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Sickness

HEALTH STATUS

Introduction

There are several available yardsticks for measuring intergroup differences in health status:

(1) lifetime longevity, i.e., average expectation of life in years (calculated at birth or other selected points in the age cycle);

(2) annual overall mortality rate, i.e., number of deaths during the year per 1,000 population (the obverse can alternatively be stated in positive terms as the group's annual overall survival rate);

(3) annual mortality rate from a specific disease;

(4) annual morbidity rate from a specific disease, e.g., number of new polio cases during the year per 1,000 population, irrespective of their life or death outcomes in that year. Within all the Jewish populations studied, longevity and annual survival rates are consistently higher for females than for males. In New York City (1949–51) the average annual death rate for Jewish males was 22% higher than for Jewish females.

Lifetime Longevity

Research according to the yardstick of lifetime longevity in the 1960s showed that Jewish women outlived Jewish men in three countries as follows: Israel (1965) – males, 70.7, females, 73.5; Canada (1961) – males, 68.4, females, 72.2; United States (the three cities Detroit, Milwaukee, and Providence, 1963), males, 67.0, females, 71.9.

This pattern is repeated almost universally in the non-Jewish world, despite enormous international contrasts in economic, political, and cultural levels and styles of life. Differences by sex are also visible across almost the entire age spectrum from the first year of life onward, most sharply of all above the age of 45. Also noteworthy is that among both sexes longevity is highest in Israel and lowest in U.S. Jewry. The longevity of Israel male Jews is one of the highest among the nations of the world, exceeded in 1968 by the male life expectancies only of Sweden (71.6), the Netherlands (71.1), Norway (71.0), and Iceland (70.8). On almost all other yardsticks of health status, the latter four Western countries also lead the world. Perhaps the most interesting finding of all emerges upon finer examination of age-specific mortality rates. In all available Canadian and U.S. studies, the Jewish age progression of mortality for both sexes deviates significantly from that of their non-Jewish neighbors. The divergence is most clearly evident in the four stages of the age cycle discernible in a Canadian study conducted in 1940–42 (Spiegelman, 1948).

Stage I. The first year of life. Here, among both sexes, the all-Canadian death rate was 2.5 times greater than for Jewish children. Infant mortality rates are, of course, influenced by differentials in SES (socioeconomic status).

Stage II. Ages 1 through 34. Here, compared to their all-Canadian peers at every age level, the Jewish death rates for each sex separately are consistently about 50% lower.

Stage III. Ages 35 through 54. The Jewish survival advantage continues in each sex, but by steadily shrinking margins with increasing age.

Stage IV. Age 55 and beyond. At age 55 for the first time Jews appear with higher mortality rates than their Christian fellow countrymen. Thereafter, the unfavorable Jewish margin in mortality rates widens progressively with advancing age.

The higher Jewish survivorship rates of U.S. and Canadian Jews from birth to the middle period of life can be explained by the tradition of being health-minded and health-active people, derived largely from their religious practices. The frequent use of medical resources is clearly an advantage for survival below the age of 45–55. It presumably must also operate beyond that point, with the result that the higher rate of Jewish mortality would have been higher still were it not for their greater use of medical resources. Two further facts should be taken into account:

(1) comparing the U.S. and Canadian studies of the 1960s with those of earlier decades, the Jewish tendency to outclimb non-Jewish mortality rates beyond the middle years was seen to become more pronounced;

(2) mortality rates of Israeli males and females in older age were significantly lower than Jews of the same age and sex in the U.S. and Canada. In fact, Israeli life expectancies at age 65 matched those of Swedish females (15.7 and 15.8 years for Israel and Swedish women, respectively) and exceeded those of Swedish males (14.4 and 13.9 years for Israel and Swedish men, respectively).

In subsequent decades, the life expectancy of Jews in advanced countries has been growing by about one year of life every five calendar years, and around the year 2000 it reached 80 years for women and 75 years for men. Although only little different from that of the general population in the corresponding countries or cities, a tendency for infant mortality to be lower among Jews persisted. On the other hand, crude mortality rates of Jews considerably exceed those of the respective general populations, mainly due to the overaged composition of the respective Jewish groups.

BIBLIOGRAPHY:

HEALTH STATUS: O.W. Anderson, in: E. Gartly Jaco (ed.), Patients, Physicians and Illness (1958), 10–24; A. Antonovsky, in: Journal of Chronic Diseases, 21 (1968), 65–106; S.J. Fauman and A.J. Mayer, in: Human Biology, 41 no. 3 (Sept. 1969), 416–26; M. Fishberg, The Jews (1911), 225–67 (age reversal in mortality); S. Graham, in: H. Freeman et al., Handbook of Medical Sociology (1963), 65–98; R.U. Marks, in: MMFQ, 45 (April, 1967), pt. 2, 51–108; D. Mechanic, "Religion, Religiosity and Illness Behavior: the special case of the Jews," in: Human Organization, 22, 202–8; H. Seidman, L. Garfinkel, and L. Craig, in: JJSO (Dec. 4, 1962), 254–73. MORBIDITY: A.M. Cohen, in: Metabolism, 10 (1961), 50; F.H. Epstein, E.P. Boas, and R. Simpson, in: Journal of Chronic Diseases, 5 (1957), 300; E. Goldschmidt and T. Cohen, in: Cold Spring Harbor Symposia on Quantitative Biology, 29 (1964), 115; R.M. Goodman (ed.), Genetic Disorders of Man (1970); W. Haenszel, in: Journal of the National Cancer Institute, 26 (1961), 37; B. Mac-Mahon, in: ACTA, Unio Internationalis Contra Cancrum, 16 (1960), 1716; C.E. Martin, in: American Journal of Public Health, 57 (1967), 803; V.A. McKusick et al., in: Israel Journal of Medical Sciences, 3 (1967), 372; J.H. Medalie et al., ibid., 4 (1968), 775; B. Modan et al., in: Pathology and Microbiology, 35 (1970), 192; idem, in: Proceedings of the Xth International Cancer Congress (1970); V.A. Newill, in: Journal of the National Cancer Institute, 26 (1961), 405; H. Seidman, in: Environmental Research, 3 (1970), 234; S. Shapiro, in: American Journal of Public Health (Supplement), 59 (1969), 1; Ch. Sheba, ibid., 52 (1962), 1101; idem, in: Lancet, 1 (1970), 1230; R. Steinitz, 5-Years Morbidity from Neoplasms in Israel's Population Groups (196064) (1967); M. Toor et al., in: Circulation, 22 (1960), 265. WEBSITE: www.health.gov.il.