HEALTH AND ILLNESS IN THE JEWISH

CULTUREBY MARY CLOUSE

Learning Objectives

Health and Illness in the Jewish Culture

Where did the Jewish culture originate from and what are their cultural beliefs and practices?

Understand health and illness in the Jewish culture and the importance of following Jewish Dietary Laws

Compare Jewish (Israel) and United States healthcare and leading causes of death

What are socio-cultural behaviors during illness and what healthcare caregivers need to know providing cultural care for the Jewish population?

Jewish History

History of Jewish people begins with Abraham. God told Abraham to leave his homeland with his descendants and promised them a new land called Canaan which is known as Israel (The Promised Land)

Land of Israel is central to Judaism Jewish law is tied to land of Israel and can only be performed there Walking in it gives you a place in the “World to Come” Prayers as well as holiday observances and special events refer to

returning to Israel and Jerusalem Living outside of Israel is viewed as an unnatural state for a Jew

(living in exile from our land) Jews were exiled from Israel by the Romans in 135 C.E. Jews regained control over the land again in 1948 C.E. After British

control handed palestine over to the United Nations. The Jews of Palestine declared the creation of the State of Israel and have protected it ever since not without continuous Arab-Israeli wars.

Jerusalem is considered “Zion” a Jewish idea of utopia (Judaism 101, 1995-2011a)

Jewish Populations Around the World

Israel- 7,703,700United States- 5,275,000France- 483,500Canada- 375,000United Kingdom- 292,000Russia- 205,000Argentina- 182,300Germany- 119,000Australia- 107,500Brazil- 95,600Ukraine- 71,500South Africa- 70,800

Hungary- 48,600Mexico- 39,400Belgium- 30,300Netherlands- 30,000Italy- 28,400Chile- 20,50010,000-19,000- 118,6001-9,999- 131,606

(DellaPergola, S., 2010)Image retrieved from http://www.bje.org.au/learning/people/index.html)

Jewish Population

United States

2.1% of Americans are JewishEight states have a Jewish population of 200,000 or more

New York- 1,635,000California- 1,220,000Florida- 639,000New Jersey- 504,000Illinois- 298,000Pennsylvania- 295,000Massachusetts- 278,000Maryland- 238,000

The four states with the largest Jewish population accountFor more than 60% of the Jewish population in the United States(Sheskin & Dashefsky, 2011)

Jewish Denominations

Orthodox Judaism Most traditional 7% of American Jews Observe Sabbath Follow Jewish

dietary laws

Reform Judaism Most liberal of modern Judaism 42% of American Jews Lack observance of dietary laws Sabbath on Sundays Inclusive and welcome all

including gays and lesbians and all society

Have women rabbis and presidents of synagogues

Hasidic Judaism Center on Rebbe who they look

to guide them through all aspects of life to buying a house, through illness and choosing a spouse

Heavily influenced by Kabbalah movement

Conservative Judaism Moderate sect avoids extremes

of orthodox or reform Observe the sabbath and

dietary laws (Religiousfacts, 2004-2012)

Trad

ition

al

Jew

ish

B

elie

fs

Rambam’s 13 Principles of FaithG-d existsG-d is one and uniqueG-d is incorporeaG-d is eternalPrayer is to be directed to G-d alone and to no otherThe words of the prophets are trueMoses prophecies are true, and Moses was the greatest of the prophetsThe Written Torah (first 5 books of the Bible) and Oral Torah (teachings now contained in the Talmud and other writings) were given to MosesThere will be no other TorahG-d knows the thoughts and deeds of menG-d will reward the good and punish the wickedThe Messiah will comeThe dead will be resurrected (God is written G-d by observant Jews to avoid risk of defacing name)

(Judaism 101, 1995- 2011b)

Jew

ish

Rite

s o

f P

assag

e

Birth Life begins at birth Hebrew name given Circumcision performed on 8th day First born natural males “redeemed” No procedure for adoption

Bar or Bat Mitzvah and Confirmation Boys at age 13 and girls at age 12 Ceremony signifies adulthood and ability to

follow commandments Confirmation takes place a age 16-18

Marriage Bashert- soul mates Contract called “Ketubah” terms of marriage

Divorce Divorce permitted Man can divorce wife for any reason, Rabbi must

approve for women Life, Death and Mourning

Jewish law can be broken to save human life Euthanasia prohibited, refusing extraordinary

measures allowed Mourning show respect for dead, comfort the

living Graves marked with tombstones, unveiled after

12 months Olam Ha-Ba: The Afterlife

Belief in afterlife called Olam Ha-Ba or “The World To Come” (Judaism 101, 2011b)

