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Author(s): Kasstan, Ben
Date: 2021
Abstract: Maintaining ‘faith’ in vaccination has emerged as a public health challenge amidst outbreaks of preventable disease among religious minorities and rising claims to ‘exemption’ from vaccine mandates. Outbreaks of measles and coronavirus have been particularly acute among Orthodox Jewish neighbourhoods in North America, Europe and Israel, yet no comparative studies have been conducted to discern the shared and situated influences on vaccine decision-making. This paper synthesises qualitative research into vaccine decision-making among Orthodox Jews in the United Kingdom and Israel during the 2014–15 and 2018-19 measles epidemics, and 2020–21 coronavirus pandemic. The methods integrate 66 semi-structured informal interviews conducted with parents, formal and informal healthcare practitioners, and religious leaders, as well as analysis of tailored non-vaccination advocacy events and literature. The paper argues that the discourse of ‘religious’ exemption and opposition to vaccination obscures the diverse practices and philosophies that inform vaccine decisions, and how religious law and leaders form a contingent influence. Rather than viewing religion as the primary framework through which vaccine decisions are made, Orthodox Jewish parents were more concerned with safety, trust and choice in similar ways to ‘secular’ logics of non-vaccination. Yet, religious frameworks were mobilised, and at times politicised, to suit medico-legal discourse of ‘exemption’ from coercive or mandatory vaccine policies. By conceptualising tensions around protection as ‘political immunities,’ the paper offers a model to inform social science understandings of how health, law and religion intersect in contemporary vaccine opposition.
Date: 2021
Abstract: The COVID-19 pandemic hit the British Jewish community hard. According to data gathered by JPR in July 2020, 25% of British Jews had already contracted the virus by that time and Jewish mortality rates in London in April 2020 – the peak of the first wave – were almost three times as high as usual. In Manchester, the picture was even worse.

Building on our previous studies on this topic, this paper looks at Jewish mortality over the first year of the pandemic, taking in both the first wave (March to May 2020) and the second wave (December 2020 to February 2021).

Whilst it confirms that excess mortality among Jews during the first wave was considerably higher than among comparative non-Jews (280% higher compared to 188%), it reveals that the second wave saw the opposite picture: 69% higher than expected levels of mortality for that period among Jews, compared to 77% among the non-Jewish comparative group. This second wave picture is exactly what one might expect to see given that Jews typically enjoy relatively good health and longevity, so it forces us to ask again: what happened during the first wave to cause such devastation across the Jewish community?

Whilst not yet definitive about their conclusions, the authors point towards the ‘religious sociability’ hypothesis – that notion that close interaction between Jews, prior to the first lockdown, caused the devastating spike in Jewish deaths early on. The paper also demonstrates that the ‘Jewish penalty’ at this time was greater among Orthodox Jews than Progressive ones which further strengthens the hypothesis, as much higher proportions of Orthodox Jews gather regularly for religious reasons than Progressive Jews (even though Progressive Jews do so more regularly than British society as a whole).

The fact that the picture of extremely high excess mortality among British Jews was not repeated during the second wave (on the contrary, excess mortality among Jews was very slightly lower than among the comparator non-Jewish population, and slightly higher among Progressive Jews than Orthodox ones), suggests that the religious sociability theory was no longer a major factor at this time. With many synagogues closed or complying closely with the social distancing policies established by government, Jews were affected by coronavirus in much the same way as others.

The findings in this paper should be taken seriously by at least two key groups. Epidemiologists and public health experts should explore the impact of religious sociability more carefully, as currently, socioeconomic factors tend to dominate analysis. And Jewish community leaders must also reflect on the findings and, in the event of a similar pandemic in the future, consider instituting protective measures much more quickly than occurred in early 2020.

Date: 2021
Abstract: In this report, the authors investigate the likely prevalence of COVID-19 and Long Covid among Britain’s Jewish population. Based on data collected by JPR in July 2020 – five months into the pandemic – they found that infection was already widespread in the Jewish community with a quarter (25%) of respondents (aged 16 and above) reporting having experienced COVID-19 symptoms (although testing in the UK was not widely available at this stage.) This accords with other national data showing that BAME groups, including Jews, suffered particularly badly in the early stages of the pandemic.

The data also confirm findings that the strictly Orthodox community was most likely to have been infected (40%) at this stage. And while respondents who self-described as having ‘very strong’ religiosity or who characterised their outlook as ‘religious’ were also far more likely to report having experienced COVID-19 symptoms, it appears that synagogue or communal involvement (rather than membership) is associated with higher levels.

The report also shows that almost two out of three (64%) respondents first experienced symptoms in March 2020, which was the clear peak of infection up to July 2020 when the survey took place. Nevertheless, more than one in six (16%) said they first experienced symptoms in February 2020, and these cases were mainly among more secular members of the Jewish community.

