Health and Hegemony: Preventive Medicine, Immigrants and the Israeli Melting Pot

In recent decades much historical research has been published on the core role of public health in the formulation of various social practices. Additional research highlights the ongoing process of medicalization of daily life that has been taking place over the past two centuries—a process in which key events in our lives, from birth to death, have become legitimate subjects for discussion by various medical experts: physicians, nurses, psychologists, social workers, dietitians, and others.¹ One of the outstanding areas in which public health personal have played a significant role in the hegemonic machinery of the state is the formulation of policy vis-à-vis absorption of immigrants.² Public health personnel stationed at points of immigration entry (such as at Ellis Island in the United States) have become part of a machinery for supervision and classification of immigrants in which preservation of the health policies within the homelands of the immigrants constitutes the guiding principle underlying their work.

In recent years, questions of health and immigration have been fueled by accelerating globalization processes. The attitude of health systems workers toward immigration have even been the subject of conferences and countless articles.³ The "marking" of the immigrant as an Other by veteran populations—as a source of disease, crime, and social ills that contaminates local societies—is a recurrent theme in various host countries and at various time periods. The issue of immigration and health has amplified questions of prejudices, racial discrimination, and equality in access to health services. The State of Israel constitutes a unique case study of immigration and health issues.

Zionist ideology, which championed an "Ingathering of the Exiles," considered Jewish immigration to Israel as one of the most important objectives of the Zionist movement, and later of the State of Israel. The use of the value-loaded term aliyah [to climb], rather than the neutral term in Hebrew applying to immigration anywhere [hagira], is indicative of the different light in which Zionism views immigration to Israel. Yet, over the years, tensions have arisen at times between viewing olim [immigrants] as the most important asset of the nation and seeing them as chomer enoshi [human material]—a term that reflects both fear and suspicion of changes such immigrants might cause within veteran Jewish society.

This article focuses on the period of mass immigration to Israel in the 1950s, using categories of health, illness, and preventive medicine as a yardstick. It is not our objective to survey the entire development of Israeli public health policy in the context of immigration—a vast topic that is only in the early stages of inquiry. Accordingly, following a short overview of health and immigration policy during the first years of the newly established Israeli state, we chose to focus on the vaccination policy vis-à-vis immigrants as an example of the reciprocal relationships between the health system, various health agents, and the immigrants—particularly the immigrant's body as an entity that states want to supervise and define. Although the Israeli vaccination program for immigrants was generally described by its designers as unproblematic and as a necessary step in transforming the immigrants into members of "modern civilization," deeper research reveals that the vaccination policies, indeed, encountered difficulties.

Immigrants who were the target of health education programs were often described as "passive raw material" could be molded by various authorities. Yet, the immigrants possessed a world outlook on health and illness that was not always in keeping with the plans of the absorbing society. Vaccination policies in the ma'abarot [transit camps]⁴ provide a case study for understanding the interaction between the absorbing systems and the immigrants in terms of conflicting perceptions of illness and health. Analysis of the vaccination program and the way it was "marketed" to the immigrants in various frameworks of health education and the response of the immigrants to this are all indicative of...