Patterns and prevalences of self-reported health problems reflect both underlying diseases and cultural concepts of illness. High reported rates of certain illnesses may reflect a high prevalence of the corresponding disease(s), or a broad definition of the illness, or both. This calls for caution when analyzing self-reported health problems. Utilization of health care services is measured more easily through interviews. Symptoms of distress are always measured through self-reporting, although the methodology may, of course, be more or less refined.

The data on health draws a broad and general picture of what people perceive as health problems and how prevalent these are, where and to which extent they seek medical services, and whether they suffer from symptoms of psychological distress. This presentation gives but a rough baseline for further and more refined analysis of particular questions of interest. Consequently, interpretations must be made with reservations at this stage.

One important question to discuss on the basis of these results is the following: Is there a well-functioning health care system in the occupied territories that serves people equally, independent of their economic resources?

Another major question is: How and to what extent does the Israeli occupation and the intifada influence people's health, and in particular their mental health?

None of these questions can be answered directly. However, the data provides indirect evidence that can be of use when discussing these problems.

It seems that although illnesses and health problems are unequally distributed in the population (that is, illnesses and problems caused by illness are more prevalent among the poor than among the rich), people tend to seek medical services once they have defined themselves as ill, and such services seem to be relatively equally distributed in the sense that nearly all groups have access to health care. UNRWA serves refugees both in- and outside camps, and appears to be an important factor in counteracting social inequality in health care. Low health insurance coverage does not prevent people from using health care services. The appropriateness and quality of the health care may of course vary along social gradients.

The second question needs further analysis as well, but the impression is that reported rates of symptoms of psychological distress are very high, and the few indications we have of stressful and possibly traumatic experiences show strong correlations with high degrees of distress. These events are partly related to general living conditions, and partly to the social uprising and occupation. Further analysis of these problems would be useful for assessing the quality of life in the occupied areas.


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