Another major question is how and to what extent health conditions are influenced by the Israeli occupation, the social uprising - the intifada - and the sometimes warlike situation that Palestinians experience. Under such circumstances, individuals will experience traumatic events like injuries caused by confrontations with military personnel, arrest and perhaps even torture. Others will react to the general stress of living induced by curfews and restrictions on movement. This topic will be elaborated further in the section on symptoms of distress.
This chapter will first present data on patterns, prevalences and consequences of self-reported acute and chronic health problems, as well as on utilization of health services and health insurance coverage. Second, we will present major concepts concerning psychological and psychosomatic distress, as well as results of the questions on symptoms of distress.
All individuals in the sample were asked questions about their health and health behaviour (were they absent from work or other duties, did they consult health personnel, were they able to go out on their own?). Women answered additional questions focusing on utilization of health services during pregnancy.
The intention here is mainly to report the data collected in the FAFO survey. Only brief references will be made to other studies from the area and international sources. For an overview of literature on health in the occupied territories, see 'Health in the West Bank and the Gaza Strip, an annotated bibliography' (Health Development Information Project, 1992).
The concept of health transition (Feachem et al, 1992) parallels the concept of demographic transition, referring to changes in levels and causes of illness and death that occur in the course of social and economic development. The health transition is the net result of a demographic component (the demographic composition and development of a society), a risk factor component (smoking, alcohol, diet, physical activity, traffic, uprising/conflict and violence) and a therapeutic component (availability and quality of health services). In a recent World Bank Report (Feachem et al, 1992), analysis of the health of adults in the developing world indicates that age-specific rates for both communicable and non-communicable diseases are declining in these countries, while the number and relative importance of non-communicable diseases (hypertension, diabetes, coronary heart disease, etc.) are increasing.
The present survey has not been designed to analyze health transition, but the concept is useful to keep in mind when interpreting the results.
In spite of these inherent problems, studies of self-perceived illness serve useful purposes. They offer the possibility of relating perceived health problems in a representative sample with a broad range of social and economic factors.