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Date: 2020
Abstract: Отношение к кладбищам в еврейской традиции амбивалентно: оно является одновременно и сакральным объектом – на идише оно называется «святое место», хейлике орт, – и местом нечистоты, которое связано с нечистотой мертвого тела и может осквернять людей. В статье рассматриваются практики, связанные с паломничеством к могилам хасидских цадиков, распространенные в настоящее время в России, Украине, Израиле и США. В большинстве случаев мы имеем дело с различными вариациями почитания праведников в хасидизме, причем многие индивидуальные практики на могилах цадиков перекликаются с историческими и мемуарными свидетельствами о поклонении этим же людям при их жизни. На могилах оставляют записки с просьбами о помощи, иногда кладут на них монеты и различные предметы, которые требуют благословения. Приходя к месту погребения, соблюдают правила поведения, установленные самими цадиками: не поворачиваются спиной к могиле, снимают кожаную обувь, читают определенные псалмы и молитвы. Отдельно в статье рассматриваются паломнические практики, связанные с субститутами могил праведников: с местами бывших захоронений, перенесенных в другую страну или к могиле жены праведника, которая находится в Иерусалиме.
Author(s): Staetsky, L. Daniel
Date: 2021
Date: 2016
Abstract: Objective: To explore determinants of participation in breast cancer screening in orthodox Jewish women living in Antwerp, Belgium, and to uncover their opinions and attitudes towards screening, and thereby to detect ways to optimize participation. Study design: Focus group discussions were performed during the last months of 2011 and the first half of 2012 to explore motivation to participate or not in breast cancer screening. Groups consisted of five to seven women. Inclusion criteria were: being female, considering oneself as orthodox Jewish, aged between 50 and 69 years. Results: Three focus group discussions with in a total of 20 women had taken place. All participants in the focus group discussions had a screening mammography taken on a regular base. All participants agreed that the social cohesion between Jewish orthodox women and the importance that is given to healthcare within the Jewish tradition are important contributors to their participation in a breast cancer screening program. Pain, lack of information during the exam, lack of confidence in the quality of the exam, perceived problems when the examining doctor/technician is male, and fear of the results are mentioned as barriers. The participants, however, state that these were not important enough to result in non-participation. Barriers could be diminished by information sessions specifically aimed at orthodox Jewish women. Conclusion: This qualitative research demonstrates a generally positive attitude of orthodox Jewish women living in Antwerp, Belgium, towards mammographic breast cancer screening. Increased and repeated structured information sessions are likely to improve breast cancer awareness in this population.
Date: 2020
Date: 2021
Abstract: Background: The importance of community involvement in the response against disease outbreaks has been well established. However, we lack insights into local communities’ experiences in coping with the current COVID-19 pandemic. This study explored both the impact of, and response to, COVID-19 within the Orthodox Jewish communities of Antwerp (Belgium) during the first lockdown period (March 2020 – May 2020).

Methods: We conducted an explorative qualitative study using a participatory approach. First, we performed a community mapping to identify relevant stakeholders. Through the active involvement of a community advisory board and based on qualitative interviews with key-informants and community members, we elicited lived experiences, attitudes, and perceptions towards COVID-19. Interviews were conducted both face-to-face and using online web conferencing technology. Data were analyzed inductively according to the principles of thematic analysis.

Results: Government-issued outbreak control measures presented context-specific challenges to the Orthodox Jewish communities in Antwerp. They related mainly to the remote organization of religious life, and practicing physical distancing in socially and culturally strongly connected communities. Key informants described how existing community resources were rapidly mobilized to adapt to the outbreak and to self-organize response initiatives within communities. This included the active involvement of community and religious leaders in risk communication, which proved to be of great importance to facilitate coverage and uptake of pandemic control measures while protecting essential community values and traditions. Creating bottom-up and community-adapted communication strategies, including addressing language barriers and involving Rabbis in the dissemination of prevention messages, fostered a feeling of trust in government’s response measures. However, unmet information and prevention needs were also identified, such as the need for inclusive communication by public authorities and the need to mitigate the negative effects of stigmatization.

Conclusion: The experiences of Orthodox Jewish communities in Antwerp demonstrate a valuable example of a feasible community-centered approach to health emergencies. Increasing the engagement of communities in local decision-making and governance structures remains a key strategy to respond to unmet information and prevention needs.
Date: 2021
Abstract: Background Ethnic and religious minorities have been disproportionately affected by SARS-CoV-2 worldwide. The UK strictly-Orthodox Jewish community has been severely affected by the pandemic. This group shares characteristics with other ethnic minorities including larger family sizes, higher rates of household crowding and relative socioeconomic deprivation. We studied a UK strictly-Orthodox Jewish population to understand how COVID-19 had spread within this community.

