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The European Public Health Alliance (EPHA) is currently undertaking an evidence-based literature review on the Roma life expectancy gap, based on the following indicators:

  1. Life expectancy gap between Roma and non-Roma
  2. Roma children and infant mortality
  3. Determinants of life expectancy

The poor state of health in Roma communities is prevalent—and largely ignored—across Europe. Some Roma are completely excluded from health care, while most face hostility and discrimination within healthcare settings. Available literature on Roma and health agrees that:

  • Roma people suffer from poorer health and unhealthier living conditions compared to majority populations;
  • better data is needed to explain the Roma health gap and design better interventions to reduce this gap;
  • the poor health of Roma is closely linked to the social determinants of health.

In order to identify the Roma life expectancy gap in the literature, a search was carried out using terms such as life expectancy, mortality, early childhood development, infant mortality and determinants. Both qualitative and quantitative studies were included. English and national language published articles were selected. Reports, surveys, statistics, strategy and discussion papers sources were also consulted. Different databases using a combination of specific terms were also searched.

In total a number of 57 specific information sources were selected and reviewed.

The report will be available at the end of October 2018.

Key findings
  • Overall life expectancy years for the Roma community are estimated to be between 5 and 20 years lower[1]
  • The longevity rate — i.e. the proportion aged 75 and over — was, 25.7 % for the EU-27 Roma population and 51 % for the EU-27 non-Roma population in 2009[2]
  • According to Roma Inclusion Index 2015 the infant mortality rate of Roma in Bulgaria is twice that of total population and the situation has not changed over the last decade. In Bosnia and Herzegovina earlier data show that infant mortality of Roma is 4 (3 for females) times more than others, but recent data is not available to assess any change. In Spain, the infant mortality rate for Roma is almost three times greater than for children from other parts of the country.
  • According to EU MIDIS II,[3] 80% of the Roma surveyed and their children live with an income below the respective national at risk-of-poverty threshold. In comparison, on average across the EU, 17% of the population were at risk of poverty in 2014. In Spain (98%), Greece (96%) and Croatia (93%), almost the entire Roma population covered by the survey has incomes below the national income poverty threshold.
  • EU MIDIS II shows that half of Roma between 6 and 24 years of age do not attend school.
  • EPHA’s scoping survey[4] shows that 42.75% answered that there is no kindergarten in the community and out of 630 children (0-6 years old), almost two thirds of them go to kindergarten while 40.79% do not attend or are missing from kindergarten.
  • In all Member States compiling statistics on Roma employment, unemployment rates of Roma are higher than non-Roma. For instance, in Bulgaria 40% of Roma are unemployed compared to 20% of non-Roma[5]. In Ireland up to 84% of Roma are unemployed[6]. In Lithuania, 57% were unemployed[7]. In Croatia only 14% of Roma is employed, while 49% of non-Roma is employed[8]. In Hungary only 20% of Roma are employed, compared to 55% of non-Roma[9].
  • While many Roma live in households without tap water inside the dwelling, an even higher percentage live in households without a toilet and shower or bathroom inside their homes. This rate ranges from 17% in Portugal to 44% in Bulgaria and 79% in Romania (FRA 2016).
  • A considerable number of Roma report that pollution, grime and other environmental problems – such as smoke, dust and unpleasant smells or polluted water–are a problem, particularly in the Czech Republic and Portugal, where 41% and 36%, respectively indicate this to be an issue.[10] as well as nearly one in every three Roma in Slovakia and Croatia, and for more than every fourth in Hungary, Spain, Bulgaria and Greece. [11]
  • When discussing women aged over 50, Roma women declare themselves to be in significantly worse health than their non-Roma counterparts. in Poland 75% of Roma women stated that they were in ‘bad’ or ‘very bad’ health and in Italy a 58% difference exists between the self-declared health status of Roma and non-Roma women
  • With regard to accessing health care, the results of EPHA’s 2017 scoping survey show that in Romania 67,9 % had experienced negative attitudes in access to health services, mostly based on Roma ethnicity.   According to respondents’ answers, 44.91% of women (wives or female relatives) went to hospital or had seen a doctor for a pregnancy check-up or examination. 26.39% of them talked with a doctor during their pregnancy and 40.12% were visited/supervised by a doctor/nurse/pediatrician or other person in the first month after the baby was born.[12]
  • On the whole, data on immunisation uptake suggests that in general the Roma population is more likely to be below the level required for herd immunity than the non-Roma population.[13]

