Why aliyah to Israel for many old Jews just isn't an option

As I sit in the comfort and security  of my home in the South West of the UK, I am still reflecting on the two Jewish men who were stabbed two Jewish pedestrians in Golders Green, an area that, for as long as I can remember has been one of the most iconic area for both secular and haredi Jews in London.

Shortly after the attack inevitable  platitudes came out in force from politicians of all persuasions who condemned the acts of violence in time-honoured meaningless words. The government spokesmen spoke of their shock as to what had happened whilst serving up a good mix of “word salad.”

And guess what - nothing has really changed

Condolences without action

So many politicians’ “hearts went out to the Jewish community,” to such an extent that now, a couple of weeks later, I am forced to consider how they even  managed to catch their breath between their slippery banalities. “They all felt our pain,” though we saw none writhing in agony.

Virtually every one of these political hyenas wanted us to know “words are not enough,” though none suggested any practical solution  to ease  community fears and the ever insipid British Prime Minister, Keir Starmer, who has consistently shown himself incapable of doing anything that might directly confront Muslim voters, or criticize any country other than Israel has now shown he could not be bothered to travel the 6 miles from Downing Street to Golders Green

Instead he ordered a Cobra security meeting where they sat around and chatted about the problem of Jews under attack. After all, after a comfortable chat comes a time for reflection, closely followed by a Cabinet Committee where they can submit a report to some nameless Select Committee, who will will question witnesses from a range of NGO's with no conclusive solutions ever being put on the table.

Meanwhile, Starmer will not grasp any nettle that needs grasping lest he offends anybody because he so terrified of being decisive in case a "stalking horse" comes forward to challenge his leadership.

At the same time, the mayor of London, Sadiq Khan, told those who bothered to listen that he was “angry” and “appalled,” then, while feeling our pain, returned to Spain to meet Spanish Prime Minister Pedro Sanchez and discuss their shared views on Gaza

Is it any wonder that while so much passionate disinterest was taking place, many Jews started asking whether now is finally the time to make Aliyah. Is this the time to return home.

But herein we have the core problem - and it has become the problem that remains the elephant in the room and no-one is talking about it. Unless you have plenty of money, a well-paid job, or a good pension, moving to Israel is not an option.

Cost of living in Israel

We know there is a significant cost-of-living crisis in Israel, with roughly 2 million people, or ~21% of the population, living below the poverty line, including high rates of child poverty and food insecurity. It is now also common knowledge there has been a disturbing rise in food insecurity and financial struggles, with about 28% of Israeli households unable to meet all monthly expenses and 1 in 4 children live below the poverty line.

Additionally, data shows utilities average roughly 935 shekels per month (£230/  $310) and food is generally 21% higher than the richest European nations, with high prices for dairy and staples.

Now, of itself this is a matter of concern but not necessarily critical if an immigrant is fortunate enough to have a high salary, substantial investments and savings or a really good pension.

Socioeconomic status of Jews

However, data from the Office of National Statistics (UK) shows that roughly 40% of the Jewish population in the UK are, on average in receipt of a median or below income each month, and that roughly 3,000 Jewish children were classified as living in poverty, while in the US, 15% of Jews live below the poverty line and 26% reported difficulties paying for necessities like food or medicare. 

Put into a more accessible manner, data suggests in the UK, 9,000 Jews are almost certainly living in poverty, while in the USA this could be as high as 1.1 million people

Financial support

Of course, cynics would argue that potential immigrants would be able to access financial support to allow a move to Israel and I would have to agree. As I understand it, a couple wishing to make such a move would be able to access the "Absorption Basket" allowing eligible claimants to access up to £12,500 ($16,4000 during the first six months of residency plus possible free flights to Israel. However, this aid is only for the first six months then aid ends. So, unless a couple can secure an annual income of between £24,000 to £40,000 ($32,000 to 54,000) they are almost certain to be on or below the poverty threshold and likely to be in much worse financial position than they were before immigration.

Older people

Those above pension age are most likely to be living on a fixed income ie a state pension. For UK citizens this averages at a maximum of £12, 000 (and anything up to $36,000 for US citizens) per year, meaning that unless the older person has one or more private pensions they are unlikely to have sufficient money to survive. This, pf course, may be offset for some by the Israeli social security system who, in certain circumstances, may supplement any income if the claimant is eligible.

For British citizens in particular this is highly problematic as, even with a full state pension there would be insufficient to live on and they would not be eligible for supplementary a UK pension credit.

In most countries, but the UK in particular there has been a long history of significant deprivation amongst our older population and never has this become more clear than when exploring how older Jews living on a severely limited income may be disenfranchised from fleeing to Israel if ever the need arose.

