Neutrality, conflict, and structural determinants of health in a Jerusalem emergency department

Abstract

Background Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict. Methods Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital’s ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory. Results The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics. Conclusions The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.

Predictive Value of PRISMA-7, qSOFA, ESI, and CFS for 28-Day Mortality in Elderly Patients in the Emergency Department

“…However, the misjudgment was more prominent due to the poor specificity of the score and the unclear grading of MEWS. 6 This study explored the value of PRISMA-7, qSOFA, ESI, and CFS and their combination in predicting 28-day mortality risk in elderly patients in the emergency department. It confirmed that the sensitivity and specificity of different assessment systems were significantly different.…”

“… 4 At the same time, the emergency department is also one of the departments with a relatively high incidence of medical disputes, especially among the elderly and dead patients. 5 , 6 Therefore, it is essential to find an effective assessment method or scoring system for the early detection of high-risk elderly emergency patients.…”

Barriers to the Healthcare System Faced by Ultra-Orthodox Religious Disaffiliates

“…In most cases, the classification was similar; in the few instances where the classification differed, a discussion to resolve differences ensued. As described in Orr et al (2023), we subsequently identified connections between the initial categories, refined them, and combined similar categories. We finalized six core categories that comprised the meaningful thematic clusters around which we organized the findings (Corbin and Strauss 2014).…”

“…Cultural competency improves providers’ communication and increases patient satisfaction, compliance, and healthcare access (Betancourt et al 2002; Campinha-Bacote 2002; Schuster, Elroy, and Rosen 2018). In the past decade, the needs and challenges of ultra-Orthodox people in Israel have been increasingly acknowledged in the framework of culturally competent healthcare (Freund, Cohen, and Azaiza 2019; Genut et al 2022; Orr et al 2023). Yet, the needs and challenges of religious disaffiliates have been completely ignored in this framework.…”

“…Hence, we recommend incorporating these issues in future structural competency training. As described in Orr et al (2023:3), structural competency refers to the health practitioners’ trained ability to recognize and address the upstream structural drivers of health, such as laws, public policies, and economic systems, and the ways they affect healthcare and create and perpetuate health disparities (Metzl and Hansen 2014; Neff et al 2020; Orr et al 2022). To date, this emerging conceptual framework, which has become increasingly prevalent in many countries, does not refer to religious disaffiliates, and we suggest adding this subject to structural competency training programs.…”