Rapid Lifestyle, Diet and Health Changes Among Urban
Total Page：16
File Type：pdf, Size：1020Kb
K. ABU-SAAD, S.WEITZMAN, Y. ABU-RABIAH, H. ABU-SHAREB AND D. FRASER Rapid lifestyle, diet and health changes among urban Bedouin Arabs of southern Israel Kathleen Abu-Saad, MA, is Coordinator and Haijer Abu-Shareb ver the past half cen- cess to running water, mains electricity and tury, with the forma- telephone services and numerous small is Research Assistant for the tion of nation states neighbourhood grocery stores. There are Bedouin Dietary Study, and the encroachment few jobs, so most urban Bedouin work out- of modernization, as- side their places of residence (Lithwick, Simon Weitzman, MD, MPH pects of Bedouin life 2000). In 1998, the Negev Bedouin popu- and Drora Fraser, Ph.D. Othroughout the Middle East have been lation numbered 111 475, of whom 56 per- gradually changing. Traditionally, the cent lived in the government-planned are professors of epidemiology. Bedouin Arabs of the Negev desert in towns. The remaining 44 percent continued All are with the Epidemiology and southern Israel had a nomadic/semi- to live more traditionally in shantytowns nomadic lifestyle based upon herding and and extended family groups that were not Health Services Evaluation seasonal agriculture. After the establish- recognized by the governmental planning Department, Faculty of Health ment of Israel in 1948, their land base and authorities (Ben-Gurion University, 1999), mobility were greatly reduced. Most and thus not connected to central water, Sciences, Ben-Gurion Bedouin, however, maintained their tradi- electricity and telephone services University of the Negev, Israel. tional lifestyle until the mid-1960s when (Lithwick, 2000). they began to integrate with the modern Dr Weitzman Israeli labour market (Marx, 1967). Changing patterns in is Director of the Fraida Foundation diets, activity and disease Urbanizing the Bedouin The transition of over half of the Bedouin Chair of Diabetes Research and population population from a semi-nomadic and Dr Fraser In the late 1960s the Israeli Government agrarian lifestyle to an urban one was ac- developed plans for settling the Bedouin companied by rapid changes in diet, levels is Director, S. Daniel Abraham population in urban areas, and significant of physical activity and chronic disease International Center for Health movement into towns began in the mid- rates. The rapid rise of chronic diseases in 1970s. As of 1998, there were seven planned urbanizing populations in developing and Nutrition. towns with populations ranging in size from countries in the Middle East (al-Nuaim et Yunis Abu-Rabiah, MD, 27 500 to 3 500 (Ben-Gurion University, al., 1997; Galal and Harrison, 1997a; 2000). In the towns, neighbourhoods are Musaiger and al-Roomi, 1997; Stene et al., is Director of Rahat Clinic, Clalit subdivided into 0.1 ha housing lots, with 1999) and worldwide is an issue of grow- Health Services, Israel. community health clinics and schools, ac- ing concern (Dodu, 1988; Galal and fna ana 28 2001 45 Education, poverty and health among the urban Negev Bedouin Although Israel is a developed nation, the Hayton, 1998). In 1996, the average than it is to average residents of Israel socio-economic and health indicators of annual wage per family of urbanized (Lithwick, 2001). the Negev Bedouin are similar to those Bedouin was less than half (41.4 percent) The natural rate of increase (births found in developing country populations. of the average annual wage per family in minus deaths) is 43.8 and 15.9 per The Negev Bedouin fall below the average the total Israeli population. Since the thousand Bedouin and Israeli Jews, Israeli national in terms of educational average Bedouin household size is respectively (CBS, 1999a). Fifty percent of level, school dropout rates and university approximately double that of the average Negev Bedouin are under the age of 13 attendance. The unemployment rate Israeli household size, the annual family (CBS, 1999b). Overcrowding in Bedouin among Negev Bedouin is estimated to be wage per capita of Bedouin was 20 households is common, where families 55 percent of the total workforce. percent of the Israeli average (Ben-Gurion numbering seven or more people Approximately 30 percent of all working- University, 2000; Lithwick, 200l). constitute 40-45 percent of households, as age men and over 80 percent of all Although families with children receive compared to 1-10 percent of households working-age women are unemployed. child support allowances from the in Israeli Jewish settlements (CBS, 1999a). Employment is found in low-status, low- government, the economic gap between These conditions are associated with paying occupations such as construction, the Bedouin and the Israeli Jewish higher rates of illness, hospitalization and driving and unskilled labour (Shapira and population remains very high. The mortality for infectious diseases among Hellerman, 1998). economic status