Abstract
Objectives
Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews.
Methods
We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004–2005 of stratified samples of Arabs (N = 902) and Jews (N = 1087).
Results
Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI) = 1.94 (1.57–2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI) = 0.70(0.53–0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%.
Conclusions
Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.
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Acknowledgements
We thank the participants in the studies and the Sir Isaiah Berlin Travel Scholarship Fund for MAR. The original studies were funded by the Israel National Institute for Health Policy and Health Services Research [Grants no. 2001/7, a/95/2003].
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The authors declare that they have no conflicts of interest.
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Compliance with ethical standards and guidelines of the Declaration of Helsinki involving human subjects. Both studies were approved by the Institutional Ethics Committee at Hadassah-Hebrew University Medical Centre in Jerusalem.
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Written informed consent forms were obtained from all participants in both studies.
Funding
The original studies were funded by the Israel National Institute for Health Policy and Health Services Research [Grants No. 2001/7, a/95/2003].
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Daoud, N., Soskolne, V., Mindell, J.S. et al. Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment. Int J Public Health 63, 313–323 (2018). https://doi.org/10.1007/s00038-017-1065-3
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DOI: https://doi.org/10.1007/s00038-017-1065-3