Jew

ish

Holid

ays

Rosh Hashanah- September Yom Kippur- September or October Sukkot- September or October Shemini Atzeret- September or October Simchat Torah- September or October Chanukkah- November or December Tu B’Shevat- January or February Purim- February or March Pesach (Passover)- March or April Lag B’Omer- April or May Shavu’ot- May or June Tisha B’Av- July or August (Judaism 101, 1995-2011c)

Jewish Calendar is lunar each month beginning on a new moon

Different Date each year Holiday begins the evening before the date

at sunset Holiday ends at nightfall on date of holiday Work is prohibited on some holidays Some Holidays last more than one day Holidays fall on different dates every year Candles burned and traditional foods can

be served

Health and Illness in the Jewish Culture

(Image Retrieved from http://www.judaism.com/display.asp?etn=FBCAE)

• Two components of health: Body and Spirit• Healing for the soul• Cure for the body• “Cure may occur without healing,

and healing without cure”• Pray for yourselves and others in time

of illness• Reading scriptures “Torah” and study

helps the spirit• Participate in Jewish community during

illness• Immersion in Jewish rituals during

illness(Flam, 1994)

Health is a reason to observe Jewish dietarylaws called the “Laws of Kashrut” o Eating is a religious ritual demonstrating self-control and choosing right from wrongo Dietary restrictions are taken from the scriptures (Torah) (Judaism 101, 1995-2011e)

Jewish diet

Kashrut: Jewish Dietary Laws Kashrut is body of Jewish law dealing with what foods can and cannot

be eaten or prepared “Kashrut comes from the Hebrew root Kaf-Shin-Reish meaning to be

fit, proper, or correct “Kosher” has the same root which describes food that meet these

standards Foods are Kosher when they fall with in the dietary laws There are additional dietary restrictions during Pesach (Passover)

which some kosher foods may not be considered kosher for passover Food not kosher is called “treif” Modern Jews think laws of Kashrut are primitive health regulations

and have become obsolete with modern methods of food preparation Kosher diets are followed by Jews because Torah says so and show

obedience to G-d Imposing rules on what you can and cannot eat ingrains self-control. The ability to distinguish right and wrong, good and evil, pure and

defiled, the sacred and the profane, is very important to Judaism In 2000 National Jewish Population Survey 21% of American Jews kept

kosher in their home (Judaism 101, 1995-2011e)

General Rules for Kashrut

Certain animals may not be eaten at all. This restriction includes the flesh, organs, eggs and milk of the forbidden animals.

Of the animals that may be eaten, the birds and mammals must be killed in accordance with Jewish law.

All blood must be drained from meat and poultry or broiled out of it before it is eaten.

Certain parts of permitted animals may not be eaten. Fruits and vegetables are permitted, but must be inspected for bugs

(which cannot be eaten) Meat (the flesh of birds and mammals) cannot be eaten with dairy. Fish,

eggs, fruits, vegetables and grains can be eaten with either meat or dairy. (According to some views, fish may not be eaten with meat).

Utensils (including pots and pans and other cooking surfaces) that have come into contact with meat may not be used with dairy, and vice versa. Utensils that have come into contact with non-kosher food may not be used with kosher food. This applies only where the contact occurred while the food was hot.

Grape products made by non-Jews may not be eaten. There are a few other rules that are not universal. (Judaism 101, 1995-2011e)

Jewish Cookin

g

Influenced from Middle Eastern, Mediterranean, Spanish, German and Eastern European.

Challah-sweet eggy bread used for Shabbat and holidays

Bagels and Lox Gefilte Fish- cake or ball of

chopped up fish Matzah Ball Soup- think

chicken broth with three ping-ping sized matzah balls

Knishes- potatoe flour dumplings

Blintzes- Jweish crepe or thin flat pancake rolled around filling

Cholent- stew of vegetables and meat

Holishkes (Stuffed Cabbage) Tzimmes- sweet stew Kasha Varnishkes-

Buckwheat groats with bow tie noodles

Kugel- pudding Jewish Apple Cake (Judaism 101, 1995-2011f)

Image retrieved from http://cityroom.blogs.nytimes.com/2007/08/01/something-to-nosh-on-heres-the-skinny-on-jewish-delis/

Leading Causes of Death of Israeli People

(Non- communicable diseases)

According to World Health Organization (WHO) in 2010.

