Abstract
BackgroundResearch into social root-causes of poor health within segregated Roma communities in Central and Eastern Europe, i.e. research into how, why and by whom high health-endangering settings and exposures are maintained here, is lacking. The aim of this study was to assess the local setup of health-endangering everyday settings and practices over the long-term in one such community. It is the initial part of a larger longitudinal study qualitatively exploring the social root-causes of poor Roma health status through the case of a particular settlement in Slovakia.MethodsThe study, spanning 10 years, comprised four methodologically distinct phases combining ethnography and applied medical-anthropological surveying. The acquired data consisted of field notes on participant observations and records of elicitations focusing on both the setup and the social root-causes of local everyday health-endangering settings and practices. To create the here-presented descriptive summary of the local setup, we performed a qualitative content analysis based on the latest World Health Organization classification of health exposures.ResultsAcross all the examined dimensions – material circumstances, psychosocial factors, health-related behaviours, social cohesion and healthcare utilization – all the settlements’ residents faced a wide range of health-endangering settings and practices. How the residents engaged in some of these exposures and how these exposures affected residents’ health varied according to local social stratifications. Most of the patterns described prevailed over the 10-year period. Some local health-endangering settings and practices were praised by most inhabitants using racialized ethnic terms constructed in contrast or in direct opposition to alleged non-Roma norms and ways.ConclusionsOur summary provides a comprehensive and conveniently structured basis for grounded thinking about the intermediary social determinants of health within segregated Roma communities in Slovakia and beyond. It offers novel clues regarding how certain determinants might vary therein; how they might be contributing to health-deterioration; and how they might be causally inter-linked here. It also suggests racialized ethnically framed social counter-norms might be involved in the maintenance of analogous exposure setups.
Highlights
Research into social root-causes of poor health within segregated Roma communities in Central and Eastern Europe, i.e. research into how, why and by whom high health-endangering settings and exposures are maintained here, is lacking
Design The study comprised four methodologically distinct phases. It combined ethnography [51, 52] with methods used in applied medicalanthropological surveying [53, 54]
Based on the above-described analysis, we report on the local setup of health-endangering settings and practices across the following intermediary social determinants of health, as defined in the World Health Organization (WHO) source [45]: material circumstances, psychosocial factors, health-related behaviours, social cohesion and health-system interactions
Summary
Research into social root-causes of poor health within segregated Roma communities in Central and Eastern Europe, i.e. research into how, why and by whom high health-endangering settings and exposures are maintained here, is lacking. According to conventional social-scientific criteria, summing up of all the involved subgroups under one ethnically framed label “Roma” is problematic [1, 2] Despite their shared common ancient ancestry on the Indian subcontinent [3], Roma subgroups show much greater variability in most tangible aspects, including e.g. their ethnonyms and mother tongues [4, 5], social organizations, customs, mutual relations [1, 6] and genes [3, 7], than subgroups of other ethnically defined European groups (such as the Dutch or the Slovaks). Numerous surveys claim worse self-rated health e.g. [19, 20], demographic projections report higher mortality rates and a shorter life-span e.g. [21], and clinical studies show a significantly greater communicable and non-communicable disease burden across the lifecourse e.g. [22,23,24,25,26,27]
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