Inequalities in Mortality between Arabs and Jews in Israel

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Dr. Amid Saabni

Despite significant mortality improvements in Israel over the last four decades, life expectancy for the Arab-Palestinian minority has been persistently three to four years less than that of the Jewish majority, a sizable gap that has widened over the last 20 years yet has received scant attention. Using decomposition methods, the proposed research project analyzes this mortality inequality by identifying mortality differences in specific age groups and causes of death that contribute to the total gap in life expectancy. It examines mortality gaps in a period over which the minority group was undergoing an epidemiological transition, and explores possible consequences of the transition on changes in the main causes of death contributing to the total gap. The proposed research also examines trends in mortality inequality over the last two decades within the Arab minority juxtaposed with recent trends in social mobility, such as higher levels of education and greater participation in the labor force, factors that vary by geographic region and gender and are likely to exacerbate inequality in health and mortality. Studying ethnic health inequalities through an examination of the Arab-Jewish gap in life expectancy will shed light on an old-age mortality gap that has widened over the last 20 years. In addition, it will enable the examination of a disadvantaged ethnic minority in the midst of epidemiological transition and processes of stratification that are likely to exacerbate inequalities in health and mortality. Expected results from the proposed research include: (1) the identification of the main sources of ethnic inequality in mortality, i.e., the estimation of the relative and absolute contributions of specific causes of death and age groups to the total Arab-Jewish gap in life expectancy; (2) The identification of mortality differences in geographic regions among the Arab population and the estimation of the relative and absolute contributions of specific causes of death and age groups to these differences; and (3) The estimation of the association between inequality in mortality and socioeconomic inequality among the Arab minority in Israel. The proposed research responds to a critical deficiency in the field of ethnic mortality studies and helps to address persistent health disparities long overlooked in the academic literature. The proposed project is in line with official calls for reducing health inequalities and will better inform health policies in Israel and other multi-ethnic societies where minority groups demonstrate comparatively lower health status.

The proposed research explores inequalities in mortality with an emphasis on the health status of ethnic minorities. It analyzes differences in mortality between the Arab minority and Jewish majority in Israel as well as mortality differences within the Arab minority.

Research objectives & expected significance: 

Understanding gaps in life expectancy between Arabs and Jews and within the Arab population in Israel will be achieved by research addressing the following objectives: 1. Using decomposition methods, we will systematically estimate the contribution of specific age groups and causes of death to the Arab-Jewish gap in life expectancy and changes in these contributions over the last four decades. A special emphasis will be devoted to the growing ethnic mortality gap among the population aged 50 and above. 2. Using decomposition methods, we will decompose regional and gender gaps in life expectancy among the Arab population in Israel. Specifically, we estimate what mortality differences in a specific age group or cause of death contribute to the total regional or gender gap in life expectancy. Regional differences will be examined among the main four regions where the Arab minority is concentrated: the Galilee, the Triangle, the Negev, and the Mixed Cities (Tel-Aviv-Yaffo, Haifa, Akko, Ramleh, Lod, and NazarethIlit). 3. Similar to the analysis by Friedlander et al (1995), using Arab sub-populations in small geographic regions as units of analysis, we will first estimate variations in life expectancy between these units in 1995 and 2008, the last two census years, and changes in the level of inequality between the two periods. Second, we will examine if these variations are Page 6 related to socio-economic measures at the level of the geographic unit. We will also examine if gains in life expectancy are equal among regions especially among regions of low and high socioeconomic status.

Current Results:

Regarding ethnic gaps in life expectancy, our preliminary results show that for males the ArabJewish gap in life expectancy at age 50 has been increasing constantly since the early 1990s. For females, however, during the last decade, the gap at age 50 shows a small decline. This possible divergence between males and females in the size and direction of the ethnic mortality gap warrants further investigation. Regarding mortality differences within the Arab populations, as presented earlier, our preliminary results indicate considerable regional variations in life expectancy at birth (more than 4 years, and age 50, more than 3 years. These gaps indicate significant regional differences in both childhood and old-age mortality. In addition, our preliminary results reveal Page 10 remarkable regional variations in the size of the gender gap in life expectancy: in the Mixed Cities the gender gap reaches 6.8 years, more than twice the gap in the Galilee and the Triangle. The proposed research aims to examine trends in these inequalities and identify the specific age groups and causes of death that contribute to them.

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