ABSTRACTObjective. To determine the social class gradient in health in general Spain population and the health status of the Spanish Roma.Design. The National Health Survey of Spanish Roma 2006 (sample size = 993 people; average age: 33.6 years; 53.1% women) and the National Health Surveys for Spain 2003 (sample size: 21,650 people; average age: 45.5 years; 51.2% women) and 2006 (sample size: 29,478 people; average age: 46 years; 50.7% women) are compared. Several indicators were chosen: self-perceived health, activity limitation, chronic diseases, hearing and sight problems, caries, and obesity. Analysis was based on age-standardised rates and logistic regression models.Results. According to most indicators, Roma's health is worse than that of social class IV–V (manual workers). Some indicators show a remarkable difference between Roma and social class IV–V: experiencing three or more health problems, sight problems, and caries, in both sexes, and hearing problems and obesity, in women.Conclusion. Roma people are placed on an extreme position on the social gradient in health, a situation of extreme health inequality.