Healthcare

As many will know, the Israeli healthcare system is a mandatory public/ private hybrid that provides universal coverage where about 20% of spending is out of pocket expenses including co-payments for visits to consultants, medication and imaging, As a consequence, currently nearly 6% of Israelis face catastrophic health spending and we can legitimately assume that senior immigrants without significant private pensions could easily become part of this group,

Additionally, we cannot afford to ignore those who are elderly and infirm, as well as our disabled. For some a flight to Israel is something far beyond their physical ability, while for others, disability creates so many problems as to make immigration an impossibility. And of course, there are also rare occasions where the Ministry of Interior can block immigration, so, in many respects the issue of aliyah for older people is something of a health minefield.

Political comment

For many the notion of making aliyah is not an option if life deteriorated in their current location. British or US Jews living in poverty would have neither the wherewithal to make the move, nor the income to support themselves in Israel after six months. 

The only choice available to them is to bring about effective change; For these people there is no other option and, what surprises me is how this point is never made. All too often we hear Jews saying 'well, if it gets really bad we'll just go to Israel', as if this is an option for everyone. But nobody talks about what happens to our poor, or weak, our disabled and our elderly. Where do they go if the pogroms were to start? Where are they to go when the synagogues are burned or the Jewish schools are forced to close? Are they expected to stay? Are they the ones we sacrifice?

It is a question no-one is asking and someone needs to. Remember, right now nobody is doing anything to end antisemitism and with nothing being done, we must assume that it will get worse. And if it gets worse what happens to those we, in our blind ignorance choose to leave behind.

Jews are more predisposed to colorectal cancer but there is a shortfall in funding and a lack of desire to change

As someone who two years ago was diagnosed with colorectal cancer and who, by the grace of HaShem and an outstanding consultant and surgeon was cured, I feel an overwhelming moral responsibility to urge people to look out for symptoms of colon/ bowel cancer before it is too late. It is a vile disease and each year we lose far too many good people. Yes the treatment is unpleasant but the alternative is far worse. The reality is those who seek treatment early can recover, even if, like me you delay for a while before going to your doctor. A  diagnosis is not an automatic death sentence.

So, let's look at the facts:

Good news and bad

First, the good news, among Americans under the age of 50, the overall cancer mortality has plummeted by 44% over the last quarter of a century and better diagnostic tools, along with a sharp reduction in smoking, help to explain why deaths from leukaemia as well as lung, breast and brain cancer are falling so dramatically.

Unfortunately, but inevitably there is also bad news - cancer mortality rates in the UK for those under 50 show a concerning trend and while overall cancer deaths are falling, incidences in under-50s have risen by 24% since 1995. Approximately 6,000 younger adults die from cancer annually in the UK, with early-onset bowel cancer mortality projected to rise significantly. In addition, colorectal cancer has risen 1.1% annually since 2005  advancing it from the fifth most common cause of cancer death in the early 1990s to second place today, 

Of even more concern is the fact the data shows how Jews, in particular should be especially alarmed as the research has shown how people of Ashkenazi, or Eastern European Jewish descent are likely to be two or three times more likely to develop colorectal cancer than nearly any other ethnic grouping.

According to the Norton and Elaine Sarnoff Center for Jewish Genetics, "Individuals of Ashkenazi Jewish ancestry have among the highest rates of colorectal cancer (CRC) of any ethnic group. In the general population, the lifetime risk of CRC is about five percent. In the Ashkenazi Jewish populations, this risk is two to three times greater than the general population.

About 10 percent of colorectal cancer is hereditary and within these two known cancer syndromes account for a significant proportion of hereditary colorectal cancer. However, having a cancer gene mutation does not mean a person will definitely have cancer, but it does increase their cancer risk. 

                   Alan Herman , National Executive Director of ICRF and a cancer survivor

According to  Alan Herman, the executive director of ICRF, which is the largest non-governmental funding resource for cancer research in Israel. “Colorectal cancer is rising at an alarming rate among young adults, challenging long-held assumptions about who is at risk ... These realities make research more urgent than ever.  By funding Israel’s most promising cancer scientists, the ICRF is driving discoveries that could lead to earlier detection, better treatments and ultimately save lives.”

Indeed, Israel has been very much at the heart of research into colorectal cancer. For example, Irit Ben-Aharon, is a medical oncologist specialising in gastrointestinal cancers and is Director of the Fishman Oncology Centre at Haifa’s Rambam Health Care Campus and also heads the European Organisation for Research and Treatment of Cancer task force for young-onset gastrointestinal cancer.

“There’s been an increase in the past three decades of early-onset colorectal cancer, and we don’t really know the reason,” she said. “Only 15% to 20% of these cases are hereditary; the rest came out of the blue.”

There has long been a belief that eating red meat and, in particular highly processed meats such as hot dogs and sausages is a major risk factor in early-onset colorectal cancer. However, Ben-Aharon remains unconvinced. "I don’t think it’s diet only — it’s multi-factorial,” she argues. “When you look at the data, if it would have been only diet, you’d not see the incidence of early-onset colorectal cancer rising all over the world. Diets are different in the U.S., Japan and Scandinavia, yet you see this increasing trend everywhere, and we probably would have seen a much higher incidence, as many people eat ultra-processed food and don’t develop colorectal cancer.”

