1. BY MARY CLOUSE

2. 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?

3.  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)

4. Israel- 7,703,700 Hungary- 48,600
United States- 5,275,000 Mexico- 39,400
France- 483,500 Belgium- 30,300
Canada- 375,000 Netherlands- 30,000
United Kingdom- 292,000 Italy- 28,400
Russia- 205,000 Chile- 20,500
Argentina- 182,300 10,000-19,000- 118,600
Germany- 119,000 1-9,999- 131,606
Australia- 107,500
Brazil- 95,600
Ukraine- 71,500 Image retrieved from http://www.bje.org.au/learning/people/index.html) (DellaPergola, S., 2010)
South Africa- 70,800

5. United States
2.1% of Americans are Jewish
Eight states have a Jewish population of 200,000 or more
New York- 1,635,000
California- 1,220,000
Florida- 639,000
New Jersey- 504,000
Illinois- 298,000
Pennsylvania- 295,000
Massachusetts- 278,000
Maryland- 238,000
The four states with the largest Jewish population account
For more than 60% of the Jewish population in the United States
(Sheskin & Dashefsky, 2011)

6.  Orthodox Judaism
 Most traditional  Hasidic Judaism
 7% of American Jews  Center on Rebbe who they look to
guide them through all aspects of
 Observe Sabbath Follow Jewish life to buying a house, through
dietary laws illness and choosing a spouse
 Heavily influenced by Kabbalah
movement
 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 Sundays orthodox or reform
 Inclusive and welcome all including  Observe the sabbath and dietary
gays and lesbians and all society laws
 Have women rabbis and presidents (Religiousfacts, 2004-2012)
of synagogues

7. Rambam’s 13 Principles of Faith
G-d exists
G-d is one and unique
G-d is incorporea
G-d is eternal
Prayer is to be directed to G-d alone and to no other
The words of the prophets are true
Moses prophecies are true, and Moses was the
greatest of the prophets
The Written Torah (first 5 books of the Bible) and Oral
Torah (teachings now contained in the Talmud and other
writings) were given to Moses
There will be no other Torah
G-d knows the thoughts and deeds of men
G-d will reward the good and punish the wicked
The Messiah will come
The dead will be resurrected
(God is written G-d by observant Jews to avoid risk of defacing name)
(Judaism 101, 1995- 2011b)

8.  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)

9.  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
 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)

10. Health is a reason to observe Jewish dietary
laws called the “Laws of Kashrut”
o Eating is a religious ritual demonstrating
self-control and choosing right from wrong
o 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, 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)
(Image Retrieved from
http://www.judaism.com/display.asp?etn=FBCAE)

11. 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)

12.  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)

13. Jewish
Cooking
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/

14.  According to World Health Organization % of total deaths, all ages
(WHO) in 2010. Proportional mortality
 Israel in 2010 population was 7,418,400
approximate 81% of population  Injuries- 5%
 Respiratory diseases- 6%
 5,703,700 Jewish in Israel  Diabetes- 7%
(DelaPergola, 2010)
 Communicable, maternal, perinatal,
 Mortality rate and nurtitional conditions- 8%
156,000-males  Other non-communcable diseases-
166,000-Females 20%
 Cardiovascular disease (CVD)- 27%
 Cancers- 27%
(WHO, 2010)
“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)

15. Halocaust
 Began in January 1933
when came to power
 Ended on May 8th 1945
 11 million men, women,
 Halocaust means “burnt sacrifice
and children were
murdered and six million  Adolf Hitler and the Third Reich defined anti-Semitism
were Jews  The Nazi regime used their power to eradicate the Jews- The Final
 Over one million at Solution (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 Catholic
cars to the camps and churches for not converting to Christianity
children often died by
 First victims of Hitler’s murders were the handicapped, mentally ill,
suffocation
 Of the 9 million Jews who and those suffering from hereditary illness
lived in Europe before the  Jews were blamed for Germany’s misfortunes known as “stab in the
Holocaust 2/3 were back”
murdered  Jews were killed mostly in concentration camps most notably
 One way to escape was to Aushwitz
convert to Christianity only  Died from gas chambers, euthanasia, and execution, death
if ancestry did before 1871
marches, starvation, and disease
 The brutality was extreme
(Random facts, 2012)  Jews were separated from their families
(Wegner, 2003)

16. United Leading Causes of Death
States (Non-communicable disease)
 According to the World Health % of total deaths, all ages
Organization(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- Men
11,505,000- Women (WHO, 2011)

17. SERVICES PROVIDED RESOURCES
 Medical diagnosis and treatment both at clinics  In 1995 National Health Insurance Law
and at the home of the patient. passed to entitle every Israeli citizen health
 Preventive medicine and health education (i.e. care services
early diagnosis of embryo abnormalities,
vaccinations, counseling for pregnant women,  Universal and required
mothers and the elderly).  Choose from Four health care
 Hospitalization (general, maternity, psychiatric organizations- funding from government
and chronic).  Same uniform benefits package funded for
 Surgery and transplant. If medical treatment is not all citizens regardless of financial means or
available in Israel, treatment abroad will be age and state of health
covered.  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 (HMO’s)
 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 the
Ministry 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.).

18. 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 reformed Physician Assistants, Nurses,
Types of coverage Physical Therapists, etc.
 Medicare  Hospitals, Clinics, Doctors offices,
 A federal system of health insurance for
Mobile Health Units, Alternative
people over 65 of age and
for certain younger people with
Medicine, Urgent Care, etc.
disabilities  Health People 2020
 Medicaid  10-year national objectives
 A federal system of health insurance for for improving the health of
those requiring financial assistance all 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
 Uninsured communities to improve
 Carry no health insurance coverage health
(Healthy People, 2012)

19.  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)

20.  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)

21. 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

22.  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?

23. 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 from
http://www.mfa.gov.il/MFA/MFAArchive/1990_1999/1998/7/National%20Health%20
Insurance

24. Jewish 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

25. 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_20
11.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

26. 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)