of urban Bedouin is closer Bedouin children than Jewish children Sixty-five percent of Bedouin families to that of the average residents of Egypt, (Fraser et al., 2001; Levy et al., 1998; live below the poverty line (Ghanem, 1998; the Syrian Arab Republic and Lebanon Weitzman, 1997). Harrison, 1997b; McMurry et al., 1991; changes in lifestyle were altering the pat- Health services Whiting and Mackenzie, 1998). As diabe- tern of cardiovascular risk factors in this An important difference between the tes and cardiovascular disease are best population. Negev Bedouin and the populations of de- prevented through appropriate diet and Table 1 contains the age-adjusted veloping countries is that the Bedouin have physical activity, it is important to under- rates (per thousand) of hospitalizations access to Israel’s highly developed health stand how traditional dietary and lifestyle from 1994 to 1998 for AMI and CVD care system. As a consequence, while the patterns changed with urbanization in or- among Negev Bedouin and Israeli Jews infant mortality rate of Negev Bedouin is der to develop effective disease prevention by gender and community type. The rates higher than that of Israeli Jews (12.3 and and health promotion interventions. for Bedouin men and women were much 5.2 per thousand live births, respectively) Chronic diseases such as ischemic heart higher than those of rural Jews, and simi- (CBS, 1999b), it is much lower than the disease (IHD), acute myocardial infarction lar to those of urban Jews (Weitzman, infant mortality rate in developing coun- (AMI), cerebrovascular disease (CVD) and 1999). tries in the Middle East and worldwide. diabetes, which were very rare among the Table 2 contains the results of two With regard to chronic diseases, however, Bedouin until the 1970s, are increasing rap- studies on diabetes among urban Israeli utilization of available services is problem- idly (Ben Assa, 1961, 1964; Weitzman, Jews and Bedouin in the Negev, and in- atic. Traditionally, Bedouin used health Lehrmann and Abu-Rabiah, 1974; Fraser dicates that the prevalence of diabetes was care services for acute illness; an under- et al., 1990; Weitzman, 1997, 1999). In a approximately twice as high among the standing of how chronic illness is cared for, study conducted in 1985, Fraser et al. Bedouin as it was among the Jews. In ad- and the importance of preventive medi- (1990) found that urbanized Bedouin men dition, the data in Table 3 show that the cine, is not well developed. In addition, were significantly more likely than tradi- mean body mass index (BMI) (weight/ some traditional Bedouin customs associ- tional Bedouin men to be obese and over- height) in diabetic Bedouin males and ated with food and hospitality make com- weight, and to have high low density females was generally higher than that pliance with treatment regimes for chronic lipoproteins (LDL)-cholesterol rates, indi- of diabetic Jewish males and females illnesses such as diabetes and hypertension cating that urbanization and the associated (S. Weitzman, 2000, unpublished data). problematic. 46 fna ana 28 2001 TABLE 1 Age-adjusted rates (per thousand) of hospitalizations for acute myocardial infarction (AMI) and cerebrovascular disease (CVD) among Negev Bedouin and Israeli Jews by gender, ethnicity and community type, 1994-1998 Males Females Bedouin Rural Jews Urban Jews Bedouin Rural Jews Urban Jews AMI 9.37 5.47 8.55 6.92 1.99 3.96 CVD 9.13 3.10 9.86 10.43 2.34 8.21 Traditional lifestyle and diet TABLE 2 Livestock and animal products Traditionally, the Bedouin livelihood prima- Prevalence of diabetes (percent) rily involved herding of sheep, goats and among urban Israeli Jews and Bedouin camels that provided meat, milk products Age category Jews Bedouin and wool. Meat was only eaten on special occasions (such as feasts, weddings and vis- 35-44 0.9* 3.4 its from guests) as this entailed slaughtering 45-54 5.6 10.0 an animal and consuming it before the meat 55-64 12.8 20.0 spoiled. Limited amounts of meat were >65 11.7 18.1 made into hamit (meat cooked and then * Age 30-44 sealed in mutton fat at a ratio of 1:2), which kept well for extended periods and was used as a source of fat, flavouring and meat for cooking. Many families raised chickens as a TABLE 3 source of eggs rather than of meat. In addi- tion, they trapped or captured wild birds and Mean body mass index for urban fowl, particularly during the planting and Bedouin and Israeli Jewish diabetics harvesting seasons. Milk products made up a large portion by gender, age and ethnicity of the traditional Bedouin diet. Fresh milk Males Females was used for cooking and drinking. The Age category Bedouin Jews Bedouin Jews most common preserved milk products 35-44 28.0 26.5 34.0 29.0 were rayib, fresh butter, semneh, leben, 45-54 29.2 27.5 31.0 28.0 jameed and ‘afiq. Rayib (yoghurt with but- 55-64 28.5 29.0 28.0 27.0 terfat), was churned by hand to separate the >65 28.8 26.6 30.0 27.0 butterfat from the milk.