Israel in 2010 population was 7,418,400 approximate 81% of population

5,703,700 Jewish in Israel (DelaPergola, 2010)

Mortality rate 156,000-males 166,000-Females

“Tay-Sachs disease (TSD) is the most familiar of the Jewish genetic disorders. It is caused by a deficiency of an enzyme called hexosaminidase A, or hex A. Lack of this enzyme affects the brain and the nervous system, causing rapid and progressive deterioration. Death usually occurs by the age of 6. A late-onset form of Tay-Sachs also occurs, although it is rare.” (Jewish Genetics, 2008)

% of total deaths, all agesProportional mortality

Injuries- 5% Respiratory diseases- 6% Diabetes- 7% Communicable,

maternal, perinatal, and nurtitional conditions- 8%

Other non-communcable diseases-20%

Cardiovascular disease (CVD)- 27%

Cancers- 27% (WHO, 2010)

Halocaust

Began in January 1933 when came to power

Ended on May 8th 1945 11 million men, women,

and children were murdered and six million were Jews

Over one million at Aushwitz

Taken by trains in cattle cars to the camps and children often died by suffocation

Of the 9 million Jews who lived in Europe before the Holocaust 2/3 were murdered

One way to escape was to convert to Christianity only if ancestry did before 1871

The brutality was extreme

(Random facts, 2012)

Halocaust means “burnt sacrifice Adolf Hitler and the Third Reich defined anti-Semitism The Nazi regime used their power to eradicate the

Jews- The Final Solution (to deport all Jews to Poland to be murdered)

Jews were considered racially undesirable Jews were hated and were outcasts by Lutheran and

Catholic churches for not converting to Christianity First victims of Hitler’s murders were the handicapped,

mentally ill, and those suffering from hereditary illness Jews were blamed for Germany’s misfortunes known as

“stab in the back” Jews were killed mostly in concentration camps most

notably Aushwitz Died from gas chambers, euthanasia, and execution,

death marches, starvation, and disease Jews were separated from their families (Wegner, 2003)

United States

According to the World Health Organization(WHO) in 2010.

United States in 2010 population was 310,383,948

The Jewish Population in the United States in 2010 was

5,275,000

Mortality Rate 10,550,000- Men 11,505,000- Women

Leading Causes of Death

(Non-communicable disease)

% of total deaths, all agesProportional Mortality

Diabetes- 3% Communicable, maternal,

perinatal and nutritional conditions- 6%

Injuries- 7% Respiratory Diseases- 7% Other Non-communicable

diseases- 19% Cancers- 23% Cardio vascular disease- 35%

(WHO, 2011)

Health Care Servicesand Resources- Israel

SERVICES PROVIDED

Medical diagnosis and treatment both at clinics and at the home of the patient.

Preventive medicine and health education (i.e. early diagnosis of embryo abnormalities, vaccinations, counseling for pregnant women, mothers and the elderly).

Hospitalization (general, maternity, psychiatric and chronic).

Surgery and transplant. If medical treatment is not available in Israel, treatment abroad will be covered.

Preventive dental care for children. First Aid and transportation to a clinic or hospital. Medical services at the workplace. Medical treatment for drug abuse and

alcoholism. Medical equipment and appliances. Obstetrics and fertility treatment. Treatment of injuries caused by violence. Medication, in accordance with a list issued by

the Ministry of Health. Treatment of chronic diseases. Paramedical services (i.e. physical therapy,

occupational therapy, etc.).

RESOURCES

In 1995 National Health Insurance Law passed to entitle every Israeli citizen health care services

Universal and required Choose from Four health care

organizations- funding from government Same uniform benefits package funded for

all citizens regardless of financial means or age and state of health

High quality provides life expectancy for Women 79.1 and for Men 75.3 and Infant Mortality rate of 7.5 per 1000 live births

Developed as Health Maintenance Organizations (HMO’s)

Can buy supplementary insurance that covers services and treatments not covered

Publicly-funded system Supervised by the Ministry of Health (Israel Ministry of foreign Affairs, 2008)

Health Care Services and

Resources- United States

Services of Health Insurance in the United States Coverage for most ailments and

treatments covered by insurance. Preventative care can have coverage.

