BY MARY CLOUSE

Health and Illness in the Jewish CultureWhere did the Jewish culture originate from and what are their cultural beliefs and practices? Understand health and illness in the Jewish culture and theimportance of following Jewish Dietary LawsCompare Jewish (Israel) and United States healthcare and leading causes of deathWhat are socio-cultural behaviors during illness and what healthcare caregivers need to know providing cultural care for the Jewish population? History of Jewish people begins with Abraham from the Bible. God toldAbraham to leave his homeland with his descendants and promisedthem a new land called Canaan which is known as Israel (The PromisedLand) 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 toreturning to Israel and Jerusalem Living outside of Israel is viewed as an unnatural state for a Jew (living inexile 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 Britishcontrol handed palestine over to the United Nations. The Jews ofPalestine declared the creation of the State of Israel and have protectedit ever since not without continuous Arab-Israeli wars. Jerusalem is considered Zion a Jewish idea of utopia Israel- 7,703,700 Hungary- 48,600United States- 5,275,000Mexico- 39,400France- 483,500 Belgium- 30,300Canada- 375,000 Netherlands- 30,000United Kingdom- 292,000 Italy- 28,400Russia- 205,000 Chile- 20,500Argentina- 182,30010,000-19,000- 118,600Germany- 119,0001-9,999- 131,606Australia- 107,500Brazil- 95,600Ukraine- 71,500Image retrieved from http://www.bje.org.au/learning/people/index.html) (DellaPergola, S., 2010)South Africa- 70,800 United States2.1% of Americans are JewishEight states have a Jewish population of 200,000 or moreNew York- 1,635,000California- 1,220,000Florida- 639,000New Jersey- 504,000Illinois- 298,000Pennsylvania- 295,000Massachusetts- 278,000Maryland- 238,000The four states with the largest Jewish population accountFor more than 60% of the Jewish population in the United States(Sheskin & Dashefsky, 2011) Orthodox Judaism Most traditional Hasidic Judaism 7% of American Jews Center on Rebbe who they look toguide them through all aspects of Observe Sabbath Follow Jewish life to buying a house, throughdietary lawsillness and choosing a spouse Heavily influenced by Kabbalahmovement Reform Judaism Most liberal of modern Judaism 42% of American Jews Conservative Judaism Lack observance of dietary laws Moderate sect avoids extremes of Sabbath on Sundaysorthodox or reform Inclusive and welcome all including Observe the sabbath and dietarygays and lesbians and all society laws Have women rabbis and presidents(Religiousfacts, 2004-2012)of synagogues Rambams 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 thegreatest of the prophetsThe Written Torah (first 5 books of the Bible) and OralTorah (teachings now contained in the Talmud and otherwritings) 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) 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 followcommandments 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 approvefor women Life, Death and Mourning Jewish law can be broken to save human life Euthanasia prohibited, refusing extraordinary measuresallowed 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 ToCome (Judaism 101, 2011b) Jewish Calendar is lunar each month beginning on anew 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 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 BShevat- January or February Purim- February or March Pesach (Passover)- March or April Lag BOmer- April or May Shavuot- May or June Tisha BAv- July or August (Judaism 101, 1995-2011c) Health is a reason to observe Jewish dietarylaws called the Laws of Kashruto 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) Two components of health: Body and Spirit Healing for the soul Cure for the body Cure may occur without healing, andhealing 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)(Image Retrieved fromhttp://www.judaism.com/display.asp?etn=FBCAE) Kashrut: Jewish Dietary Laws Kashrut is body of Jewish law dealing with what foods can and cannot be eaten orprepared Kashrut comes from the Hebrew root Kaf-Shin-Reish meaning to be fit, proper, orcorrect 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 kosherfoods 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 becomeobsolete 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 sacredand the profane, is very important to Judaism In 2000 National Jewish Population Survey 21% of American Jews kept kosher in theirhome (Judaism 101, 1995-2011e) Certain animals may not be eaten at all. This restriction includes the flesh, organs, eggsand milk of the forbidden animals. Of the animals that may be eaten, the birds and mammals must be killed in accordancewith 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 beeaten) 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 intocontact with meat may not be used with dairy, and vice versa. Utensils that have comeinto contact with non-kosher food may not be used with kosher food. This applies onlywhere 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) JewishCookingInfluenced from Middle Eastern,Mediterranean, Spanish, Germanand Eastern European. Challah-sweet eggy breadused for Shabbat andholidays Bagels and