Social and political determinants of health equity of Palestinians in Jerusalem: a qualitative assessment

Abstract

BackgroundEast Jerusalem was occupied in 1967, and the Palestinian people living there made permanent residents and became separated from those living in the West Bank. In a qualitative assessment we sought to understand the social and political determinants of health equity for this population in East Jerusalem. MethodsWe reviewed the scientific literature into health disparities and social determinants in Jerusalem and comparative studies between Israeli Jews and Palestinians, whether Israeli citizens, residents, or people living in the remaining part of the occupied Palestinian territory. Our review was limited to English-language articles published after 2000. 682 results were scanned and 117 articles reviewed. We did semistructured interviews with 15 key health policymakers or experts from Palestinian, Israeli, and other international stakeholder groups. Data were recorded, transcribed, coded, organised into themes, and analysed with Rifkin's CHOICE framework that links human rights, empowerment, and health equity. FindingsFew health studies examined Palestinians living in Jerusalem as a distinct population group; official data was representative of Jerusalem's annexed status. In the reviewed literature, research methods showed little participation by Palestinians, the lack of an appropriate reference group, selection bias in data sets, and survey methods that were not adapted to the studied population. Health differences between populations in Israel were attributed to differences in culture, ethnic origin, sex, or lifestyle, with little discussion of underlying social determinants. Well documented social and political restrictions on Palestinians in Jerusalem and life-course analyses were absent from health research. Key informant narratives transcended sociopolitical identities and showed differences in ideological or value systems. Informants recognised that Palestinians have poor social determinants, but had different perspectives about the causes of the causes of health inequalities. 14 of 15 key informants offered insight into Palestinian experience in Jerusalem, including perceptions of discriminatory demographic and planning laws, exclusionary policies, imposed language and health system, and social and labour integration inequities. InterpretationOur results were consistent with evidence in scientific literature that structural barriers, cultural subordination, and hostile state values adversely affect health of minority populations. Palestinians in East Jerusalem might perceive exclusionary national policies, which inequitably distribute social determinants, create structural barriers to equity, and hinder Palestinian development and free choice, to adversely affect their health and wellbeing. FundingNone.