A closer look at the health of Arab citizens of Israel.

The Arab citizens of the state of Israel make up nearly a fifth of the total population of the country, and 90% of them were born, raised and educated in Israel. Despite the large size of the Arab minority and their long presence in the country, Arab localities still suffer from underdevelopment: their infrastructures are inferior to those in Jewish localities and they have been systematically discriminated against in national development plans and thus lack employment opportunities. Whatever the measure of socio-economic status, be it education achievements, income or level of occupation, Arab citizens are at the bottom of the ladder. As health status is inseparable from socioeconomic status, it is perhaps not surprising that the health of Arabs in Israel has lagged behind that of the Jewish population. On the other hand, the fact that planned national support systems have achieved a comparatively high health status level for large groups of Jewish immigrants arrriving in Israel with limited means illustrat es the potential effectiveness of a government policy designed to improve the health of specific communities, if it is implemented with commitment and backed up with adequate budgets.

The brief interval in the early 1990s, when the incumbent government recognized the unequal treatment of the Arab minority in Israel and adopted a social support ideology accompanied by policies aimed at narrowing the gaps, has since given way to the current (1998) government's firm commitment to free market policies and privatization practices that reproduce and exacerbate inequities.

Health Status Indicators

Despite extensive statistics on all aspects of life in Israel, specific data on the Arab minority are often lacking, and one is forced to draw conclusions based on footnotes, explanatory notes or extrapolations. In light of this neglect, The Israel Center for Disease Control deserves mention for incorporating and systematically analyzing most available morbidity and mortality data on Arabs as compared to Jews in its 1997 report (ICDC, 1997).

The table above offers a close look at Infant Mortality Rates over time. It reveals a persistent Relative Risk Ratio of Arabs to Jews amounting to twofold throughout the last four decades. As rates for both groups follow a downward trend, specific levels of infant mortality are reached by Arabs 10-20 years later than by Jews. If the Infant Mortality Rate is considered by the age of the infant's death, we find the Arab to Jewish Relative Risk Ratio to be higher in the post-neonatal period (3.4 in 1990-93), where the effects of the physical and economic home and community environment play a more decisive role. This ratio has been on the rise, whereas the Relative Risk Ratio in the neonatal period has remained stable at a lower level (1.5 in 1990-93) (CBS, 1997d, Table B). In the neonatal period, causes of infant mortality related to the birth process as well as those resulting from congenital malformations have a greater effect. Again, a closer look at Relative Risk Ratios by specific causes of death reveals t hat the discrepancy resulting from environmental and external factors is greater than that associated with genetic and obstetric ones. For example, in 1990-93, the Relative Risk Ratio of Infant Mortality Rates of Arabs to Jews from infections was 4 (the infant mortality rate from infectious diseases was low for both groups: 0.8 for Arabs and 0.2 for Jews), while that from congenital malformations was 2 (4.3 for Arabs and 1.8 for Jews) (CBS, 1997c, Tables 17 and 18). The comparisons are more striking when put in relative terms than in absolute ones. Moreover, throughout the past two decades, the Relative Risk Ratio of Arabs to Jews was higher for females than for males, possibly reflecting the traditional preferential treatment of males in Arab society.

Politically motivated statements by some government officials attribute the excess Infant Mortality Rate among Arab citizens of Israel to their high rate of consanguineous marriage. This seems to follow the discredited colonial tradition of "blaming the victim." While it is true that congenital malformation is higher among Arabs than Jews (accounting for 31% compared with 26% of infant deaths), as the above figures show, causes related to the environment and the health care system have resulted in greater disparities. Obviously, not all congenital malformations can be blamed on consanguineous marriages, as this is the second highest cause of infant mortality among Jews, for whom consanguineous marriages are not the rule. From clinical observations, as well as occasional reports in the Israeli medical literature, it is clear that various disabilities, including congenital deaf mutism and blindness and thalassemia, occur in various Arab clans due to consanguinity, but the case is not convincing when this is of fered as the sole or even main cause of excess mortality, as only 10-25% of congenital malformations are reported to be inherited in the standard obstetric literature. If we extend the consideration to higher age groups, we find that the Relative Risk Ratio of Arab to...