On the 4th of September 2014 the European Commission published a report on the state of health of Roma populations in Europe which points out that discrimination towards Roma has direct consequences on their accession to housing, health care and education. The outcome of the report is that Roma manifest some worrying characteristics when it comes to health, such as shorter life expectancy, higher rates of infant mortality and higher risks of infectious diseases than the non-Roma people.
Data were collected in the 28 EU countries plus Norway, Liechtenstein and Switzerland by Matrix Knowledge in collaboration with the Centre for the Study of Democracy, the European Public Health Alliance and individual national researchers on behalf of the Consumers, Health and Food Executive Agency (Chafea) and DG SANCO. The main obstacles to this huge research, which covers the period 2008-2013, were the non-homogeneity of Roma populations and the insufficient data at the national level on their health situation. Notwithstanding the obstacles, common patterns among Member States and among different Roma groups emerged. Unfortunately they disclose a worrisome picture which asks for a more integrated approach among Member States in order to deal with this problem.
The life expectancy of Roma is 10 to 20 years less than the rest of the population. In Croatia the difference is around 10 years (66,6 years compared to 77), in Hungary is also 10 years less for men but around 18 years less for women. In Belgium, the Brussels municipal Social Services estimate that Roma have a life expectancy of 55 years and their health is even poorer than that of refugees. Roma populations also present higher rates of infant mortality observed in Bulgaria, Slovakia, Hungary and Czech Republic. In addition, they are also more vulnerable to outbreaks of measles and hepatitis A, B and C. The 2009 outbreak of measles occurred in Bulgaria concerned primarily Roma, since the 89,3 of the infected people were of Roma origin.
All these problems derive from difficulties they face in accessing health care systems in the Member States. The existing barriers are of several nature and they all need to be addressed in an efficient way.
One problem is administrative in nature and regards the lack of registration of these people in national population registers, which prevents them to have access to primary care services in many States. This is aggravated by social exclusion and lack of health care education of Roma. In many cases they are not aware of the possibilities available or they simply do not understand the information given. Linguistic and literacy barriers play an important role in the reduced use of the available services. Therefore States need to address these issues by providing interprets for appointments and simply written and translated material regarding health problems.
What contributes to the existing situation is also a discriminating attitude of the health care professionals combined with a lack of trust by Roma towards them. There is also a cultural element which plays against prevention. The report discovered a high level of use of acute hospital services, but very little use of preventive care, such as vaccination, adopting of healthy diet or doing physical activity. A first solution to this would be that of using health mediation programmes and providing training for health care professionals and reading material on Roma culture and, in particular, on relations between men and women inside this culture.
A special attention regarding gender issues is necessary since the report pointed out the severe condition of Roma women who are more disadvantaged than Roma men and other women because of traditional gender roles. They receive a more limited education than men, which leads to even less employment opportunities, and experiment physical and social isolation and poorer living conditions if compared to Roma men. All these factors lead to maternal health risks such as early and late pregnancies and poor access to antenatal care. They are also subjected to higher risk of domestic violence and mental health risks due to the subordinate role in Roma communities.
What can be done?
In the end, the report calls both for a coordination among Member States, and also for tailored responses to the particular needs of each Roma group, or population, present on the territory of every State.
The EU has made considerable efforts to better Roma populations’ conditions. Among those we remember the organization, in 2008, of European Roma Summit on Roma Inclusion with the aim of discussing these issues at the highest decision-making levels, including national and regional authorities and involving civil society. This Summit was followed by the creation of the European Platform for Roma Inclusion. In 2011 the European Commission adopted the EU Framework for National Roma Integration Strategies (NRIS) up to 2020. Member States were asked to prepare NRIS in order to deal with the challenges of Roma integration. Again, in 2013, the Commission made a proposal for a Council Recommendation on effective Roma integration measures in Member states with the aim of improving the effectiveness of their measures to achieve Roma integration and to coordinate the NRIS. Also the European Parliament deals with Roma issues, in particular LIBE Commission is responsible for EU strategy on Roma inclusion. In addition there are some EU agencies, such as European Union Agency for Fundamental Rights and CHAFEA which are working on the same issues.
The point is that all the instruments adopted at EU level are non-binding, so it is up to Member States to implement these recommendations. The idea is that national governments should make efforts in order to improve the literacy and skills of Roma people and combat the discrimination they are exposed to through campaigns which bring together civil society and Roma populations. The critiques made to the Member States were that of lack of political will for real commitment in this field, manifested by the retards in using the available European funds allocated to Roma inclusion.
(Ana Daniela Sanda)
To know more:
Roma Health Report: Health status of the Roma population. Data collection in the Member States of the European Union: http://ec.europa.eu/health/social_determinants/docs/2014_roma_health_report_en.pdf
The situation of Roma women: FRA data analysis: http://fra.europa.eu/en/news/2013/situation-roma-women-fra-data-analysis
Report on the implementation of the EU framework for National Roma Integration Strategies: http://ec.europa.eu/justice/discrimination/files/roma_implement_strategies2014_en.pdf