Context
Israel’s population is characterized by socioeconomic and cultural diversity, reflected in differences in health behaviours, access to services and health outcomes across groups. Health disparities between population groups have long been documented, and in recent years national efforts have been undertaken to reduce these gaps, for example, through the development of community-based health units in Arab towns (https://eurohealthobservatory.who.int/monitors/health-systems-monitor/updates/hspm/israel-2015/strengthening-existing-and-establishing-new-health-units-at-the-local-level-to-improve-health-promotion-among-arabs). Ultra-Orthodox Jews constitute 1.39 million people (13.9% of Israel’s population), with rapid demographic growth expected to reach 16% by 2030 (The Israel Democracy Institute, https://www.idi.org.il/haredi/2024/?chapter=57492).
Impetus for the reform
The COVID-19 pandemic demonstrated that conventional health messaging and service delivery do not effectively reach culturally distinct communities. The crisis demonstrated the vulnerability of the ultra-Orthodox community to spreading infectious diseases and highlighted the need for a national, culturally responsive strategy to prevent disease and reduce disparities. The government therefore initiated the first national strategic program culturally designed specifically for ultra-Orthodox Jews.
Main purpose of the reform
The reform seeks to reduce health outcomes disparities among ultra-Orthodox Jews through the design and implementation of culturally adapted health intervention programs. These programs were tailored to ultra-Orthodox religious language norms, modesty considerations, communal structures and trusted communication channels.
Content and characteristics
The reform builds on existing community anchors; community centres, mother and child health clinics, rabbinic leadership, and trusted local networks, to promote healthier behaviours and increase uptake of preventive services. The government worked closely with the leadership and members of the ultra-Orthodox community, strengthening mutual trust in order to increase adherence to government regulations and recommendations. This partnership ensures programs are not only based on medical best practice, but also linguistically, socially and religiously appropriate.
Research to assess community needs informed intervention programs. Priority was given to the most prevalent health issues, including low childhood vaccination coverage, high rates of unintentional child injuries, high prevalence of dental caries among children, low physical activity, high diabetes prevalence, obesity among individuals with diabetes, limited healthy diets, low uptake of cancer screening, elevated smoking rates among men and underuse of mental health services.
Implementation steps taken
- Mobile mother and child health clinic that provides routine immunizations, developmental screening, and early childhood guidance, through culturally adapted services tailored to the needs of ultra-Orthodox families and improving access in rapidly growing communities. The first unit was launched in December 2024.
- Implementing health promotion programs in 19 community centres serving ultra-Orthodox neighbourhoods. Activities integrate healthy lifestyle habits into routine community programming; nutrition workshops, physical activity sessions and smoking-prevention activities.
- Strengthening existing mother and child health clinics by adding dietitians to reduce childhood anemia and dental health services to prevent dental caries. The program currently operates in 15 clinics across 13 ultra-Orthodox cities and has already served approximately 600 infants.
Outcomes to date and evaluation
More than 75 000 participants have taken part in activities to date. Early results show high engagement and satisfaction, increases in childhood vaccination rates, greater registration for cancer screening, improved nutrition and physical activity behaviours, and rising participation in preventive dental care.
Considerations for future implementation
While early improvements in engagement are encouraging, long-term evaluation is needed to assess sustained behaviour change and clinical outcomes. Tracking indicators such as vaccination coverage, smoking rates, dental caries and diabetes control will clarify whether the program leads to population-level improvements.