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

This article examines the tension between an ethos of medical neutrality and the recognition of difference in the treatment of Arab patients in a Jerusalem emergency department (ED). Through interviews with mostly Jewish medical staff, the authors found that they operated with an ethos of neutrality in which they were expected to provide equal treatment regardless of patients' national identity or ethnic and religious backgrounds. However, the staff recognized the influence of political conflict and the differing health status of Arab patients, but were more likely to understand these differences through depoliticized concepts of cultural and behavioral difference. The authors suggest that the normative demand for neutrality works to exclude discussion of the Israeli-Palestinian conflict from clinical spaces, and that the normative exclusion of politics is an important aspect of how political conflict operates as a structural determinant of health and healthcare.The study found that participants supported the ethos of neutrality as a humanitarian approach to care, while also recognizing its limits in the context of the Israeli-Palestinian conflict. However, they were more likely to understand the influence of political conflict through depoliticized concepts of cultural and behavioral difference rather than addressing it directly. This suggests that the normative demand for neutrality can operate to exclude discussion of the political conflict from clinical spaces, which can have important implications for how healthcare is delivered in these contexts.The authors argue that a structural competency framework, which is relatively new and underutilized in Israel, could be effective in challenging the "depoliticization as artificial deconflictualization" [11]. Healthcare professionals, especially in the ED, should be trained in structural competency to better understand the fundamental influences on patients' health. This training will allow them to move beyond understanding social determinants of health, such as poverty, and comprehend the underlying structures that create and perpetuate these inequalities.The study highlights the importance of addressing the political determinants of health in clinical spaces, particularly in contexts of ongoing conflict. By recognizing the structural factors that contribute to health disparities, healthcare professionals can work towards promoting solidarity, social justice, and health equity [2, 21, 72]. The authors suggest that ED staff can engage in promoting varying structural-political solutions, according to their diverse perspectives, values, and beliefs. These solutions can vary from the individual patient level to the policy change level [53].Overall, the study highlights the complex interplay between medical neutrality and political conflict in healthcare delivery. By recognizing the structural determinants of health and promoting a more nuanced understanding of the factors that influence patients' health, healthcare professionals can work towards addressing these inequalities and promoting better health outcomes for all patients.