Of major interest is her belief that bacteria may play a part in causing colorectal cancer., “Some toxins from specific bacteria have been shown to have increased levels in cases of early-onset colorectal cancer, implying these bacteria may induce cancer. Also, there is evidence linking increased risk due to exposure to specific pesticides.”

With regard to prevalence of colorectal cancer amongst Jews she has argued it is more common because Ashkenazi Jews are genetically predisposed to the disease, though not necessarily to the early-onset form of CRC.

“Environmental factors such as diet and other exposures like plastic and pesticides — and the combination with specific predisposition and host features such as microbiome and other pathways — may underlie this trend,” she said.

“Elucidating the interplay between environmental factors and unique features of patients predisposed to developing cancer at an early age would allow us to delineate the high-risk population,” she added. 

Irit Ben-Aharon is a medical oncologist specializing in gastrointestinal cancers. (Courtesy)

Hope for more effective and less toxic treatment

Drug discovery expert Professor Nir London works at Rehovot’s Weizmann Institute of Science as well as being the president of the Israel Chemical Society’s medicinal chemistry section.

                                                              Professor Nir London

“Many cancers are driven by specific mutations, which we call driver mutations. They tend to appear in the same types of cancers,” argues Professor London, “If a particular cell gains this mutation, it has a high propensity to transform into a cancerous cell. Such cancers get addicted to the mutation, so if you inhibit a protein with this mutation, you’ll have a way to mitigate the cancer’s growth. It’s a soft spot.”

“Not all colorectal cancers are the same,” London said. “We are focusing on developing drugs that are specific to a vulnerability found in about 13% of CRC patients. If successful, this could bring hope to hundreds of thousands of patients.”

In other research, Gilad Bachrach, who teaches at Hebrew University-Hadassah’s Institute of Dental Science in Jerusalem has focussed  on oncobacteriology — the study of bacteria as a treatment for cancer.

“Cancer has been treated by surgery and then by chemotherapy, radiotherapy and, most recently, immunotherapy. We believe bacteria therapy can be the next potential option in cancer treatment,” Bachrach said.

“We know bacteria are involved in cancer promotion, as well as anti-cancer activities,” he added. “Now the challenge is to harness bacteria for cancer detection and therapy.”

Ultimately, he said, “surgery, radiotherapy, chemotherapy and immunotherapy are established cancer treatments. My hope is that using bacteria to identify and target cancer will become the next major breakthrough in the field.”

Now, I cannot speak for other people who have experienced treatment for cancer, so here I can only speak for myself. Chemotherapy felt like being hit by a bus and while after only six weeks my cancer was substantially reduced, the treatment process was debilitating and unpleasant with symptoms that, in my case included extreme exhaustion, loss of appetite, inabillity to stand cold weather, nausea and quite severe anaemia. In addition, as a diabetic, glucose levels that had once been previously stable suddenly went out of control resulting in an urgent trip to the A&E department.. 

So any new treatment offering a significant improvement to general wellness can only be of benefit to the patient.

Political constraints

While scientific discoveries like those shown above give us all hope, all is not well in the implementation of cancer healthcare delivery. In the USA, there are clear budget shortfalls, exacerbated by projected reductions in federal funding for the National Institutes of Health (NIH) and National Cancer Institute (NCI), resulting in delays in colorectal cancer treatment and stalling research,  forcing clinical trial cuts across the USA. These fiscal constraints have resulted in treatment delays of four weeks or more for patients, allowing tumours to spread.

Furthermore, chemotherapy costs in the USA typically range from $1,000 to over $12,000 per month for drugs alone, with total annual treatment often exceeding $100,000. As a result total costs for the patient, including administration and supportive care, can lead (depending on insurance plans) to high out-of-pocket expenses of anything from $5,000 to $10,000+ annually) even with insurance. 

Meanwhile, in the UK, cancer cases are increasing, and cancer care could add £14.4bn to UK health spending annually by 2050, according to the latest OECD modelling. Add to this a lack of trained staff resulting in an NHS unable to deliver timely, high-quality care and diagnostic services. All these issues are further complicated by budgetary constraints that have led to the removal of some drugs from the Cancer Drugs Fund (CDF), sparking concerns about access to innovative treatments., 

So while we have outstanding breakthroughs happening across the world and I have only concentrated today on Israeli innovation, we have neither the practical facilities or the budget to implement these developments and until there is a willingness to bring about significant change across health provision internationally people will die unnecessarily.

So, should we be concerned? Well clearly any illness affecting Jews more than the rest of the population and more needs to be done to protect us but I'm not calling for armed rebellion or revolution her. The solution is much simpler and in our own hands.

A commercial FITT test is available to buy through your pharmacy or you csn ask your doctor. They only cost £60 or so, making them.reasonably affordable

 In addition, my US readers have the additional benefit of being urged to have occasional colonoscopies that can detect this form of cancer.

The bottom line is don't sit by and do nothing - the price of peace is eternal vigilance.