Health care constantly being reformed

Types of coverage Medicare

A federal system of health insurance for people over 65 of age and

for certain younger people with disabilities

Medicaid A federal system of health

insurance for those requiring financial assistance

Private Health Insurance Privately paid health insurance

Employer Health Insurance Health insurance premiums paid

in full or partially by employers Uninsured

Carry no health insurance coverage

Resources for Health Care Primary Care Doctors, Nurse

Practitioners, Physician Assistants, Nurses, Physical Therapists, etc. Hospitals, Clinics, Doctors

offices, Mobile Health Units, Alternative Medicine, Urgent Care, etc.

Health People 2020 10-year national

objectives for improving the health of all Americans Create a society where

all people live long and healthy lives Work with national,

state, and communities to improve health

(Healthy People, 2012)

Jewish Health Care Behaviors and Beliefs

Hasidic Jewish population practices strict religious observance (Orthodox Jews)

Belief in using Spiritual leader a Rabbi or “Rebbe” to facilitate communication between Jewish Population and health care providers.

The Rebbe assumes responsibility for the well-being of his followers

The Rebbe is sought during illness to provide religious understanding of suffering

The Rebbe could interpret what spiritual issues required correction to produce improvement in physical health

The Rebbe can encourage compliance by endorsing treatments The Rebbe may be a member of the multidisicplinary team The Rebbe may be involved in spiritual healing, medical

referrals, and treatment options Fear of stigma related to illness affects patient outcomes and

willingness to seek medical services Jewish communities insularity can impede education about

health care options The language barrier can make difficult to seek health care as

well as distrust Hasidic Jewish population involvement with a Rebbe doesn’t

always imply non-compliance with traditional medicine (Coleman-Brueckheimer & Dein, 2011)

Providing Cultural Care for the Jewish Culture

Make available Jewish clergy for visiting, spiritual care, counseling. Chaplains who are Christian would not help them spirtually

The Sabbath (Shabbat) goes from sundown Friday to nightfall Saturday. Observant Jews don’t do work, travel, use electricity, handle money, or bathe on the Sabbath or special holidays. Special prayers and rituals are observed on Friday at sundown with bread, wine, and lighting candles.

Don’t discharge observant patients during the Sabbath or other holy days unless there is a lounge they can wait for nightfall in order to drive a car.

Exemptions to the Sabbath rules must be made to save a life.

Some medications are made with non-kosher products. Jewish patients can take most medications but they should be made aware and able to discuss with Doctor alternatives. (Alberta Health Services, 2012)

Providing cultural competent care involves overcoming the language and communication barriers

Provide an environment where people from diverse backgrounds feel comfortable discussing their cultural and spiritual health beliefs and practices during treatment options

Be respectful to different healing systems and beliefs and when suiting integrate into treatment plans

(Coleman-Brueckheimer & Dein, 2011)

Health and Illness in the Jewish Culture

Summary

The Jewish culture is rich in tradition with holidays and life experiences To restore health is through the body and the spirit Believing in G-d and living the Jewish laws help in dealing with health and illness Following the dietary laws of Kashrut is for health and religious reasons Leading causes of death are similar in Israel and United States There are health care differences between Israel and United States but more accessible with Universal Health Care in Israel where largest concentration of Jewish population resides in the world

Questions???

Kashrut is a body of Jewish law dealing with what foods can and cannot be eaten or prepared known as “Kosher” foods. What is a true statement that pertains to the Jewish dietary laws?

There are Jewish Beliefs that are called Rambam’s 13 principles of faith. What principles do they believe?

Hasidic Jewish population practice strict religious observance (Orthodox Jews) which include Sabbath observance. Sabbath goes from sundown Friday to nightfall Saturday. For the Jewish patient in a hospital what statements are true?

Is Living outside of Israel in exile from their land considered an unnatural state for a Jew?

The most common type of Jewish denomination practiced in America is Reform Jewish. What characteristics make it different from Orthodox Jewish?

