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      Israel’s response to the COVID-19 pandemic: tailoring measures for vulnerable cultural minority populations

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          Abstract

          Every country has vulnerable populations that require special attention from policymakers in their response to a pandemic. This is because those populations may have specific characteristics, culture and behaviours that can accelerate the spread of the virus, and they usually have less access to healthcare, particularly in times of crisis. In order to carry out a comprehensive national intervention plan, policy makers should be sensitive to the needs and lifestyles of these groups, while taking into account structural and cultural gaps.

          In the context of Israel, the two most prominent and well-defined minority groups are the ultra-Orthodox Jewish community and parts of the Arab population. The government was slow to recognize the unique position of these two groups, public pressure eventually led to a response that was tailored to the ultra-Orthodox community and during the month of Ramadan a similar response has been implemented among the Arab community.

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          Israel: Health System Review.

          Israel is a small country, with just over 8 million citizens and a modern market-based economy with a comparable level of gross domestic product per capita to the average in the European Union. It has had universal health coverage since the introduction of a progressively financed statutory health insurance system in 1995. All citizens can choose from among four competing, non-profit-making health plans, which are charged with providing a broad package of benefits stipulated by the government. Overall, the Israeli health care system is quite efficient. Health status levels are comparable to those of other developed countries, even though Israel spends a relatively low proportion of its gross domestic product on health care (less than 8%) and nearly 40% of that is privately financed. Factors contributing to system efficiency include regulated competition among the health plans, tight regulatory controls on the supply of hospital beds, accessible and professional primary care and a well-developed system of electronic health records. Israeli health care has also demonstrated a remarkable capacity to innovate, improve, establish goals, be tenacious and prioritize. Israel is in the midst of numerous health reform efforts. The health insurance benefits package has been extended to include mental health care and dental care for children. A multipronged effort is underway to reduce health inequalities. National projects have been launched to measure and improve the quality of hospital care and reduce surgical waiting times, along with greater public dissemination of comparative performance data. Major steps are also being taken to address projected shortages of physicians and nurses. One of the major challenges currently facing Israeli health care is the growing reliance on private financing, with potentially deleterious effects for equity and efficiency. Efforts are currently underway to expand public financing, improve the efficiency of the public system and constrain the growth of the private sector.
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            Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges.

            Israel is a high-income country with an advanced health system and universal health-care insurance. Overall, the health status has improved steadily over recent decades. We examined differences in morbidity, mortality, and risk factors for selected non-communicable diseases (NCDs) between subpopulation groups. Between 1975 and 2014, life expectancy in Israel steadily increased and is currently above the average life expectancy for the Organisation for Economic Co-operation and Development countries. Nevertheless, life expectancy has remained lower among Israeli Arabs than Israeli Jews, and this gap has recently widened. Age-adjusted mortality as a result of heart disease, stroke, or diabetes remains higher in Arabs, whereas age-adjusted incidence and mortality of cancer were higher among Jews. The prevalence of obesity and low physical activity in Israel is considerably higher among Arabs than Jews. Smoking prevalence is highest for Arab men and lowest for Arab women. Health inequalities are also evident by the indicators of socioeconomic position and in subpopulations, such as immigrants from the former Soviet Union, ultra-Orthodox Jews, and Bedouin Arabs. Despite universal health coverage and substantial improvements in the overall health of the Israeli population, substantial inequalities in NCDs persist. These differences might be explained, at least in part, by gaps in social determinants of health. The Ministry of Health has developed comprehensive programmes to reduce these inequalities between the major population groups. Sustained coordinated multisectoral efforts are needed to achieve a greater impact and to address other social inequalities.
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              Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment

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                Author and article information

                Contributors
                ruthw@jdc.org
                nadavd@bgu.ac.il
                gideon.leibner@mail.huji.ac.il
                NadavPe@jdc.org
                shuli.brammli@mail.huji.ac.il
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                19 May 2020
                19 May 2020
                2020
                : 19
                : 71
                Affiliations
                [1 ]GRID grid.419640.e, ISNI 0000 0001 0845 7919, The Smokler Center for Health Policy Research, , Myers-JDC-Brookdale Institute, ; JDC Hill, P.O.B. 3886, 91037 Jerusalem, Israel
                [2 ]GRID grid.7489.2, ISNI 0000 0004 1937 0511, Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, , Ben-Gurion University of the Negev, ; Beer-Sheva, Israel
                [3 ]GRID grid.6734.6, ISNI 0000 0001 2292 8254, Department of Health Care Management, Faculty of Economics & Management, , Technical University Berlin, ; Berlin, Germany
                [4 ]GRID grid.9619.7, ISNI 0000 0004 1937 0538, The Hebrew University, Hadassah Medical School, ; Jerusalem, Israel
                [5 ]GRID grid.9619.7, ISNI 0000 0004 1937 0538, Department of Health Administration and Economics, Braun School of public health, Faculty of Medicine, , the Hebrew University of Jerusalem, ; Jerusalem, Israel
                Author information
                http://orcid.org/0000-0001-6358-5059
                Article
                1191
                10.1186/s12939-020-01191-7
                7235537
                32429995
                0de448de-a4d6-4edd-b88d-9b00ff573c4e
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 1 May 2020
                : 11 May 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100006245, Ministry of Science and Technology, Israel;
                Award ID: -
                Award Recipient :
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                Commentary
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                © The Author(s) 2020

                Health & Social care
                covid-19,health policy,cultural minorities,ultra-orthodox jews,ramadan
                Health & Social care
                covid-19, health policy, cultural minorities, ultra-orthodox jews, ramadan

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