Methods We performed a household-focused cross-sectional SARS-CoV-2 serosurvey specific to three antigen targets. Randomly-selected households completed a standardised questionnaire and underwent serological testing with a multiplex assay for SARS-CoV-2 IgG antibodies. We report clinical illness and testing before the serosurvey, seroprevalence stratified by age and gender. We used random-effects models to identify factors associated with infection and antibody titres.

Findings A total of 343 households, consisting of 1,759 individuals, were recruited. Serum was available for 1,242 participants. The overall seroprevalence for SARS-CoV-2 was 64.3% (95% CI 61.6-67.0%). The lowest seroprevalence was 27.6% in children under 5 years and rose to 73.8% in secondary school children and 74% in adults. Antibody titres were higher in symptomatic individuals and declined over time since reported COVID-19 symptoms, with the decline more marked for nucleocapsid titres.

Interpretation In this tight-knit religious minority population in the UK, we report one of the highest SARS-CoV-2 seroprevalence levels in the world to date. In the context of this high force of infection, all age groups experienced a high burden of infection. Actions to reduce the burden of disease in this and other minority populations are urgently required.

Funding This work was jointly funded by UKRI and NIHR [COV0335; MR/V027956/1], a donation from the LSHTM Alumni COVID-19 response fund, HDR UK, the MRC and the Wellcome Trust. The funders had no role in the design, conduct or analysis of the study or the decision to publish. The authors have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Evidence before the study In January 2020, we searched PubMed for articles on rates of SARS-CoV-2 infection amongst ethnic minority groups and amongst the Jewish population. Search teams included “COVID-19”, “SARS-CoV-2”, seroprevalence, “ethnic minority”, and “Jewish” with no language restrictions. We also searched UK government documents on SARS-CoV-2 infection amongst minority groups. By January 2020, a large number of authors had reported that ethnic minority groups experienced higher numbers of cases and increased hospitalisations due to COVID-19. A small number of articles provided evidence that strictly-Orthodox Jewish populations had experienced a high rate of SARS-CoV-2 infection but extremely limited data was available on overall population level rates of infection amongst specific ethnic minority population groups. There was also extremely limited data on rates of infection amongst young children from ethnic minority groups.

Added value of the study We report findings from a population representative, household survey of SARS-CoV-2 infection amongst a UK strictly Orthodox Jewish population. We demonstrate an extremely high seroprevalence rate of SARS-CoV-2 in this population which is more than five times the estimated seroprevalence nationally and five times the estimated seroprevalence in London. In addition the large number of children in our survey, reflective of the underlying population structure, allows us to demonstrate that in this setting there is a significant burden of disease in all age groups with secondary school aged children having an equivalent seroprevalence to adults.

Implications of the available evidence Our data provide clear evidence of the markedly disproportionate impact of SARS-CoV-2 in minority populations. In this setting infection occurs at high rates across all age groups including pre-school, primary school and secondary school-age children. Contextually appropriate measures to specifically reduce the impact of SARS-CoV-2 amongst minority populations are urgently required.
Date: 2020
Abstract: Yiddish was the everyday language spoken by most Central and East European Jews during the last millennium. As a result of the extreme loss of speakers during the Holocaust, subsequent geographic dispersal, and lack of institutional support, Yiddish is now an endangered language. Yet it continues to be a native and daily language for Haredi (strictly Orthodox) Jews, who live in close-knit communities worldwide. We have conducted the first study of the linguistic characteristics of the Yiddish spoken in the community in London’s Stamford Hill. While Krogh (in: Aptroot, Aptroot et al. (eds.) Leket: Yiddish studies today, Düsseldorf University Press, Düsseldorf, pp 483–506, 2012), Assouline (in: Aptroot, Hansen (eds.) Yiddish language structures, De Gruyter Mouton, Berlin, pp 39–62, 2014), and Sadock and Masor (J Jew Lang 6(1):89–110, 2018), investigating other Hasidic Yiddish-speaking communities, observe what they describe as morphological syncretism, in this paper we defend the claim that present-day Stamford Hill Hasidic Yiddish lacks morphological case and gender completely. We demonstrate that loss of morphological case and gender is the result of substantial language change over the course of two generations: while the case and gender system of the spoken medium was already beginning to undergo morphological syncretism and show some variation prior to World War II, case and gender distinctions were clearly present in the mental grammar of both Hasidic and non-Hasidic speakers of the relevant Yiddish dialects at that stage. We conclude the paper by identifying some of the language-internal, sociolinguistic and historical factors that have contributed to such rapid and pervasive language change, and compare the developments in Stamford Hill Hasidic Yiddish to those of minority German dialects in North America.
Date: 2020
Author(s): Staetsky, Daniel
Date: 2020
Abstract: Since the earliest days of the coronavirus outbreak in the UK, concerns have been expressed that Jews have been disproportionately affected, with mortality levels among them abnormally high. Initial hypotheses arguing that this could largely be explained by geographical and age factors were both proven and challenged by a June 2020 paper published by the Office for National Statistics. It showed that Jews were more likely to be affected because of their above average age profile and where they tend to live (London and other urban centres), but that even after accounting for these and other socio-demographic variables, they were still found to be disproportionately vulnerable.