Lox Gefilte Fish- cake or ball ofchopped up fish Matzah Ball Soup- thinkchicken broth with threeping-ping sized matzah balls Knishes- potatoe flourdumplings Blintzes- Jweish crepe or thinflat pancake rolled aroundfilling Cholent- stew of vegetablesand meat Holishkes (Stuffed Cabbage) Tzimmes- sweet stew Kasha Varnishkes- Buckwheatgroats 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/ According to World Health Organization % of total deaths, all ages(WHO) in 2010. Proportional mortality Israel in 2010 population was 7,418,400approximate 81% of population Injuries- 5% Respiratory diseases- 6% 5,703,700 Jewish in Israel Diabetes- 7%(DelaPergola, 2010) Communicable, maternal, perinatal,Mortality rateand nurtitional conditions- 8%156,000-males Other non-communcable diseases-166,000-Females20% Cardiovascular disease (CVD)- 27% Cancers- 27% (WHO, 2010)Tay-Sachs disease (TSD) is the most familiar ofthe Jewish genetic disorders. It is caused by adeficiency of an enzyme called hexosaminidaseA, or hex A. Lack of this enzyme affects thebrain and the nervous system, causing rapidand progressive deterioration. Death usuallyoccurs by the age of 6. A late-onset form ofTay-Sachs also occurs, although it is rare.(Jewish Genetics, 2008) Halocaust Began in January 1933when came to power Ended on May 8th 1945 11 million men, women, Halocaust means burnt sacrificeand children weremurdered and six million Adolf Hitler and the Third Reich defined anti-Semitismwere Jews The Nazi regime used their power to eradicate the Jews- The Final Over one million atSolution (to deport all Jews to Poland to be murdered)Aushwitz Jews were considered racially undesirable Taken by trains in cattle Jews were hated and were outcasts by Lutheran and Catholiccars to the camps andchurches for not converting to Christianitychildren often died by First victims of Hitlers murders were the handicapped, mentally ill,suffocation Of the 9 million Jews whoand those suffering from hereditary illnesslived in Europe before the Jews were blamed for Germanys misfortunes known as stab in theHolocaust 2/3 were backmurdered Jews were killed mostly in concentration camps most notably One way to escape was to Aushwitzconvert to Christianity only Died from gas chambers, euthanasia, and execution, deathif ancestry did before 1871 marches, starvation, and disease The brutality was extreme(Random facts, 2012) Jews were separated from their families (Wegner, 2003) UnitedLeading Causes of DeathStates (Non-communicable disease) According to the World Health% of total deaths, all agesOrganization(WHO) in 2010. Proportional Mortality United States in 2010 population Diabetes- 3%was 310,383,948 Communicable, maternal, perinatal and nutritional conditions- 6% The Jewish Population in the Injuries- 7%United States in 2010 was Respiratory Diseases- 7%5,275,000 Other Non-communicable diseases- 19% Cancers- 23% Mortality Rate Cardio vascular disease- 35%10,550,000- Men11,505,000- Women (WHO, 2011) SERVICES PROVIDED RESOURCES Medical diagnosis and treatment both at clinics In 1995 National Health Insurance Lawand at the home of the patient. passed to entitle every Israeli citizen health Preventive medicine and health education (i.e.care servicesearly diagnosis of embryo abnormalities,vaccinations, counseling for pregnant women, Universal and requiredmothers and the elderly). Choose from Four health care Hospitalization (general, maternity, psychiatricorganizations- funding from governmentand chronic). Same uniform benefits package funded for Surgery and transplant. If medical treatment is not all citizens regardless of financial means oravailable in Israel, treatment abroad will be age and state of healthcovered. High quality provides life expectancy for Preventive dental care for children. First Aid and transportation to a clinic or hospital. Women 79.1 and for Men 75.3 and Infant Medical services at the workplace.Mortality rate of 7.5 per 1000 live births Medical treatment for drug abuse and alcoholism. Developed as Health Maintenance Medical equipment and appliances. Organizations (HMOs) Obstetrics and fertility treatment. Can buy supplementary insurance that Treatment of injuries caused by violence. covers services and treatments not covered Medication, in accordance with a list issued by theMinistry of Health. Publicly-funded system Treatment of chronic diseases. Supervised by the Ministry of Health Paramedical services (i.e. physical therapy,(Israel Ministry of foreign Affairs, 2008)occupational therapy, etc.). Services of Health Insurance in the United States Coverage for most ailments and treatments Resources for Health Care covered by insurance. Preventative care can Primary Care Doctors, Nurse have coverage. Practitioners, Health care constantly being reformedPhysician Assistants, Nurses, Types of coverage Physical Therapists, etc. Medicare Hospitals, Clinics, Doctors offices, A federal system of health insurance forMobile Health Units, Alternative people over 65 of age and for certain younger people withMedicine, Urgent Care, etc. disabilities Health People 2020 Medicaid 10-year national objectives A federal system of health insurance forfor improving the health of those requiring financial assistanceall Americans Private Health Insurance