Reports of ongoing health issues following a COVID-19 infection began to appear early on in the pandemic. Gradually, data emerged about Long COVID showing it to be associated with 205 symptoms affecting multiple organs. In January 2021 it was estimated that 300,000 people in the UK may have been suffering from Long COVID. Our data showed that at least 15% of respondents, who said they had experienced COVID-19 symptoms, reported Long COVID symptoms in July 2020, similar to the levels found in the UK generally.

Respondents who had pre-existing health conditions, were far more likely to report Long COVID than those without such conditions. The most commonly reported health concerns were shortness of breath, affecting half of sufferers (51%), followed by ‘severe fatigue’ affecting 43%. Long COVID sufferers were also more likely to report lower levels of happiness and higher levels of anxiety.

Long COVID may ultimately be one of the main long-term health legacies of the coronavirus pandemic. While many gaps in our understanding of this complex health issue remain at the time of publication, JPR will continue to investigate this and other key health issues confronting the Jewish community during the pandemic.
Author(s): Staetsky, L. Daniel
Date: 2021
Author(s): Boyd, Jonathan
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: 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: 2012
Abstract:

The countries of the Former Soviet Union (FSU) are the home today for a substantial number of Jews, many of whom live in poor, economically disadvantaged communities. Throughout the FSU, the American Jewish Joint Distribution Committee (JDC) has supported the development of Hesed welfare and Jewish community centers to assist in the provision of services to Jews in need and to support the renewal of Jewish life after years of suppression. The present report is designed to review the current economic, health, and social conditions of these elderly Jews in need in the FSU and to compare their circumstances, as best possible, to their counterparts who live in western countries such as the United States.

Data from a large number of sources are reviewed and analyzed, including national statistics, national and local surveys, and client-level data. The data indicate clearly that, in view of demographic composition, as well as economic and social conditions, elderly Jews in the FSU have tremendous needs for supportive services funded by philanthropy compared to their peers in the United States. The comparisons also highlight the disparities in available care among those most in need.

There is a clear need for external support for basic health and social services for elderly Jews in the FSU. Twenty years after the collapse of the Soviet Union, there is not an adequate safety net for the elderly. The situation is in flux and there are unique challenges associated with understanding service delivery in societies that are in transition. The available data on pensions and living circumstances make clear that the economic situation for elderly in the FSU who seek Hesed services is dire. Faced with increasing costs for basic needs such as utilities and food, along with health services including essential medicines, quality care and homecare, the pension amounts that Hesed clients rely on are inadequate to meet their 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: This study, the first to assess mortality among Jews around the world during the COVID-19 crisis, draws on data from a wide variety of sources to understand the extent to which Jews were affected by coronavirus in different parts of the world during the first wave of the pandemic, March to May 2020.

The first section describes the methods of quantification of COVID-19 mortality, and explains why measuring it using the excess mortality method is the most effective way to understand how Jewish communities have been affected. The second section presents data on Jewish mortality during the first wave of the COVID-19 epidemic, drawing particularly on data provided to JPR by Jewish burial societies in communities all over the world. It does so in a comparative perspective, setting the data on Jews alongside the data on non-Jews, to explore both the extent to which Jews have been affected by the COVID-19 epidemic, and how the Jewish experience with COVID-19 compares to the experience of non-Jewish populations.

The immediate impression is that there is not a single ‘Jewish pattern’ that is observable everywhere, and, with respect to the presence of excess mortality, Jewish communities, by and large, followed the populations surrounding them.

The report cautions against speculation about why Jews were disproportionately affected in some places, but rule out two candidate explanations: that Jewish populations with particularly elderly age profiles were hardest hit, or that Jews have been badly affected due to any underlying health issue common among them. They consider the possibility that Jewish lifestyle effects (e.g. above average size families, convening in large groups for Jewish rituals and holidays), may have been an important factor in certain instances, noting that these are unambiguous risk factors in the context of communicable diseases. Whilst they suggest that the spread of the virus among Jews “may have been enhanced by intense social contact,” they argue that without accurate quantification, this explanation for elevated mortality in certain places remains unproven.

