Roma Health Research Articles

An examination of Roma health insurance status in Central and Eastern Europe

Roma in Central and Eastern Europe (CEE) face problems in accessing health care, and a lack of access to statutory health insurance schemes is a key factor. This study seeks to quantify differences in health insurance coverage between Roma and non-Roma and assess whether variations can be explained by socio-economic factors. Secondary household survey data collected in 12 CEE countries in 2011 were analysed. A univariate analysis assessed the effect of Roma status on insurance coverage by country. Multivariate analyses were used to progressively adjust for socio-demographic factors, employment status and income. Country-specific literature was drawn on to examine the context of the findings. Lack of insurance coverage for Roma populations varied considerably between countries, from 2.8% without insurance in Slovakia to 67.7% in Albania. Roma were significantly less likely to have health insurance than non-Roma in all countries except Slovakia and Serbia. The greatest differences in Roma and non-Roma insurance coverage were in Montenegro, Bosnia and Herzegovina, Croatia, Bulgaria and Romania. When adjusting for employment status and income, the gap between Roma and non-Roma remained significant in Montenegro, Croatia, Bosnia and Herzegovina, Bulgaria, Romania and Moldova. Roma are significantly less likely to have insurance coverage in most CEE countries, and this gap remains when adjusting for socio-economic differences between Roma and non-Roma in many countries. Much needs to be done to address the known barriers that Roma face in accessing insurance coverage, such as tackling problems related to documentation and the receipt of social benefits.

Primary care and Roma health

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003–2012

To conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012. Systematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria. We found evidence for lower self-reported health and significantly higher mortality risk for Roma compared to non-Roma, and greater prevalence of health risk factors for Roma children, including environmental risks, low birth weight, and lower vaccination coverage. Studies of non-communicable and infectious disease remain insufficient to make firm conclusions on disparities. Barriers to care include lack of documentation and affordability of care, though more studies on health care utilization are needed. Roma youth and adults are in need of programs that reduce health disparities and their increased mortality risk. Reducing exposure to risk factors such as smoking, obesity, and poor living conditions may be a target for interventions. More intervention studies and rigorous evaluations are needed.

Towards a legal duty to produce disaggregated data on Roma health in Romania

Towards a legal duty to produce disaggregated data on Roma health in Romania

A.3. Round Table: Bridging the gap between policy and practice in Roma health: from common European goals to local achievements

A.3. Round Table: Bridging the gap between policy and practice in Roma health: from common European goals to local achievements

A.3. Round Table: Bridging the gap between policy and practice in Roma health: from common European goals to local achievements<subtitle>Organized by: Open Society Foundations, Public Health Program</subtitle>

A.3. Round Table: Bridging the gap between policy and practice in Roma health: from common European goals to local achievements<subtitle>Organized by: Open Society Foundations, Public Health Program</subtitle>

Roma health rights in Macedonia, Romania and Serbia: a baseline for legal advocacy

Issue Despite a range of international, regional, and national frameworks protecting their health and human rights, Roma report a shocking array of abuses in healthcare, ranging from denial of services to segregation. For Roma who manage to access services, the health system remains a place of stigmatization and discrimination. There is, however, increasing recognition of these systematic violations. Essential to building on this momentum is the ability of Roma NGOs to conduct effective legal advocacy to …

Evaluation of Roma Health Scholarship Program mentoring component in Serbia – promising results

Evaluation of Roma Health Scholarship Program mentoring component in Serbia – promising results

Increasing responsibility of future healthcare professionals for vulnerable patients: an innovative and unique initiative from Romania

Background Starting with 2010, with the help of the Open Society Foundations’ Roma Health Project, the Association for Development and Social Inclusion from Romania (ADIS) has created and introduced into the curricula of four Romanian medical universities (state universities of Iasi, Targu Mures, Cluj Napoca and Bucharest) a university course on “Ethics and non-discrimination of vulnerable groups in the health system”. The course focuses on the Roma …

Empowered Leaders and Alone in Community: Stories of Romanian Roma Health Mediators

This article investigates the experiences of Roma women who work as health mediators to build bridges between Romani patients and the public health system. Given the precarious socioeconomic conditions, overt discrimination, policy changes, and rights advocacy that mark these women's lives—and at the same time the near invisibility of Roma women in scholarship—this study offers women's stories as communicative practices of telling oneself. The mediators narrate stories of successes and challenges in their profession, of discrimination, of empowerment, and of identity shifts toward hybridity and contextual alliances. This study suggests that although a sense of entitlement makes sense in the context of much responsibility on the Romni's shoulders, speaking for their own ethnicity may become problematic and is accompanied by feelings of loneliness.