This short paper draws on existing evidence to investigate why this might be the case. In particular, it explores whether the long-established above average health profile of Jews in the UK has shifted in such a way as to result in elevated levels of mortality from COVID-19, and whether behavioural factors – particularly in the most Orthodox parts of the community – affect the numbers in any significant way. In brief, it finds that there has been no such change in the fundamental health status of British Jews, and that regardless of any specific issues within haredi communities, the vast majority of COVID-19 related deaths among Jews have occurred in the mainstream, non-haredi sector.

Its key conclusions are as follows:
1) Even though Jewish mortality from COVID-19 is high as it is for other Black, Asian and minority ethnic groups, Jews are a completely different case and should be analysed and understood as such;
2) The high mortality levels found among Jews is not caused in any significant way by any particular developments occurring in the strictly Orthodox (haredi) population;
3) Elevated mortality among Jews may in part be due to the interconnected and contact-rich social and religious lives that Jews have, but further analysis is required to confirm this.
Date: 2020
Abstract: Written by the world’s leading Jewish demographer, Professor Sergio DellaPergola, and Dr Daniel Staetsky, Director of JPR’s European Jewish Demography Unit, this report shines a light on the demography of Jewish in Austria today, and presents in-depth analysis of fertility rates, age distribution data, patterns of Jewish identity, migration and intermarriage rates to predict Austrian Jewry’s future. It demonstrates, through careful and methodical analysis, that the population is projected to grow.

Whilst the Austrian Jewish population is small, its projected growth constitutes an important finding in European Jewish demography. The Jewish population of Europe has declined dramatically over the past century and a half, particularly as a result of mass migration and the Holocaust. Yet today, in several European countries, demographers are beginning to see signs of growth, driven particularly by high birth rates in the strictly Orthodox population. This study provides an important example of this phenomenon.

The report is a publication of JPR’s European Jewish Demography Unit, an initiative established in 2019 to produce new data to support Jewish community planning across Europe. Funded by the Rothschild Foundation Hanadiv Europe, the Unit is working to produce country-specific reports annually, and this study about Austria is the first of these.

The report draws on three major sources of data: the 2001 Austrian Census, comprehensive records of the Austrian Jewish community and a survey carried out by a JPR/Ipsos consortium in 2018 for the European Union Agency for Fundamental Rights (FRA).

Key findings include:

Today the core Jewish population of Austria is estimated to be just above 10,000. The ‘core Jewish population’ consists of people who would explicitly identify themselves as Jews. This is the highest number of Jews observed in Austria since the 1960.
According to the Israeli Law of Return – which uses a broader definition to determine who is entitled to migrate to Israel and immediately apply for Israeli citizenship – the eligible Jewish population in Austria is currently about 20,000.
The core Jewish population constitutes 0.1% of the total population of Austria. 64% of all Austrians are Roman Catholics, 17% are unaffiliated in religious terms, and 8% are Muslims.
The Jewish population of Austria is growing and may reach 11,000-12,000 by the mid-2030s.
About 86% of all Austrian Jews reside in Vienna. Only 19% of all Austrians live in Vienna
The average number of children that a Jewish woman in Austria is expected to have in her lifetime is 2.5; strictly Orthodox Jewish women have 6–7 children per woman, on average, while non-strictly Orthodox Jewish women typically have about 2. The average among Austrian women in general is 1.5.
Migration has been a powerful factor of growth in the Austrian Jewish population. Jews born in Israel constitute about 20% of Jews in Austria today.
About 78% of Jewish households in Austria are affiliated with the Jewish community through membership of its representative organisation. Compared to other communities around the world, this is a very high level of affiliation.
About 30% of Jews in Austria identify as ‘Orthodox’ or ‘Traditional’ and 19% as ‘strictly Orthodox.’ 15% identify as ‘Reform/Progressive’ and 19% as ‘just Jewish.’ Austrian Jewry has one of the highest proportions of strictly Orthodox Jews of all European Jewish communities.
Due to their high fertility, the strictly Orthodox represent the main engine of population growth for the Jewish community as a whole. For the same reason, their share in the Jewish population is expected to increase significantly in the medium term.
About two thirds (70%) of partnered Austrian Jews have a Jewish partner.
About 70% of all Jewish children of compulsory school age in Austria attend Jewish schools. While 100% of strictly Orthodox Jews attend Jewish schools, among the non-strictly Orthodox uptake is still significant – about 52%.
Author(s): Fromson, Hadassah
Date: 2018
Abstract: This thesis aimed to explore whether religion, sexual knowledge and sexual attitudes impact sexual satisfaction amongst Orthodox Jews. This thesis intended to address weaknesses of previous research by using robust multidimensional measures of religion and sexuality and focusing on a specific religious group. 515 participants completed measures circulated through an online survey. The measures used were: The New Sexual Satisfaction Scale; Centrality of Religiosity Scale (CRS); threes subscales of the Brief Sexual Attitudes Scale (Permissiveness, Communion and Instrumentality); and a new measure, the Brief Sexual Knowledge scale, developed for this study. Participants were also presented with optional open-ended questions that asked about their sexual expectations and sexual education. Religious level was categorised using self-defined groups for Religious Culture; Ultra-Orthodox, Modern-Orthodox and Non-Orthodox groups as well as CRS categories for Religious Practice; Highly Religious, Religious, Not Religious. The findings show significant differences in the sexual satisfaction between Religious Practice groups but not Religious Culture groups. Significant differences in sexual knowledge and sexual attitudes were found for both types of religious variables. A correlation analysis revealed that sexual satisfaction is positively correlated with CRS and Communion scores whilst negatively correlated with Sexual Knowledge, Permissiveness and Instrumentality scores. Communion and Sexual Knowledge were significant predictors of sexual satisfaction in a multiple regression analysis. The findings of this study enhance theoretical understanding of religion and sexuality and address gaps in the literature. Clinical implications for therapists working with Orthodox Jewish clients suffering from sexual dissatisfaction are discussed.
Author(s): Kasstan, Ben
Date: 2016
Abstract: Using an integrated archival and ethnographic approach, this study investigates how the growing Haredi Jewish minority and the UK government negotiate their positions in the context of healthcare services in Manchester as one of the few sites where they directly engage. Low-level uptake of certain maternal and infant health interventions has led to claims that Haredi Jews are ‘hard to reach’ or a ‘non-compliant community.’ This thesis critically engages the above outlook by exploring how responses to healthcare services should be framed.
Rather than evading the NHS altogether, as the ‘hard to reach’ label implies, Haredi Jews in Manchester selectively negotiate healthcare services in order to avoid a cosmological conflict with the halachic custodianship of Jewish bodies. Maternal and infant care is situated as a particularly sensitive area of minority-state relations in which competing constructions of bodily protection are at play. Whilst maternal and infant care has historically formed part of the state’s strategy to govern the population, it is increasingly being seized as a point of intervention by Haredi rabbis, doulas, and parents when attempting to reproduce the Haredi social body.
Following Roberto Esposito’s (2015 [2002]) theoretical elaboration of ‘immunitas’ the present work depicts the margins as giving rise to antonymic conceptions of ‘immunity’ as a means of protecting collective life. Interventions that the state regard as protecting the health of the nation can, in turn, be viewed as a threat to the life of the Jewish social body. Immunity at the margins can be characterised by an antonymic fault of both the Haredim and the state to understand each other’s expectations of health and bodily care. The margins of the state illustrate how responses to healthcare interventions can be entangled within a struggle of integration, insulation, and assimilation for minority groups in ways that are contiguous over time.
Date: 2005
Date: 2003
Date: 2020
Date: 2004
Date: 1997
Abstract: This paper examined stress among two groups of orthodox Jews suggested to differ in the strength of the boundary of their religious group. Comparisons were made between the two groups, and with urban and rural groups studied by other researchers. Proportions of boundary-maintenance events (events whose threat had been caused or exacerbated by Jewishness) and of severe events, and proportions and rates of regular, irregular and disruptive events were examined. Boundary-maintenance events were higher among the more religiously orthodox affiliated group, and among whom religious observance was indeed reported to be higher. It was suggested that conditions of higher boundary maintenance would be associated with higher rates and proportions of regular events and with lower rates and proportions of irregular and disruptive events. Generally, the analyses supported this expectation. Boundary-maintenance events themselves were somewhat less severe, though not less likely to be irregular or disruptive than other events. Depression was shown to be unrelated to boundary-maintenance events and (surprisingly) unrelated to contextual threat when the effects of irregularity-disruption were controlled. Depression was, however, strongly related to irregular and disruptive events. The results are compared with those of related work, and suggest that the general lowering effect of affiliation to a religious group may be partly explained by the effects of boundary maintenance, which involves stress, but of a less depressogenic kind than the disruptive stress associated with conditions of low/no boundary maintenance. The findings have implications for understanding the relations between culture and mental disorder.
Author(s): Morawska, Lucia
Date: 2012
Author(s): Rowland, Gemma
Date: 2016
Abstract: Previous research suggests that children of minority groups may be underserved by
mainstream services (Elster, Jarosik, VanGeest & Fleming, 2003). There has been
an identified need for research that focuses on barriers to accessing services faced
by minority groups, such as the Orthodox Jewish community (Dogra, Singh,
Svirdzenka & Vostansis, 2012). Given that parents are often the gate-keepers to
care (Stiffman, Pescosolido & Cabassa, 2004), understanding their help-seeking
behaviour is crucial to ensure that Orthodox children and families are given the same
opportunities to access services as their majority group peers. To date there is
extremely limited research on the help-seeking behaviours of Orthodox Jewish
parents. The current study sought to consider the experiences of Orthodox Jewish
parents who have accessed Child and Adolescent Mental Health Services (CAMHS)
in order to seek help for their families.

