Women’s health in the occupied Palestinian territories: Contextual influences on subjective and objective health measures

Abstract

The links between two commonly used measures of health—self-rated health (SRH) and self-reported illness (SRI)–and socio-economic and contextual factors are poorly understood in Low and Middle Income Countries (LMICs) and more specifically among women in conflict areas. This study assesses the socioeconomic determinants of three self-reported measures of health among women in the occupied Palestinian territories; self-reported self-rated health (SRH) and two self-reported illness indicators (acute and chronic diseases). Data were obtained from the 2010 Palestinian Family Health Survey (PFHS), providing a sample of 14,819 women aged 15–54. Data were used to construct three binary dependent variable—SRH (poor or otherwise), and reporting two SRI indicators—general illness and chronic illness (yes or otherwise). Multilevel logistic regression models for each dependent variable were estimated, with individual level socioeconomic and sociodemographic predictors and random intercepts at the governorate and community level included, to explore the determinants of inequalities in health. Consistent socioeconomic inequalities in women’s reports of both SRH and SRI are found. Better educated, wealthier women are significantly less likely to report an SRI and poor SRH. However, intra-oPt regional disparities are not consistent across SRH and SRI. Women from the Gaza Strip are less likely to report poor SRH compared to women from all other regions in the West Bank. Geographic and residential factors, together with socioeconomic status, are key to understanding differences between women’s reports of SRI and SRH in the oPt. More evidence is needed on the health of women in the oPt beyond the ages currently included in surveys. The results for SRH show discrepancies which can often occur in conflict affected settings where a combination of ill-health and poor access to health services impact on women’s health. These results indicate that future policies should be developed in a holistic manner by targeting physical and mental health and well-being in programmes addressing the health needs of women, especially those in conflict affected zones.

Maternal and child access to care and intensity of conflict in the occupied Palestinian territory: a pseudo-longitudinal analysis (2000–2014)

“…Such under-reporting can become even more pronounced in more deprived and conflict-afflicted areas, reflected in our results which show lower reporting of pregnancy complications for women in the Gaza Strip. Previous research on subjective health shows that Gaza Strip residents reported better subjective health than the West Bank but worse objective health, which is based on diagnosis rather than self-report [47].…”

Health care access and satisfaction in Judean and Samarian communities: opportunities for improving care

“…While there have been a number of articles related to the health care access of Arab residents in the region studied [ 19 – 23 ], there have been almost none focusing on the primarily Jewish areas that we researched. One reason for the paucity of literature on this topic may be because it involves a politically sensitive and often controversial geographic area.…”

“…While there have been a number of studies investigating access to care and satisfaction for the Arab population in this area [ 20 – 23 ], to our knowledge none have focused on the Jewish communities of Judea and Samaria. There have been studies on health care access and patient satisfaction of Israelis in general, but they have either omitted Judea and Samaria or had limited success in recruiting respondents from this area [ 13 , 24 , 25 ].…”

The mental health impact of multiple deprivations under protracted conflict: A multi-level study in the occupied Palestinian territory

“…For the subjective measure, we rely on one question asking respondents to rate their economic status, with a possible range of responses from very poor to rich. We also created a composite 'wealth' score using principle component analysis taking into account household material conditions and amenities [46,47]. We then classified respondents into wealth quartiles, in order to take into account where they stand in relation to others.…”

“…Initially, we estimated a single level continuous regression model, then given the multilevel nature of the determinants of health outcomes and the multilevel structure of the survey we added random intercepts at the locality level. Locality is taken as a proxy for community effects as demonstrated in previous literature [46]. We first ran the aggregate model and then separate models for the WB and GS.…”