The report also includes a strongly worded preface from Hebrew University Professor Sergio DellaPergola, the Chair of the JPR European Jewish Demography Unit, and the world’s leading expert in Jewish demography. In it, he stresses the importance of systematically testing representative samples of the population at the national and local levels, and, in Jewish community contexts, of routinely gathering Jewish population vital statistics. He states: “If there is one lesson for Jewish community research that emerges out of this crisis it is that the routine gathering of vital statistics – the monitoring of deaths, as well as births, marriages, divorces, conversions, immigrants and emigrants – is one of the fundamental responsibilities community bodies must take.”
Author(s): Jong-min, Jeong
Date: 2017
Abstract: What have those living with dementia lost? If they have lost aspects of their mind and self, who are they now? Are they 'normal'? Prevailing medical, therapeutic and sociopsychoanalytic interventions and studies on dementia, largely influenced by Tom Kitwood's person-centred approach, have focused mainly on revealing and evaluating the remaining intact bodily abilities and functions beyond loss. In contrast to this predominant understanding of dementia, my decade-long involvement in a Jewish Care Home as a volunteer and researcher has raised ontological, epistemological and practical critiques, acknowledging that we are never beyond loss but always alongside it, and that we simply do not know how to dwell well with it. Although the expressive and performative words, gestures and behaviours of those with dementia are often regarded as inarticulate, repetitive and nonsensical, these are the lived worlds of dementia that those affected feel, experience and live through, whilst continuously making relations and familiarising themselves with people, things, and their surroundings. This demands a paradigm shift in the ontological, epistemological and practical horizon within the study of dementia. Critically developing Canguilhem's notion of the normal and the abnormal, Ingold's dwelling perspective and Deleuze's concept of becoming, I redefine dementia not as a fixed mode of being but as a continuous process of becoming-dementia through an attentive engagement with one's immediate surroundings. In more detail, this study explores the ways in which people challenge the taken-for-granted concepts of loss and abnormality in five different dementia contexts: ethics, repetition, time, agency and emplacement. By rejecting medical preconceptions or categorisations, this study focuses on uncovering what loss does in everyday life rather than asking what loss means or what people lose. In particular, this study emphasises bodily movement, sensory perception and affect, not because of the language deterioration during dementia trajectories but because of a new way of understanding and new reality that those affected practise in daily life. Consequently, this study illustrates the immanent potential of the anthropological view for thinking and dwelling with those living with dementia alongside their limits and implications. This study is thus an autobiographical ethnographic testimony of my past decade living, learning, volunteering, studying and most importantly co-dwelling with those living with dementia. This is a collaborative co-production created with those involved, as without the participation of those affected and the co-presence of significant others, my work could not be done. Accordingly, there is neither a beginning nor end to this study, but a moving forward and generating dementia becoming as the lives of those affected and those who care for them unfold.
Date: 2020
Abstract: JPR’s COVID-19 survey looks at how Jews have been impacted by the pandemic in terms of their health, jobs, finances, relationships and Jewish lives. The findings are being shared in a series of short reports looking at key policy issues, and this one focuses on the issue of how comfortable Jews feel about attending Jewish activities and events in person.

Drawing on survey responses from July 2020, it finds that whilst Jews situate themselves across the full length of the ‘comfort scale’ (running from very comfortable to very uncomfortable), there is a clear leaning towards the uncomfortable end.

Unsurprisingly, those who are uncomfortable are likely to be in older age bands and/or suffering from health conditions that make them particularly vulnerable to the virus. Similarly, those who have had the virus and continue to suffer from secondary symptoms (i.e. ‘Long COVID’) also tend to be uncomfortable about attending events in person.

However, there are some interesting exceptions. The most elderly appear to feel more comfortable than average, and the youngest age bands (those aged 16-24) feel more uncomfortable than average. Those who have had COVID-19 and recovered feel more comfortable than those who have not. And those who have experienced job losses, or have been furloughed, are rather less comfortable than those whose working loves have remained reasonably stable.

It is also very striking to see that, denominationally, the Strictly Orthodox feel most comfortable about attending in-person events, whereas non-synagogue members feel most uncomfortable. Members of other ‘mainstream’ denominations cluster together in between. However, people’s level of religiosity is actually a slightly better predictor than denomination of how comfortable they feel about attending community activities or events in person – those with strong religiosity are most likely to feel comfortable, and those with weak religiosity most likely to feel uncomfortable.

Perhaps most interestingly, there is an important relationship between how comfortable people feel about attending community activities and events in person, and their general state of mental health. Those showing signs of psychological distress feel notably less comfortable than others.

