Life Expectancy and Aging Life expectancy: In the year 2000, life expectancy for women was 80.9 years, and 76.7 years for men. However, the gap in life expectancy between women and men is smaller in Israel than in other developed countries. Israel placed last among developed countries in a comparison of gender differences in life expectancy, according to international data amassed in 1999. Among the 23 developed countries, Israel’s gender gap in life expectancy was 3.8 years, compared to an average of 5.8 years in the other developed countries. The life expectancy of Israeli women was low compared to women in other countries, while the life expectancy of Israeli men was high, compared to men in other countries. This difference can be explained in part by the fact that Israeli women suffer from relatively high mortality from cancer and heart disease compared to women in other developed countries, while the mortality of Israeli men from these diseases is relatively low compared to men in other developed countries. In the year 2000, life expectancy for Jewish women reached 81.2 years, and that of Arab women 77.9 years. The gap of 3.3 years represents higher mortality rates for Arab women in almost all age groups, including a higher infant mortality rate. Aging: In the year 2000, 10% of Israel's population was age 65 or older. The higher life expectancy of women is reflected in the higher proportion of women among the elderly: women represent 57% of those over 65, and 62% of those over 85. In the Jewish population, 13% of women and 10% of men are 65 or older. The Arab population is much younger; only 3% of Arab men and women are 65 or older.

Mortality Causes of death: Heart disease, cancer, and stroke (in that order) are the major causes of death for women in Israel, as they are for men. However, there have been changes in the proportionate distribution of causes of death among women between 1975 and 1995. There has been a large increase in the percentage of deaths caused by cancer (31%), a slight increase in the percentage of deaths caused by heart disease, and a decline of 36% in the percentage of deaths caused by stroke. Although the leading causes of death are the same for Jewish and Arab women, the distribution is different. The proportion of deaths by heart disease and cancer are lower in Arab women, and the proportions of death by stroke, diabetes and external injuries are higher. As expected, the leading causes of death vary with age: among young women (aged 15-24), the leading cause is external injuries. Among women aged 25-74, cancer is the leading cause of death, accounting for nearly half of all deaths among women aged 25-64. Only among women age 75 and older is heart disease the leading cause of death, accounting for almost 40% of all deaths.

