The relationship between economic status, poverty, and health among Arabs in Israel

Arabs in Israel, comprising about 21% of the population, are recognized as an indigenous minority with full citizenship rights, yet they face persistent structural disadvantages compared to Jewish citizens. These disparities are evident across socioeconomic, educational, employment, and health domains. High poverty rates, particularly among women, children, and the older adults, are aggravated by limited governmental investment in infrastructure, education, and health services. Arab women's labor force participation remains notably low due to systemic barriers. Extensive evidence links socioeconomic status with health outcomes and behaviors. This study examines how sociodemographic factors and health knowledge are associated with economic status, self-rated health, and health behaviors among Arabs in Israel.

This cross-sectional study utilized data from the 2015-2016 Health and Environment Survey among Arabs in Israel (HESPI). Employing a three-stage stratified cluster sampling of over 2,000 households, face-to-face interviews gathered socio-demographic, economic, and health-related data. The final sample included 2,041 adults representing diverse socioeconomic and geographic groups within Arab communities.

Approximately half of participants lived below the poverty line (51.7%). Those with lower economic status exhibited poorer self-rated health (p<.001, d = 0.22), higher prevalence of chronic illness (p=.009, d = 0.13), and lower engagement in physical activity (p<.001, d = 0.29), while smoking and BMI did not significantly differ by economic status. Family size moderated the relationships between economic status and both chronic illness (p<.001, 95%CI = 1.33, 2.19) and SRH (p<.001, 95%CI = -0.33, -0.13), indicating that smaller families are less likely to experience these negative effects of low economic status. Educational attainment slightly moderated the link between economic status and physical activity (p=.016, η2 = 0.003). Regression analyses revealed that gender, age, education, and health knowledge were significantly associated with health outcomes and behaviors (R² = 0.10 to R² = 0.43), with health knowledge mediating several of these associations.

The findings indicate that poverty is associated with poorer health outcomes and behaviors among Arabs in Israel. Smaller family size and higher education may mitigate the negative effects of poverty, and health knowledge plays a mediating role for health outcomes and behaviors. Findings suggest that socioeconomic empowerment and higher education are important in promoting health equity.