Create a society where all Privately paid health insurance people live long and healthy Employer Health Insurance lives Health insurance premiums paid in full or partially by employers Work with national, state, and Uninsuredcommunities to improve Carry no health insurance coveragehealth(Healthy People, 2012) Hasidic Jewish population practices strict religious observance (Orthodox Jews) Belief in using Spiritual leader a Rabbi or Rebbe to facilitate communicationbetween 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 ofsuffering The Rebbe could interpret what spiritual issues required correction to produceimprovement 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, andtreatment options Fear of stigma related to illness affects patient outcomes and willingness toseek 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 doesnt always imply non-compliance with traditional medicine(Coleman-Brueckheimer & Dein, 2011) Make available Jewish clergy for visiting, spiritual care, counseling. Chaplains who are Christianwould not help them spirtually The Sabbath (Shabbat) goes from sundown Friday to nightfall Saturday. Observant Jews dont dowork, travel, use electricity, handle money, or bathe on the Sabbath or special holidays. Specialprayers and rituals are observed on Friday at sundown with bread, wine, and lighting candles. Dont discharge observant patients during the Sabbath or other holy days unless there is a loungethey 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 mostmedications 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 barriersProvide 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) 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 dealingwith 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 butmore accessible with Universal Health Care in Israel where largest concentrationof Jewish population resides in the world Kashrut is a body of Jewish law dealing with what foods can andcannot be eaten or prepared known as Kosher foods. What is atrue statement that pertains to the Jewish dietary laws? There are Jewish Beliefs that are called Rambams 13 principles offaith. What principles do they believe? Hasidic Jewish population practice strict religious observance(Orthodox Jews) which include Sabbath observance. Sabbathgoes from sundown Friday to nightfall Saturday. For the Jewishpatient in a hospital what statements are true? Is Living outside of Israel in exile from their land considered anunnatural state for a Jew? The most common type of Jewish denomination practiced inAmerica is Reform Jewish. What characteristics make it differentfrom Orthodox Jewish? Alberta Health Services. ( 2012 ). Health care and religious beliefs. Retrieved fromhttp://www.albertahealthservices.ca/ps-1026227-health-care-religious-beliefs.pdfColeman-Brueckheimer, K. & Dein, S. (2011). Health care behaviors and beliefs inhasidic jewish populations: A systematic review of the literature. Jewish ReligiousHealth, 50, 442-436. DOI 10.1007/s10943-010-9448-2DellaPergola, S. (2010). World jewish population, 2010. The hebrewuniversity of Jerusalem. Retrieved fromhttp://www.jewishdatabank.org/Reports/World_Jewish_Population_2010.pdfFlam, N. (1994). The jewish way of healing. Reform Judaism Magazine. Retrievedfrom http://huc.edu/kalsman/articles/JewishWayOfHealing.pdfHealthyPeople.gov. (2012). About healthy people. Retrieved byhttp://www.healthypeople.gov/2020/about/default.aspxIsrael Ministry of Foreign Affairs. (2008). National health insurance Retrieved fromhttp://www.mfa.gov.il/MFA/MFAArchive/1990_1999/1998/7/National%20Health%20Insurance Jewish Genetics. (2008). Tay-Sachs Disease. Retrieved byhttp://www.jewishgenetics.org/?q=content/tay-sachs-diseaseJudaism 101. (1995-2011a). The Land of Israel. Retrieved byhttp://www.jewfaq.org/israel.htmJudaism 101. (1995-2011b). What do jews believe? Retrieved byhttp://www.jewfaq.org/beliefs.htmJudaism 101. (1995-2011c). Jewish holidays. Retrieved byhttp://www.jewfaq.org/holiday0.htmJudaism 101. (1995-2011e). Kashrut: Jewish dietary laws. Retrieved by http://www.jewfaq.org/kashrut.htmJudaism 101. (1995-2011f). Jewish cooking. Retrieved by http://www.jewfaq.org/food.htmRelgious Facts. (2004-2012). Jewish denominations. Retrieved fromhttp://www.religionfacts.com/judaism/denominations.htm Sheskin I., & Dashefsky, A. (2011). Jewish population in the united states, 2011.Berman Insititute- North American Jewish Data Bank, University of Connecticut.Retrieved fromhttp://www.jewishdatabank.org/Reports/Jewish_Population_in_the_United_States_2011.pdfRandom Facts, (2012). 90 Important facts about the holocaust. Retrieved fromhttp://facts.randomhistory.com/holocaust-facts.htmlWegner, G. (2003). Holocaust. Macmillian Encyclopedia of Death and Dying.Retrieved from http://www.encyclopedia.com/topic/Holocaust.aspxWorld Health Organization. (2010). Non-communicable diseases. Retrieved fromhttp://www.who.int/nmh/countries/isr_en.pdfWorld Health Organization. (2011). United States of America. Retrieved fromhttp://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 fromhttp://www.wymaninstitute.org/special/rabbimarch/pg08photos.php) Providing Cultural care for the Jewish people- (Image fromhttp://wfhsmiddleeast.wikispaces.com/Tunisia-Mayra+Garcia)