Health Status  Self-reported health status: In a 2001 study, 36% of the Jewish women and 37% of the Arab women reported suffering from fair or poor health, compared to 25% of the Jewish men and 23% of the Arab men. Women report lower health status than men in all age groups.  Cancer: Cancer is the second leading cause of death for women in Israel. In an analysis of 40 European and North American countries in 1990, Israeli women ranked tenth in the incidence of cancer, compared to Israeli men, who ranked lower, in the thirty-third place. Jewish women have much higher incidence rates of cancer than Arab women. However, Arab women who are diagnosed with cancer have a higher mortality rate than Jewish women diagnosed with cancer. One reason for this could be later detection of cancer among Arab women. The most common form of cancer in women in Israel is breast cancer, which accounts yearly for nearly 30% of all new cancers. The incidence of breast cancer has been rising steadily over the past 25 years among both Jewish and Arab women. Breast cancer incidence is much higher (about four times as high) among Jewish women than among Arab women. Compared to women in other developed countries, the incidence of breast cancer among Jewish women is very high, and the incidence among Arab women is very low. The second most common malignancy in women is cancer of the colon. Israeli women have a much lower incidence of cervical cancer than women in other developed countries.  Diabetes: This disease is the fourth leading cause of death for women in Israel and a risk factor for developing a range of chronic disabling conditions. Diabetes is more prevalent among women than men in populations over the age of 55. In the Arab population, diabetes is more prevalent than in the Jewish population. Among Arab women aged 55-64, the percentage of self-reported rates of diabetes was 25% in 1999-2000, double the rate of self-reported diabetes among Jewish women of the same age (12%).  Hypertension: The rate of self-reported hypertension (a major risk factor for cardiovascular disease) increases with age. Among populations over the age of 55, self-reported hypertension is higher among women than men. In a 1999-2000 survey, 35% of women and 27% of men aged 55-64 reported suffering from hypertension.  Domestic violence: In a 1998 survey, 11% of women reported that they had suffered violence inflicted by their partners. Among those women, 3% reported that the violence had occurred during the last year. These rates are low compared to a similar American survey, in which 32% of the women reported that they had suffered violence inflicted by their partners. Part of the discrepancy might be due to a cultural difference in the response patterns of American and Israeli women. Israeli women may be more reluctant to report violence inflicted on them by their partners. The government provides funds for services to respond to the needs of women victims of violence and their children. These services include domestic violence prevention centers, "safe houses" for women whose situations are not life-threatening, and battered women's shelters. These services have the capacity to serve only a fraction of the women who need them, and there are long waiting lists.  Mental distress: Mental distress is more prevalent among women than among men; it is also more prevalent among Arabs than among Jews. In a 2001 study, 31% of Jewish women and 48% of Arab women reported having suffered from mental distress during the past year, compared with 23% of Jewish men and 44% of Arab men.  Morbidity and disability in elderly women: A 1998 study of men and women over the age of 75 revealed that women suffered more from all of the health conditions that were measured. Arthritis or rheumatism, known to result in chronic pain and disability, was the most prevalent health condition measured. It was reported by 45% of the women, compared to 25% of the men. Women also reported a larger mean number of medical conditions than men. Among women over the age of 75, the most common injuries were caused by falls. Older women suffer from falls nearly twice as often as older men. Falls are commonly associated with injuries, particularly fractures, which can lead to disability. Hip fractures are among the most serious consequences of falls. Approximately half of older people who suffer from falls experience a deterioration in functional ability which leads to the need for assistance at home or institutional care. The 1998 study also showed that rates of disability in activities of daily living (ADL) were almost 50% higher for women than for men. Among the women, 22.5% were found to have an ADL disability (in activities such as eating and washing), compared to 15.4% of men. Among women, 45% were found to have IADL disability (Instrumental Activities of Daily Living), which involves activities necessary for household management. The study found that poverty and loneliness, conditions known to adversely affect health, are more prevalent among elderly women than elderly men. Women suffered more from poverty: 46% reported that their minimum social security benefits were their only source of support, compared to 27% of the men. They also suffered more from loneliness: a much higher percentage of elderly men were married (73%), compared to elderly women (23%), and a much higher percentage of women lived alone (58%), compared to men (20%). In a 1997/98 study of men and women over 60, 23% of the women, compared to 11% of the men, reported often feeling lonely.

Reproductive Health  Fertility: Israeli women have higher fertility rates than women in most developed countries. In 2001, the overall fertility rate for all women was 2.9, with Moslem women the highest (4.7), Christian women the lowest (2.5), and the rate for Jewish women was 2.6. Over the last 40 years, all population groups have experienced a decline in fertility. During this period, the fertility rate dropped from 3.9 to 2.9. The most significant decline was among Moslem women, who had a fertility rate of 9.2 in the early 1960's.  Age at marriage: Over the last 20 years, there has been a moderate increase in the average age at marriage for women. Among Jewish women, the average age at marriage rose from 24 in 1980 to 26 in 2000. For Moslem women, the average marriage age rose from 20.5 to 22 during the same period.  Use of contraception: Contraception is not included in the basic basket of services stipulated by the National Health Insurance Law. In a recent survey, 50% of women aged 25-44 reported that they do not use contraceptives. The most commonly used contraception methods are the pill, used by 26% of the women, and intra-uterine devices, used by 18% of the women. As expected, the more religious the women are, the less likely they are to use contraception. The higher the level of the women’s income, the more likely they are to use contraception. Safe sex is not yet widely practiced: only 7% of the women reported that they have their partners use condoms. Among the women who reported that they have casual sex, only about a quarter (27%) reported that they always have their partners use condoms, while 52% reported that they never protect themselves with a condom.  Abortions: Israeli law allows for legal abortions under certain circumstances. Consideration is given to a broad range of factors, including the woman's age and marital status, the circumstances of the pregnancy, the health of the fetus, and the woman's physical and emotional health. Abortions must be performed by a gynecologist in a certified hospital. In 2001, about 20,000 legal abortions were performed, more than half for women who became pregnant outside of marriage. There is no data available on the extent of private (illegal) abortions performed.