Brief details about the methodology used in the survey are contained in the report. A more detailed methodological is being prepared and will be available shortly.
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.
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.
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.
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.
Date: 1999
Date: 2008
Abstract: Objective To assess reasons for low uptake of immunization amongst orthodox Jewish families.
Design Qualitative interviews with 25 orthodox Jewish mothers and 10 local health care workers.
Setting The orthodox Jewish community in North East London.
Main outcome measures Identification of views on immunization in the orthodox Jewish community.
Results In a community assumed to be relatively insulated from direct media influence, word of mouth is nevertheless a potent source of rumours about vaccination dangers. The origins of these may lie in media scares that contribute to anxieties about MMR. At the same time, close community cohesion leads to a sense of relative safety in relation to tuberculosis, with consequent low rates of BCG uptake. Thus low uptake of different immunizations arises from enhanced feelings of both safety and danger. Low uptake was not found to be due to the practical difficulties associated with large families, or to perceived insensitive cultural practices of health care providers.
Conclusions The views and practices of members of this community are not homogeneous and may change over time. It is important that assumptions concerning the role of religious beliefs do not act as an obstacle for providing clear messages concerning immunization, and community norms may be challenged by explicitly using its social networks to communicate more positive messages about immunization. The study provides a useful example of how social networks may reinforce or challenge misinformation about health and risk and the complex nature of decision making about children's health.
Date: 2016
Abstract: From press release:

A ground-breaking survey commissioned by NHS Salford Clinical Commissioning (CCG) has revealed concerns about immunisation take-up, healthy eating, amounts of exercise and attitudes to mental health within the predominately orthodox Jewish communities in the city.
507 people took part in the year-long research project that included peer-led focus groups as well as questionnaires. Key findings reveal that less than half of the participants take more than one hour of exercise per week, with around a quarter taking less than 30 minutes. Only half meet recommended levels of physical activity, which is significantly below the England average of 61%. Fewer than half of respondents believe exercise is very important, with far fewer men than women valuing exercise.
There is particular concern related to men’s lack of exercise, with just over a third meeting the recommended levels of physical activity compared to 67% nationally. The percentage of women meeting recommending levels at 56% is comparable to the 55% of women nationally.
With regards to children’s exercise, only 40% think it is very important that their child exercises. Less than half the children do more than an hour’s exercise per week, with a third doing less than 30 mins per week. Boys tend to do slightly more exercise than girls (possibly because they play football or ride bikes), contra to what was reported as being undertaken by the adults themselves; the trend seems to be that boys are more active than girls but this switches as they become adults.
The research also suggests that the healthy eating message is not always getting through to this community; only 10% of children are getting their ‘5 a day’ with 40% getting less than 3 fruit or veg a day. Over half the children in this community seem eat cake at least once a day, though crisps and other unhealthy snacks seem far less frequent. Alcohol consumption for adults is, however, very low compared to the rest of the population, although 12% of respondents might be classed as ‘binge-drinkers’ on the Sabbath.
Attitudes to immunisation in the orthodox Jewish community remain a concern. 13% said they would be unlikely to immunise their child in the future whilst 20% felt they were not given enough information about immunisation. For Salford as a whole, MMR immunisation take-up by 5 years olds averages over 97% which is far higher than appears in the Jewish communities.
Take up of cervical smears is also lower than the rest of the population with 67% claiming they would be likely to have a smear compared to the 80% target in Salford. It is thought that some of the lower uptake of cervical screening may be due to the low perceived risk of HPV infection and cervical cancer, the higher number of pregnancies and religious norms relating to menstruation.
Other findings of interest include the fact that almost a half of participants believe that mental health is a big stigma within the Jewish community which may prevent many people seeking the help they need.
Date: 2011
Abstract: This report has been written at the request of Jewish Women’s Aid (JWA). JWA commissioned this 
research to better understand several key factors influencing their work: general Jewish opinion 
and knowledge about domestic violence; the ways in which current and former clients come to 
JWA and how useful they find its services; and the position of JWA in the UK and in comparison to 
other Jewish domestic violence charities in Israel, the USA and Canada. 

The researchers determined that the best way of ascertaining information about these areas of 
interest was to conduct a three- stage research project. Firstly, a literature review was undertaken 
to contextualise the work JWA does in both a national and international context. This literature 
review informs chapter two of this research report, which provides an overview of domestic 
violence in the UK with references throughout to three countries of interest to Jewish Women’s Aid 
(because of the presence of Jewish-specific domestic violence charities), namely Canada, the 
United States, and Israel.
 
Secondly, the researchers conducted a domestic violence Jewish general opinion survey, which 
yielded 842 complete responses. The survey was largely taken by women and this response rate 
makes this survey, to the knowledge of the authors and JWA, the largest Jewish survey on a 
women’s issue ever conducted.

This report discusses the findings from the survey; see chapter three for details, including a discussion of the methodology employed. 

Finally, and perhaps most importantly, the researchers conducted face –to- face interviews with 
twenty current or former JWA clients, who agreed to speak to them after communication from JWA 
employees. Chapter four of this report gives voice to the personal suffering experienced by 
women; it illuminates the ‘real life stories’ behind the statistics.
 
The report concludes with recommendations that JWA will be implementing to continue combating 
domestic violence in all of its forms; these recommendations are based both on the findings arising 
from the general survey and client interviews, and from examples of best practice from domestic 
violence charities in the UK and abroad.