Aviva Yoselis
Board Certified Patient Advocate

We need to take statistics on Haredim with a grain of salt

Israel has a problem.  Well obviously, many problems and many solutions, but this is one problem I’m not so sure is being addressed.

During this entire pandemic, the term Haredi, or ultra-Orthodox, has come up so many times in Israeli news, English news in Israel, and news abroad. Specifically, in regards to the number of Haredim who are not keeping the government-imposed guidelines about preventing the spread of the coronavirus, the number of Haredim getting sick with the virus, or, as reported today, the overrepresentation of Haredim in the number of deaths from coronavirus when compared with the mainstream Israeli population.

All of these facts may be true, but then again, they may be wildly misrepresentational, because we really don’t have a mechanism to count, measure, or analyze the Haredi population.

What do I mean by that?  I haven’t read this most recent report by an independent journalist outlet, nor I have I compared it the Israeli Ministry of Health’s report.  But I can tell you that they are basing Haredi status solely on address and geographic location.

No one goes to the hospital and upon admission is asked, ‘what is your religious affiliation’ and responds ‘oh, I definitely self-identify as Haredi’. 

First off, what does that even mean?

The number of sub groups, hasidish, yeshivish, sefardi, litvish, the list goes on and the differences go on.  From the public health perspective, there are significant differences in health behaviors, compliance with suggesting screening tests, and yes, now, compliance with COVID-19 regulations among these various groups.

But because these nuances are difficult to measure, and are based largely on self-report, which a data gathering body cannot usually access, statistics on the Haredi population are based on address.  If you’ve driven through B’nai Brak, and you’ve noticed how the majority of people dress, you will see why every address in B’nai Brak is usually counted as a Haredi household.  Same in Elad, certain neighborhoods in Jerusalem… you get the picture.

A few years ago, I was part of a lively debate in a Knesset committee session on women’s issues, where the subject of Haredi women’s health status was addressed.  The take home from that entire 2 hour arguing fest (it was the Knesset after all), was that we didn’t have enough data to really determine what Israeli Haredi women’s health status was.

It took me two years, but we were finally able to put together a comprehensive review of existing literature on Haredi women’s health status in Israel.  [Hidden Figures: Are Ultra-Orthodox Jewish Women Really so Different When it Comes to Health Care?]

Our conclusion?   We really don’t know what Israeli Haredi women’s health status is.

Too few studies and too many small nonrepresentative samples.  Some studies had self-report as definition of Haredi but many used addresses, or Bituach Leumi’s extremely complicated formula that involves voting records and addresses.  It turns out that many of the percentages linked with Haredi women’s low compliance to public health measures had more connection with sociodemographic status than religious affiliation.

What’s my point?

Yes, we have major discrepancies in this country among various groups’ compliance with screening tests and public health regulations, as well as disproportionate morbidity and mortality among those groups.  But we cannot so easily divide the line between Haredi and secular and then make a determination about policy.

We need to identify more in depth, tailored ways to identify groups at risk, and not use address as a risk factor.  We need to delve in more to this statistic of “1 in 73 ultra-Orthodox Israelis over 65 has died of COVID” and find out how is ‘ultra-orthodox’ defined, what are the sociodemographic variables of those who have died?  What were their pre-existing conditions, etc..?

Broad statistical analyses can help point us in the right direction, but we must not let them misdirect us about effective future interventions.

About the Author
Aviva Yoselis, MPH, BCPA, founder of and director of Health Advize, a social impact enterprise to improve healthcare access for all. She is an expert in the field of health research, health behavior modification, and shared medical decision making, with over 25 years of experience teaching about public health issues and health systems navigation. She has a broad understanding of the biological sciences, biostatistics, epidemiology, clinical trials, and current issues in healthcare. She holds a Masters Degree in Public Health and was the first person to become a board-certified patient advocate outside of North America. Prior to moving to Israel, Aviva worked in the USA in health education and advocacy for low-income minority communities
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