Health Behaviors  Smoking: According to a 2002 national survey of men and women over 18, 18% of women and 32% of men were smokers. The prevalence of smoking among women in Israel is somewhat lower than the prevalence in the United States, where an estimated 23% of the women are smokers. Smoking rates among Arab women are significantly lower that among Jewish women: 7% of the Arab women smoke, compared to 21% of the Jewish women. A 2000/01 survey found that the prevalence of smoking among Arab women is positively correlated to education: only 6% of the women who have a low level of education smoke, compared to 28% of those with a higher education. At a time when a greater number of Arab women are seeking higher education, this is a worrisome trend. Since the mid 1970's, smoking has declined among both men and women. However, recent studies show that since 1993 there has been an increased prevalence of smoking among 18-20 year-old Jewish women serving in the military. In 2002, 30% of female new recruits smoked. And by the conclusion of their military service at age 20, 38% of the discharged women soldiers were smokers.  Physical activity: According to a 1999/2000 survey, 20% of women aged 25-64 reported exercising at least 3 times a week, with the highest proportion in the 55-64 age group. Rates of physical activity were considerably higher among Jewish women (24%) than among Arab women (8%).  Obesity: In the above mentioned survey, measured obesity was found in about a quarter (26%) of the women. Twenty-two percent of Jewish women and 41% of Arab women were obese. Data for all age groups found Arab women to be more obese than Jewish women, with the rate more than double in the 35-44 age group. The highest rates of obesity were in the 55-64 age group, in which 36% of Jewish women and 70% of Arab women were obese.

Health Risk Behaviors of Adolescent Girls Health behaviors acquired at a young age can have an impact on health throughout life. In a 1998 international study of students in grades 6 to 10 (in Israel and 27 European and North American countries), adolescent girls and boys were asked to report on health risk behaviors. The study highlighted the high levels of dieting and physical inactivity and the low rates of smoking and alcohol consumption among Israeli girls compared to girls in other countries and to Israeli boys.  Eating habits and dieting: More than a quarter of the girls (27%), and 11% of the boys, reported dieting for weight reduction. Israeli girls and boys ranked first among participating countries in dieting. About 4% of the Jewish girls had used laxatives or vomited in order to reduce weight, and 2% had used diet pills.  Lack of physical activity: 24% of the girls reported that they did not participate in regular physical activity, compared to 11% of the boys. The lack of physical activity was especially pronounced among Arab girls, 36% of whom are inactive, compared to 21% of Jewish girls. Compared to adolescents in other countries, Israeli girls ranked sixth in inactivity and Israeli boys ranked eleventh.  Smoking: In all age groups, girls smoke less than boys. Overall, 6% of the girls reported smoking at least once a week, compared to 13% of the boys. Compared to 1994, there was a steep rise in smoking rates among Jewish girls (from 4% to 7%) as well as among Jewish boys (from 6% to 12%). As expected, smoking rates rise with age: 3% of the girls and 8% of the boys in sixth grade smoke at least once a week; by the time they reach the tenth grade, 13% of the girls and 25% of the boys smoke at least once a week. The rate of smoking among the Jewish tenth grade girls (15%) was double that of Arab girls. The international comparison ranked the overall smoking rates of Israeli girls in 1998 as relatively low (24), and that of Israeli boys as relatively high (9).  Alcohol consumption: 19% of the girls, compared to 35% of the boys, reported that they drink alcohol at least once a month (excluding drinking related to religious ritual). Jews drink more than Arabs, and as expected, alcohol consumption rises with age. Twenty-two percent of the Jewish girls drink alcohol, compared to 10% of the Arab girls. Israeli girls ranked nineteenth in the international comparison, much lower than the boys, who ranked seventh. Regarding heavy drinking, 12% of the girls and 22% of the boys reported becoming drunk at least once. These rates were relatively low, and both Israeli girls and boys were ranked last in the international comparison.