Assessing Legal Advocacy to Advance Roma Health in Macedonia, Romania, and Serbia

Across Europe, Roma suffer extreme marginalisation, negatively impacting their health. Many cannot access healthcare at all. For others, the health system is a hostile place. At the same time, good legal frameworks are in place to protect health rights, and there is increasing recognition of systemic violations experienced by Roma. Essential to building on this momentum and closing the gap between standards and implementation is Roma ability to conduct legal advocacy Since 2010, the Open Society Foundations has supported Roma engagement in Macedonia, Romania and Serbia in the following advocacy strategies: i) legal empowerment, ii) documentation and advocacy, iii) media advocacy, and iv) strategic litigation. This article presents a framework developed to evaluate the effectiveness of these efforts and a baseline against which outcomes can be measured in a few years. The evaluation framework provides a qualitative assessment of Roma capacity, accountability for violations, changes in law and practice, and impact on communities. Findings reveal that that presently Roma lack knowledge of their rights and rarely challenge violations. Accountability in healthcare is practically non-existent. However, where legal advocacy has been used, violations decrease, and power dynamics shift. As healthcare becomes more responsive to communities, it also better serves non-Roma citizens.

Risk factors for low vaccination coverage among Roma children in disadvantaged settlements in Belgrade, Serbia

BackgroundFull vaccination coverage for children under 59 months of age in Serbia is over 90%. This study assesses vaccination coverage and examines its association with birth registration among Roma children who resided in disadvantaged settlements in Belgrade, Serbia. MethodsThe First Roma Health and Nutrition Survey in Belgrade settlements, 2009, was conducted among households of 468 Roma children between the ages of 6–59 months. The 2005 WHO Immunization Coverage Cluster Survey sampling methodology was employed. Vaccinations were recorded using children's vaccination cards and through verification steps carried out in the Primary Health Care Centers. For those who had health records the information on vaccination was recorded. ResultsAbout 88% of children had vaccination cards. The mean rate of age appropriate full immunization was 16% for OPV and DTP and 14.3% for MMR. Multivariate analyses indicated that children whose births were registered with the civil authorities were more likely to have their vaccination cards [OR=6.1, CI (2.5, 15.0)] and to have their full, age appropriate, series vaccinations for DTP, OPV, MMR and HepB [OR=3.8, CI (1.5, 10.0), OR=3.2, CI (1.5, 6.6), OR=4.8, CI (1.1, 21.0), OR=5.4, CI (1.4, 21.6), respectively]. ConclusionsThe immunization coverage among Roma children in settlements is far below the WHO/UNICEF MDG4 target in achieving prevention and control of vaccine preventable diseases. It demonstrates the need to include “invisible” populations into the health systems in continuous, integrated, comprehensive, accessible and sensitive modes.

Roma and Irish Traveller housing and health – a public health concern

Roma and Irish Traveller communities have endured centuries of persecution and enforced assimilation, whilst remaining under-represented within dominant sedentarist discourses. This has contributed to their suspicion and mistrust of mainstream societies. They have maintained a distinct identity characterised by their Romani or Celtic languages, communal solidarity, close extended family bonds, and cultural traditions surrounding health, morality and social codes. The lives of such groups are grounded in multifaceted poverty stemming from health disparity, inadequate housing provision, and low educational attainment within an inter-generational cycle of social exclusion. This paper discusses health disparities as interlinked with housing situations. It is grounded in the authors’ respective Irish and UK contributions to an EU-wide comparative housing report, ‘Housing Conditions of Roma and Travellers in the European Union’, and associated research materials (commissioned by the European Union Agency for Fundamental Rights (FRA) in 2009). An inclusive and consultative approach is of paramount importance for these groups to address housing and health care provision, grounded within a culturally sensitive assessment of ethnic, individual, and familial needs.

European Public Health News * President's column * EUPHA office--Active ageing and rejuvenating * Message from the Regional Director--'Scaling up activities for Roma health' * Evaluation and follow-up of the response to pandemic influenza A (H1N1) 2009 by the European Commission * Obituary Barbara Starfield * European Public Health Conference

In this last European public health news of 2011, we inform you on the quality of health care in the century of the patient (President's column), EUPHA's active ageing and rejuvenating (office), WHO/EURO's scaling up activities for Roma Health and the EU evaluation of the flu pandemic in 2009. We have also included an obituary for Barbara Stanfield and of course, we are updating you on the 2012 EPH conference (Malta 2012). # President's column {#article-title-2} While no policy-maker or health professional would ever refrain from confirming their support to initiatives aimed to ensure and increase quality in health care, a shared definition of what we actually mean by quality does not exist. Different European countries and, within them, different institutions and interventions confer on this word a variety of meanings, which need to be carefully taken into account as we consider what quality assurance policies are currently adopted. The most widely accepted definition of ‘quality’ is the one given by the Institute of Medicine in the USA in 1990, which reads as follows: ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’) (IOM, 1990). It is remarkable that this definition mentions both individuals and populations as the addressees of health services, and, above all, that their ‘desires’ are mentioned, which reflect acknowledgement of the central role played by the values and the expectations of those interested and involved in the performance of the health system. While this definition is carefully designed, attempts to implement and pursue the notion of quality in practice require it to be broken down into components more liable to be referred to visible actors and activities—the so-called dimensions of quality. Quality is variably considered to include effectiveness , the ability of a certain care …

