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Guest article by Feras Kasabji ​[1]  and János Sándor [1,2] 

[1] Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen

[2] ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen

While Europe is furthering its work on the European Health Data Space, it is important to keep in mind the needs of people in vulnerable situations. Health equity data can help clear up many unclarities when designing social inclusion policy on the national level. Take the example of Hungary’s Roma people; the health status of Roma in Hungary is well behind the national average, which is backed up by research [1,2]. However, the extent of the problem is difficult to fully understand because of a lack of Roma-specific indicators in routine health monitoring. Without this kind of data, it is challenging to address the stark health disparities faced by Roma with targeted interventions. A significant portion of Roma live in segregated clusters (SC) [3] which are parts of settlements where lower levels of education and poor income can be observed. This is reflected in poorer health status in Hungarian statistics overall [4].

The Hungarian National Health Insurance Fund (NHIF) and the Department of Public Health and Epidemiology (University of Debrecen) have collaborated to develop a unique method that utilises available data (i.e. without primary data collection) to produce health indicators for individuals residing in segregated clusters. It was named HOGIS, the Hungarian Online GIS (Geographic Information System). By linking the geographical definition of SCs to the NHIF database, which covers the entire country, we were able to compute indicators for SCs without violating personal rights. These aggregated measures help transform and solve legal problems using IT processes. The project’s protocol was approved by the Research Ethics Committee of the Medical Research Council of Hungary, the Office of the Commissioner for Fundamental Rights, the General Director of NHIF, and the Hungarian National Authority for Data Protection and Freedom of Information Moreover, the SC specific indicators were adjusted for demographic structure, socio-economic status, and geographical location.

The Lechner Knowledge Center (Lechner Tudásközpont), in connection with the National Social Inclusion Strategy, developed the GIS application that provides a country-wide geographical demonstration of the SCs, providing an overview based on settlement, street and house number. The project processed data from 2011, 2019, and 2020 and evaluated the SCs individually, as well as individual settlements, districts, counties, regions, general medical practices, and the entire country overall.

185 health indicators were mapped and tabulated for each territorial unit, ranging from individual settlements and general medical practices to counties, and the entire country, using an online GIS service (estat.unideb.hu). The inequality indicators were calculated for and compared to indicators of people living in non-segregated areas of the same geographical unit (CA, complementary area). This project provides a country-wide demonstration of local inequalities in healthcare use in segregated communities. It is a significant step forward in identifying and addressing health disparities for individuals residing in SCs in Hungary.

The integration of the HOGIS methodology in the EHDS would allow for the analysis and visualisation of health as special data. This would create a possibility for the mapping and monitoring of health outcomes across disadvantaged European regions or population groups living in segregation, greatly improving their health status.

Additionally, incorporating more advanced techniques into the HOGIS-EHDS framework, such as the development of predictive models (e.g. machine learning on spatial data), can identify at-risk areas or populations more accurately in terms of health conditions, enabling targeted interventions. Moreover, since the legal base of protecting personal rights in Hungary does not differ from the European legal structure, this special approach could help researchers and policymakers by enhancing interpretability.

Overall, the collaboration between HOGIS and the EHDS could help create a more comprehensive and targeted approach to healthcare planning, with emphasis on the social and environmental determinants of health. If the EHDS would develop in this way, it could provide the foundation for inclusive health policy unlike what has been seen before.

Note: This study was carried out in the framework of the “Routine monitoring for the health status and health care use in the Hungarian segregated colonies” program supported by the Deputy State Secretariat for Social Inclusion, Ministry of Interior.

1. Kósa Z, Széles G, Kardos L, et al. A comparative health survey of the inhabitants of Roma settlements in Hungary.
2. Vincze F, Földvári A, Pálinkás A, et al. Prevalence of Chronic Diseases and Activity-Limiting Disability among Roma and Non-Roma People
3. Kósa K, Daragó L, Adány R. Environmental survey of segregated habitats of Roma in Hungary: a way to be empowering and reliable in minority research
4. OECD. Hungary: Country Profile 2019