Semi-structured interviews were completed with nine Orthodox Jewish parents with
regards to their experiences of accessing tier 2 CAMHS for their child. A thematic
analysis was conducted. Four themes were found: ‘The Orthodox community as
unique’, ‘Pathways to help’, ‘Attitudes towards mental health’ and ‘The parental
journey’.

Participants described a number of significant cultural barriers to seeking help.
Stigma was identified as occurring in relation to mental health and also in relation to
the process of help-seeking, as suggested by previous research within adult
Orthodox populations (Feinberg & Feinberg, 1985). These stigmas relate to
concerns regarding labelling and future matchmaking for the child and their siblings.
Parents experience emotional and practical strains in parenting a child with mental
health difficulties and in accessing psychological support for their children. The
implications for service level change and clinical practice are considered.
Date: 1994
Abstract: Background We wished to ascertain immunization uptake rates in the strictly orthodox Jewish community in Hackney and to survey reasons for non-uptake and attitudes to immunization and immunization services within this community.

Methods A total of 575 strictly orthodox Jewish children, aged under 2 5 years, were identified from three general practices in the community, and a random sampling of 100 of these children was carried out. The sample uptake recorded by family doctors was compared with District uptake rates. A questionnaire was administered to parents. The main outcome measures were immunization uptake rate, reasons for non-uptake, and attitudes to immunization. Results Percentage immunization uptake (95 per cent confidence intervals) was: third diphtheria 86 per cent (82–90 per cent); third pertussis 82 per cent (78–86 per cent); and MMR 79 per cent (75–85 per cent). District uptake rates for a cohort of the same age, and at the time of the study, were: third diphtheria 82 per cent; third pertussis 79 per cent; and MMR 83 per cent. Sixty-seven parents completed the questionnaire (72 per cent response) and their children's uptake was the same as for children of nonresponders. All parents thought immunization to be important.

ConclusionsFor all immunizations, uptake in the strictly orthodox Jewish community is not significantly different from that of the District. Responding parents had positive attitudes to the value and safety of immunizations but wished better access to services. Health professionals need to question their perceptions so that efforts to improve uptake amongst ethnic minority groups are based on facts and are responsive to identified needs.
Author(s): Boyd, Jonathan
Date: 2019
Abstract: Produced by JPR on behalf of the Board of Deputies of British Jews, and authored by JPR Executive Director, Dr Jonathan Boyd, this statistical bulletin contains data on Jewish school enrolment in the UK for the academic years 2015/16 to 2017/18. It is intended to help community educators and policy makers monitor changing trends over time and to inform thinking about the development of the field.