Treatment of Women in the Health System A nationwide survey on women's health and welfare carried out in both Israel and the US in 1998 helped to highlight several areas in which there is a need for improvement in the treatment of Israeli women .  Health education by doctors: The survey found that doctors in Israel do not routinely discuss health promotion issues with their female patients. Only 12% of Israeli women reported that their doctors spoke to them about smoking, compared to 30% of the American women. With regard to nutrition and weight, 28% of Israeli women reported that their doctors discussed these issues with them, in comparison to 45% of American women. Three percent of Israeli women reported that their doctors discussed alcohol use with them, compared to 22% of American women.  Diagnosis of depression: Diagnosis of depression by primary care physicians in Israel is low. Despite the fact that women report high levels of depressive mood (39%) at similar rates in the two countries, only 9% of Israeli women were diagnosed with depression or anxiety compared with 17% of American women.  Identification and referrals for battered women: Although violence against women is increasingly recognized as a significant health risk factor, not enough is being done to identify and refer battered women for help. Only a small proportion (22%) of women who were victims of domestic violence ever talked about it with a doctor or another medical professional, usually at their own initiative. This proportion is slightly lower than in the US, where 29% of domestic violence victims discussed the problem with a doctor. However, of the Israeli women, only 16% were referred to the police and 32% to support services, compared to 23% and 48% respectively of domestic violence victims in the United States. Recently, the Ministry of Health has initiated a program encouraging hospital staff to screen women patients for violence, even if violence was not their reason for admission to the hospital. The Ministry is now working on a directive that will obligate doctors to ask about violence as a routine part of the medical history intake.  Overall rating of physicians: It may be a reflection of these issues that Israeli women rated their doctors lower than American women did on questions related to patient-doctor interaction: the amount of time that the doctor spends with them was rated as low or moderate by 21% of the Israeli women vs. 15% of the American women; the degree to which the doctor answers questions was rated as low or moderate by 17% of Israeli women vs. 9% of American women; and the degree to which the doctors make sure that they understand the problem was rated as low or moderate by 17% of Israeli women and 9% of the American women.

Use of Selected Health Services Since the 1995 National Health Insurance Law went into effect, all Israeli citizens are insured by one of the country's four health funds and receive a basket of services which includes access to primary, secondary and tertiary care, as well as a wide range of medicines.  Physician visits: women visit physicians more than men in all age groups, except newborns through age four. In 2000, women made an annual average of eight visits to physicians, as compared to 6.2 visits for men.  Utilization of mental health services: Available data from public mental health clinics reveal that there are more women patients than men among Israelis over age 45. The difference is most marked in the population over age 65, where women comprised 63% of the patients in the year 2001. By contrast, women make less use of mental institutions than do men. In 1997, the women’s rate of psychiatric hospitalization was 256 per every 100,000 people in the population, 27% lower than for men. However, hospitalization rates for women 65 years and older are 40% higher than for men.  Gynecologists: Jewish women report visiting gynecologists more than Arab women. According to a 1998 survey, nearly half the Jewish women reported visiting a gynecologist during the past year, compared with only 27% of Arab women. A greater percentage of Arab women reported that they had never visited a gynecologist. Another survey showed that over a third of the women would prefer to be treated by a female gynecologist, but only about half of those are actually treated by a woman.  Mammography: In 2001, an estimated 60% of women aged 50-74 had mammography screenings, compared to 34% in 1995. The rate of mammography screenings among Arab women is lower than the rate among Jews (the rate among Jewish women is 65%), but the rates have risen dramatically from 18% in 1995 to 49% in 2001. The rate of mammography screenings among immigrants from the former Soviet Union has also improved significantly – from 15% in 1995 to 48% in 2001.  Cervical cancer screening: Due to a relatively low rate of cervical cancer in Israel, cervical cancer screening is not routinely recommended to women and is not included in the basket of services stipulated by the National Health Insurance Law. Even so, the percentage of women who have pap smear tests has increased from approximately 15% in 1995 to 23% in 1998. In women of all age groups, the screening rates are considerably higher among Jews than among Arabs. Overall, the screening rates in Israel are low when compared to the United States and Europe.