European Commission (2015) Roma Health Report: Health status of the Roma population. Data collection in the Member States of the European Union https://publications.europa.eu/en/publication-detail/-/publication/61505667-ec87-4a71-ba4f-845a4a510e11/language-en

[2] Fundación Secretariado Gitano et al (2009) Health and The Roma Community, Analysis of the Situation in Europe: Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain

[3] European Union Agency for Fundamental Rights (2016) Second European Union Minorities and Discrimination Survey (EU-MIDIS II) Roma – Selected Findings. http://fra.europa.eu/en/publication/2016/eumidis-ii-roma-selected-findings

[4] European Public Health Alliance (2017) From Rhetoric to Action: Bringing the Voice of Romanian Roma Communities to Europe October 2017. https://epha.org/wp-content/uploads/2017/10/Romania-Roma-Health-and-ECD-EPHA-Recommendations.pdf

[5] UNDP UNDP-WB-European Commission regional Roma survey 2011

[6] Central Statistics Office, Information Section, Profile Central Statistics Office, Information Section (2011) Profile 7: Religion, Ethnicity and Irish Travellers

[7] UNDP UNDP-WB-European Commission regional Roma survey 2011

[8] Ibid

[9] Ibid

[10] European Roma Rights Centre (2017) Thirsting for Justice, Europe’s Roma denied access to clean water and sanitation: http://www.errc.org/uploads/upload_en/file/thirsting-for-justice-march-2017.pdf?utm_medium=email&utm_campaign=Thirsting+for+Justice%253A+New+Report+Reveals+…&utm_source=YMLP&utm_term

[11] European Union Agency for Fundamental Rights (2016) Second European Union Minorities and Discrimination Survey (EU-MIDIS II) Roma – Selected Findings. http://fra.europa.eu/en/publication/2016/eumidis-ii-roma-selected-findings

[12] European Public Health Alliance (2017) From Rhetoric to Action: Bringing the Voice of Romanian Roma Communities to Europe October 2017. https://epha.org/wp-content/uploads/2017/10/Romania-Roma-Health-and-ECD-EPHA-Recommendations.pdf

[13] http://ec.europa.eu/justice/discrimination/files/roma_health_en.pdf

Conclusions

Available data consistently show higher rates of illness and mortality among Roma than in majority populations. Indeed, Roma communities’ health is significantly worse than that of the majority population of any country in which they live. Roma populations have on average a life expectancy between 5-20 years shorter and face highs infant mortality rates, two or three times higher than of the general population. A wide range of socio-economic and environmental determinants of health, including discrimination, poverty, segregation in education, unemployment, isolation and marginalization, differences in the quality of healthcare, vaccination uptake, negatively affect the Roma population, resulting in poor Roma health. 80% of Roma and their children live with an income below the respective national at risk-of-poverty threshold, half of Roma between 6-24 years of age do not attend school and in all EU Member States that collect statistics on Roma employment, unemployment rates of Roma are higher than non-Roma. A considerable number of Roma feel that pollution, and other environmental problems – such as smoke, dust and unpleasant smells or polluted water, especially in segregated and isolated communities have implications for their health. Unfortunately, Roma are caught in a vicious circle that they did not create and did not want. Good health is a precondition for wellbeing and social inclusion.  EU Member States should no longer neglect the health of the Roma population

Marius Tudor

Roma Health Project Manager

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