Book Review
Changing Health and Changing Culture: The Yemenite Jews in Israel
N Engl J Med 1993; 329:669-670August 26, 1993
- Article
Changing Health and Changing Culture: The Yemenite Jews in Israel
By Michael A. Weingarten. 187 pp. Westport, Conn., Praeger, 1992. $47.95. ISBN-0-275-94230-9.The concepts of community-oriented primary care and medical anthropology have been with us for more than 30 years, yet rarely do we see work that combines the two successfully. In this book, the author reports on a Yemenite immigrant community with which he has been involved for the past 14 years as a family physician, researcher, health administrator, and astute observer.
This book is a rare mixture of incisive vignettes and cultural and epidemiologic data, all masterfully grounded in historical and social context. It represents the first time that the facts about the health of members of this community before, during, and after their immigration and acculturation to Israeli society have been brought together. As Dr. Weingarten points out, the time to tell the story of Yemenite Jewry is now, because their unique community is succumbing to pressures of interethnic marriage, neighborhood integration, and assimilation.
The author takes us on his journey into the Yemenite immigrant town of Rosh Haayin, a community of 13,000 in central Israel. He provides a contextual “guidebook” to the population he serves: its history, identity, social life, physical environment, epidemiology, and health beliefs. He follows them from their old home through the mass migration of 1948 through 1951, into their new country and new era, documenting the effects of change.
There is substantial interest in Yemenite Jews because of the ancientness of their community (which is perhaps 2600 years old), their long history of isolation from mainstream Judaism and Western life, and their distinct social, cultural, and physical characteristics. For instance, they are at the bottom of the Israeli socioeconomic scale but have the lowest rates of crime and delinquency of any ethnic group. They retain social practices unique in Judaism, including polygyny (which scores of the original families still practice) and the chewing of qat, a leaf with mild stimulant effects. Yemenite Jews also have distinct genetic patterns and hereditary conditions, such as benign neutropenia.
Dr. Weingarten documents the health effects of this community's acculturation and assimilation into Israeli society. The most radical change has been in the improved status of women, which has been associated with dramatic gains in reproductive health, including family planning, pregnancy, and child care. In terms of demographics, the Yemenite immigration to Israel has provided an example of the classic transition curve. From a pre-immigration pattern of high fertility and high mortality, the immigrants initially experienced a burst in family size as children's survival increased rapidly. A new equilibrium was reached as fertility and birth rates fell.
In Yemen, “plagues and pestilence” -- infectious and parasitic diseases -- were the major cause of morbidity and mortality. These have been overcome since immigration, and today the rate of infectious disease among the Yemenites in Israel is comparable to that in the general population. Unfortunately, acculturation has also been linked to the acquisition of the chronic diseases of the West. For Yemenite Jewry, this has occurred rapidly within a single generation. Although they were originally shorter and lighter than members of other Israeli ethnic groups, both their weight and their height have steadily risen with the changes in their diet since immigration. With these increases has come an influx of diseases of civilization, such as dental caries, diabetes mellitus, hypertension, and heart disease. Today, Yemenite Jews and Israelis share the same list of the most common chronic diseases.
The beliefs of the community about health have also undergone rapid change. Their beliefs were originally based on the Galenic system of the “four humors,” plus strong components of the “evil eye,” evil spirits, and magic. Folk medicine has always been a vital aspect of health care, including the use of cupping, amulets, branding with heated iron nails (makwe), an herbal pharmacopeia, and magical remedies. Although therapy is directed at humoral rebalancing, supernatural forces, either divine or magical, are considered to have the ultimate power to cause or cure illness. Traditional healers were the unchallenged pillars of the medical establishment and dealt with both physical and spiritual aspects of disease and illness. Yemenite Jews' experience with modern medicine is extremely short, since there were few doctors in Yemen up to the time this group arrived in Israel. Since their immigration, modern biomedical models have been introduced. Similarly, traditional healers, such as the specialized healing rabbis, or mori, have had to share their healing authority with Western physicians and Ashkenazi (generally European) rabbis.
My only substantial criticism of this work is that the author may have attempted to comment on too many elements of Yemenite history and culture, forcing some subjects to be superficially reviewed. On the whole, however, he has succeeded both in providing community-oriented primary care and in the “art of cross-cultural care . . . learning to transcend one's own culture in order to care for patients from other cultures.” The book not only tells the tale of Yemenite Jews, but also contributes to the literature on culture change, immigration, and health. It is a well-written and scholarly labor of love, which should be of benefit to those interested in primary care medicine and nursing, medical sociology and anthropology, and community health. It contains the types of insights that all of us should be gathering about the communities we serve, but which few of us have the patience or fortitude to collect and analyze.
Jeffrey Borkan, M.D., Ph.D.
Ben Gurion University of the Negev, Beer Sheva, Israel- Citing Articles (1)
Citing Articles
1
Ilana Chefetz, Danny Ben Amitai, Sarah Browning, Karl Skorecki, Noam Adir, Mark G Thomas, Larissa Kogleck, Orit Topaz, Margarita Indelman, Jouni Uitto, Gabriele Richard, Neil Bradman, Eli Sprecher. (2008) Normophosphatemic Familial Tumoral Calcinosis Is Caused by Deleterious Mutations in SAMD9, Encoding a TNF-α Responsive Protein. Journal of Investigative Dermatology 128:6, 1423-1429
CrossRef
