Why don\u2019t segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia

Andrej Belak,Jitse P Van Dijk,Andrea Madarasova Geckova,Sijmen A Reijneveld

doi:10.1007/s00038-018-1134-2

Abstract

ObjectivesThe health status of segregated Roma is poor. To understand why segregated Roma engage in health-endangering practices, we explored their nonadherence to clinical and public health recommendations.MethodsWe examined one segregated Roma settlement of 260 inhabitants in Slovakia. To obtain qualitative data on local-level mechanisms supporting Roma nonadherence, we combined ethnography and systematic interviewing over 10 years. We then performed a qualitative content analysis based on sociological and public health theories.ResultsOur explanatory framework summarizes how the nonadherence of local Roma was supported by an interlocked system of seven mechanisms, controlled by and operating through both local Roma and non-Roma. These regard the Roma situation of poverty, segregation and substandard infrastructure; the Roma socialization into their situation; the Roma-perceived value of Roma alternative practices; the exclusionary non-Roma and self-exclusionary Roma ideologies; the discrimination, racism and dysfunctional support towards Roma by non-Roma; and drawbacks in adherence.ConclusionsNon-Roma ideologies, internalized by Roma into a racialized ethnic identity through socialization, and drawbacks in adherence might present powerful, yet neglected, mechanisms supporting segregated Roma nonadherence.

Highlights

The poor health status of segregated Roma represents the steepest and most persistent health inequalities in Central and Eastern Europe (CEE)
Expected associations often do not get confirmed here for all the proxies examined—segregated Roma seem to be doing at least some things differently or to different effects compared to low-socioeconomic position (SEP) segments of the general populations (e.g. Geckova et al 2014; Janevic et al 2012; Kolarcik et al 2009; Voko et al 2009)
We identified seven local-level mechanisms that supported the adopting of pro-nonadherence reasoning by Roma and their nonadherence practices

Summary

Introduction

The poor health status of segregated Roma represents the steepest and most persistent health inequalities in Central and Eastern Europe (CEE). Expected associations often do not get confirmed here for all the proxies examined—segregated Roma seem to be doing at least some things differently or to different effects compared to low-SEP segments of the general populations (e.g. Geckova et al 2014; Janevic et al 2012; Kolarcik et al 2009; Voko et al 2009). Such a situation is common with ethnic health inequalities research in general (Dressler 2005; Smith 2000)

Objectives

Methods

Results

Conclusion