Research on Roma health and access to healthcare: state of the art and future challenges

Health inequalities experienced by Roma people living in Europe presents a persisting challenge for health research and practice. Available literature on Roma and health agrees that: (1) Roma people suffer from poorer health and unhealthier living conditions compared to majority populations, (2) better data are needed to explain the Roma health gap and design better interventions to reduce this gap and (3) the poor health of Roma is closely linked to the social determinants of health. This editorial discusses the lessons to be learnt from recent research findings and outlines a number of challenges in exploring and addressing the various mechanisms that contribute to the health gap between Roma and majority populations.

Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary?

Background:Several models have been proposed to explain the association between ethnicity and health. It was investigated whether the association between Roma ethnicity and health is fully mediated by socioeconomic status...

Health of Roma children in Vilnius and Ventspils

According to the literature data, Roma health and living conditions in Central and Eastern Europe are poorer than of the rest of population. However, the more detailed information about Roma health is lacking. The aim of the study was to evaluate morbidity, health self-assessment, and prevalence of addictions among Roma children in Vilnius and Ventspils and to compare with health indicators of non-Roma children. Participants and methods. A descriptive epidemiological study was carried out, anonymously questioning all volunteer Roma children – 59 in Vilnius (Lithuania) and 31 in Ventspils (Latvia) schools. Results were compared with identical study, carried out in five Vilnius schools (reference group, 640). Results. The appliance rate of Roma children to doctor did not differ from reference group – half of all questioned children visited doctor 1–3 times during the last year. However, more Roma children (74.6% from Vilnius and 64.6% from Ventspils) considered their health as poor and very poor as compared to reference group (4.3%). The proportion of children indicating somatic symptoms often and very often did not differ statistically significantly among groups with exception of vomiting and nausea, which was most prevalent among Vilnius Roma and Ventspils Roma. The proportion of children indicating emotional symptoms often and very often differed significantly in all groups and was the biggest in Ventspils Roma group. The proportion of daily alcohol, drug users, and smokers was higher in Vilnius Roma and Ventspils Roma groups, although the differences among all three groups were not statistically significant. Conclusion. Although the morbidity of Vilnius Roma and Ventspils Roma groups did not differ from reference group, essential discrepancy was found in health self-assessment – more Roma children considered their health as poor and very poor.

Rural generalist nurses’ perceptions of the effectiveness of their therapeutic interventions for patients with mental illness

To explore generalist nurses' perceptions of their efficacy in caring for mentally ill clients in rural and remote settings, and their educational needs in the area of mental health care. A self-administered questionnaire adapted from the Mental Health Problems Perception Questionnaire; a Likert scale used to rate the perceptions of nursing staff of their own ability to adequately treat and care for patients experiencing mental illness. The Roma and Charleville Health Service Districts, Queensland, Australia. Nurses (Registered Nurses, Assistants in Nursing and Enrolled Nurses) in the Roma and Charleville health service districts (n = 163). Generalist nurses' perceptions regarding their therapeutic commitment, role competency and role support. Seventy per cent of respondents indicated that limited knowledge of mental health problems was an issue preventing nursing staff in rural and remote settings from providing optimum care to patients with mental illness. Twenty-nine per cent of respondents indicated that they had never received or undertaken training or education in relation to the care, treatment or assessment of patients with mental illness. Rural nurses do not feel competent, nor adequately supported, to deal with patients with mental health problems. In addition, the nurses' education and ongoing training do not adequately prepare them for this sphere.

Roma health issues: a review of the literature and discussion

Objectives. Roma health issues are under-studied from a comprehensive, epidemiological perspective. The Roma peoples (including ‘Travellers’) have been living in and around Central and Eastern Europe for centuries, and may be one of the oldest systematically oppressed minority groups in Europe. This review examines the research literature in regard to the health and epidemiology of this group with the aim of examining the breadth and depth of the literature and reflecting on the primary and applied research needed to address the health needs of Roma groups.Design. Internet, database and ancestral searches were conducted via such electronic databases as Medline and PubMed. Ancestral searches involved consulting previous literature reviews in select topical areas and obtaining all appropriate, primary literature. The time parameters of the search began with the year 1990 to current but was later expanded to 1985–2003 in order to capture slightly older published work.Results. This paper describes what is known concerning Roma health via a review of the published studies, with special emphasis on population health and epidemiological studies. One hundred and twenty-nine articles are reviewed and discussed. The majority of research (50%) examines the genetic characteristics of this group.Conclusions. Surveillance and population health indices for this international minority population is scarce to lacking in the published literature. Concluding comments focus on the unique character of the study population and the need for scientific studies of Roma health issues and the cultural concerns which might affect them.