The report confirms and adds to our existing understanding of enrolment, demonstrating again that more and more Jewish children are going to Jewish schools. The actual number has risen from about 5,000 in the 1950s to close to 35,000 today, a period which, by contrast, has also seen the UK Jewish population as a whole decline by about 30%. The most acute numerical increase has occurred over the past twenty years or so, with the total more or less doubling from about 17,000 in the mid-1990s to the level found today.

Amongst the key findings in the paper:

There were 34,547 Jewish children studying in Jewish schools in the academic year 2017/18.
This represents an increase of 3,633 children, or 11.8% since the last figures were published for the academic year 2014/2015.
This increase can be observed in both the mainstream and strictly Orthodox sectors: the mainstream sector had 1,666 more Jewish children in 2017/18 compared to 2014/15; the strictly Orthodox sector had an additional 2,367 children over the same period.
58% of Jewish children in Jewish schools are in strictly Orthodox schools; 42% in non-strictly Orthodox or ‘mainstream’ Jewish schools.
Three quarters of all Jewish children in Jewish schools are in the Greater London area or South Hertfordshire.
Enrolment in strictly Orthodox schools continues to increase dramatically over time, increasing by an estimated 166%, or over 12,000 children, since the mid-1990s.
The annual growth rate of the strictly Orthodox sector is estimated to be about 4.3%, compared to 3.1% in the mainstream sector.
The growth of the Jewish school sector is a reflection both of high fertility levels in the strictly Orthodox part of the Jewish community, and a growing interest in Jewish schooling within the more mainstream part of it. UK Jewish community leaders have focused considerable attention on Jewish schooling in recent years out of concerns about declining levels of Jewish knowledge and engagement. However, as these schools have developed, considerable attention has focused on general academic quality which has helped to attract higher numbers of pupils. In turn, as the choice of Jewish schooling has become more common, it has also grown in acceptability, pushing up numbers still further.
Date: 2017
Abstract: Background: The English National Health Service (NHS) has significantly extended the supply of evidence based
psychological interventions in primary care for people experiencing common mental health problems. Yet despite
the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably
short of the levels of access that may be necessary to offset the health inequalities created by their different exposure
to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought
to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an
Orthodox Jewish community in the North West of England.

Methods: A combination of qualitative and quantitative data were drawn upon including naturally occurring data,
observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as
well as written feedback and recorded discussions with 12 key informants.

Results: Improvements in access to mental health care for some people from the Orthodox Jewish community were
achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team
were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding,
power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process
of dialogic engagement the team was able to work with the community to develop a bespoke service that
accommodated its wish to maintain a distinct sense of cultural otherness.

Conclusions: This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy,
concordance and recursivity that are associated with improvements in access to care in under-served sections of the
population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of
community engagement. However, the full alignment of the goals of differing constituencies may not always be
possible, due the complex interaction between the multiple positions and understandings of stakeholders that are
involved and the need to respect the other’-s’ autonomy.
Date: 2009
Abstract: This paper examines how Rabbinic and communal authorities participated in treatment decisions made by a group of strictly orthodox haredi Jews with breast cancer living in London. Semi-structured interviews were conducted with five haredi breast cancer patients. The transcripts were analysed using interpretative phenomenological analysis. Demographic and personal data were collected using structured questionnaires. All participants sought Rabbinic involvement, with four seeking rulings concerning religious rituals and treatment options. Participants' motivations were to ensure their actions accorded with Jewish law and hence God's will. By delegating treatment decisions, decision-making became easier and participants could avoid guilt and blame. They could actively participate in the process by choosing which Rabbi to approach, by providing personal information and by stating their preferences. Attitudes towards Rabbinic involvement were occasionally conflicted. This was related to the understanding that Rabbinic rulings were binding, and occasional doubts that their situation would be correctly interpreted. Three participants consulted the community's ‘culture broker’ for medical referrals and non-binding advice concerning treatment. Those who consulted the culture broker had to transcend social norms restricting unnecessary contact between men and women. Hence, some participants described talking to him as uncomfortable. Other concerns related to confidentiality.

By consulting Rabbinic authorities, haredi cancer patients participated in a socially sanctioned method of decision-making continuous with their religious values. Imposing meaning on their illness in this way may be associated with positive psychological adjustment. Rabbinic and communal figures may endorse therapeutic recommendations and make religious and cultural issues comprehensible to clinicians, and as such healthcare practitioners may benefit from this involvement.