References

Alberta Health Services. ( 2012 ). Health care and religious beliefs. Retrieved from http://www.albertahealthservices.ca/ps-1026227-health-care-religious-beliefs.pdf

Coleman-Brueckheimer, K. & Dein, S. (2011). Health care behaviors and beliefs in hasidic jewish populations: A systematic review of the literature. Jewish Religious Health, 50, 442-436. DOI 10.1007/s10943-010-9448-2

DellaPergola, S. (2010). World jewish population, 2010. The hebrew university of Jerusalem. Retrieved from http://www.jewishdatabank.org/Reports/World_Jewish_Population_2010.pdf

Flam, N. (1994). The jewish way of healing. Reform Judaism Magazine. Retrieved from http://huc.edu/kalsman/articles/JewishWayOfHealing.pdf

HealthyPeople.gov. (2012). About healthy people. Retrieved by http://www.healthypeople.gov/2020/about/default.aspx

Israel Ministry of Foreign Affairs. (2008). National health insurance Retrieved fromhttp://www.mfa.gov.il/MFA/MFAArchive/1990_1999/1998/7/National%20Health%20Insurance

References ContinuedJewish Genetics. (2008). Tay-Sachs Disease. Retrieved by http://www.jewishgenetics.org/?q=content/tay-sachs-disease

Judaism 101. (1995-2011a). The Land of Israel. Retrieved by http://www.jewfaq.org/israel.htm

Judaism 101. (1995-2011b). What do jews believe? Retrieved by http://www.jewfaq.org/beliefs.htm

Judaism 101. (1995-2011c). Jewish holidays. Retrieved by http://www.jewfaq.org/holiday0.htm

Judaism 101. (1995-2011e). Kashrut: Jewish dietary laws. Retrieved by http://www.jewfaq.org/kashrut.htm

Judaism 101. (1995-2011f). Jewish cooking. Retrieved by http://www.jewfaq.org/food.htm

Relgious Facts. (2004-2012). Jewish denominations. Retrieved from http://www.religionfacts.com/judaism/denominations.htm

References continued

Sheskin I., & Dashefsky, A. (2011). Jewish population in the united states, 2011. Berman Insititute- North American Jewish Data Bank, University of Connecticut. Retrieved from http://www.jewishdatabank.org/Reports/Jewish_Population_in_the_United_States_2011.pdf

Random Facts, (2012). 90 Important facts about the holocaust. Retrieved from http://facts.randomhistory.com/holocaust-facts.html

Wegner, G. (2003). Holocaust. Macmillian Encyclopedia of Death and Dying. Retrieved from http://www.encyclopedia.com/topic/Holocaust.aspx

World Health Organization. (2010). Non-communicable diseases. Retrieved from http://www.who.int/nmh/countries/isr_en.pdf

World Health Organization. (2011). United States of America. Retrieved from http://www.who.int/nmh/countries/usa_en.pdf

Slide Image References

Introduction-(Image from http://en.wikibooks.org/wiki/Judaism) Halocaust- (Image from http://imet.csus.edu/imet4/PBL/holocaust/The%

20Holocaust.htm) Jewish History- (Image from http://www.jewish-culture.net/) Rambams Articles of Faith- (Image from

http://worldreligionswiki7.wikispaces.com/NATIJudaism-Olivia) Jewish Holidays- (Image from http://www.all-calendar.tk/calendar/category/holiday-

calendar) Jewish Rites of Passages- (Image from http

://unleashed.yakimablogs.com/2008/06/19/bar-mitzvah-marks-passage-to-manhood/)

Jewish Diet- (Image from http://www.alljewishlinks.com/kosher-foods-what-exactly-does-kosher-mean/)

General Rules for Kashrut- (Image from http://www.zingermanscommunity.com/about-us/a-bit-of-zingermans-history/)

Leading causes of death of Israeli people- (Image from http://jewishmedicalassociationuk.org/student/)

Leading causes of death United States- (Image from http://www.britannica.com/blogs/2008/12/the-us-health-care-crisis/)

Health care resources of Israel- (Image from http://jdlong.wordpress.com/2009/04/10/why-am-i-a-friend-of-israel/)

Health care services of United States- (Image from http://roxyswords.wordpress.com/2011/05/03/bin-laden-is-no-longer/)

Jewish health care behaviors and beliefs- (Image from http://www.wymaninstitute.org/special/rabbimarch/pg08photos.php)

Providing Cultural care for the Jewish people- (Image from http://wfhsmiddleeast.wikispaces.com/Tunisia-Mayra+Garcia)