and Health Fund and the Ministry of Health. The private/public partnership reflected in this collaboration demonstrates the partners’ respect and trust for one another. With each iteration, the report has seen improvements in form and content. We believe that these reports provide high quality, meticulously researched and reviewed data regarding environmental health research and policies. The current report is descriptive, providing a snapshot of the state of environmental health in Israel in 2020, and prescriptive, outlining current challenges and recommending future directions. Its fourteen chapters span a range of environmental factors that affect human health. It is indeed an honor to be involved in such an ambitious, comprehensive, and forward-looking project. Yet one cannot write anything at this time without experiencing some degree of anxiety. The appearance of the novel coronavirus, COVID-19, and subsequent efforts to deal with the pandemic have introduced uncertainty into all aspects of our lives. The ways in which our government, our society, and particularly our healthcare system are all challenged at this time, along with the politicization of public health decision-making, have sidelined much of the most essential environmental health research and policy. The threats of environmental hazards to public health in Israel, however, will not disappear simply because they have escaped from the spotlight as all attention is focused on the pandemic. In fact, one may argue that the opposite is the case. Exposure to environmental pollutants increases the severity of COVID-19. People in polluted areas are far more likely to die from the new coronavirus than are those living in cleaner areas. This knowledge should be leveraged to decide how to deploy resources to deal with the pandemic and how to ease back toward normalcy after lockdown. How exposure to environmental pollutants influences individual susceptibility to coronavirus infection has yet to be determined. One theory is that exposure to environmental chemicals or other environmental pollutants weakens immune defenses and/or compromises the functioning of organs targeted by the coronavirus, including the - 4 - Preface respiratory tract, the cardiovascular system, and the brain. Alternatively, environmental chemical exposures may indirectly exacerbate COVID-19 related disease by increasing individual risk to health issues associated with the heightened risk of death from COVID-19. For example, pre-existing asthma, diabetes, obesity, and cardiovascular disease worsen the prognosis of those with COVID-19, and each of these disease and health conditions has been linked to exposure to environmental chemicals and other pollutants in both animal models and human epidemiological studies. The lessons we are learning during the current pandemic highlight the need to enforce and even strengthen existing environmental pollution regulations. We have also learned the importance of access to open green spaces, particularly in the built urban environment. The urgency of considering the health implications of planning processes has been highlighted by the pandemic. Implementing policies and lifestyle changes to reduce human exposure to chemicals and other environmental pollutants that compromise our health and resistance to pathogens will be a critical component in preparing for the next viral threat. I would like to thank the many individuals who contributed to this volume. Professor Itamar Grotto, the outgoing Deputy Director General of the Ministry of Health, has been the single most significant figure in promoting issues of environmental health in the Israeli government for more than a decade now. Thanks to Dr. Tamar Berman, whose hard work and commitment to this project, among many, has been extraordinary. We also thank Dr. Zohar Barnett-Itzhaki for his contribution to the writing of the report and Dr. Udi Kaliner for reviewing the entire report. Maya Popper worked tirelessly as project manager and editor. Many, many contributors wrote, edited, and reviewed the chapters and deserve our gratitude. Professors Mark Nieuwenhuijsen and Mike Brauer greatly improved the report by participating in a kick-off workshop in January 2020 (MN) and offering comments on an earlier draft (MB). Dr. Linda Birnbaum, the recently retired Director of the National Institute of Environmental Health Sciences, once again read, reviewed, and commented on every chapter, every challenge, and every graph in this report, and again expressed her clear and concise wisdom in the Conclusions and Recommendations chapter. Finally, I thank my colleague, Dr. Sari Rosen. Although she is formally recognized as Editor-in- chief of this volume, that does not do justice to the time, effort, painstaking attention to detail, commitment to clarity, and uncompromising standards of excellence in everything she touches. Every aspect of this report was improved by Sari’s involvement. Ruth Ostrin, PhD Director Environment and Health Fund - 5 - Environmental Health in Israel 2020 Introduction The third edition of Environmental Health in Israel was written in 2020, the year when the COVID-19 pandemic dominated public health work globally and in Israel. The publication of this report at the end of 2020 is fitting: It demonstrates that even when public and political attention is directed elsewhere, pressing environmental health problems persist and need to be addressed. Accordingly, this report describes the most pressing environmental health problems in Israel and progress in addressing them in both research and policy. Despite parliamentary paralysis throughout 2019 and amid the COVID-19 crisis in 2020, impressive progress was made in several aspects of environmental health in Israel, including reducing air pollution, expanding biomonitoring capabilities, and closing gaps in regulating chemicals in consumer products. Additional hard work is needed to ensure that the full public health benefits of these milestones are realized and that the findings of research and surveys continue to be translated into policy. In light of new findings on