Publications

Health Commissioner Tonio Borg announced at the EPHA Annual Conference on 4 September 2014, that the European Commission has issued a report on the health status of the Roma population in Europe. The report concludes that Roma in Europe suffer a greater exposure to wider risks of ill health, have poorer access to preventive and healthcare services and suffer poorer health outcomes than the general population. The report also highlights that as a result of cutbacks linked to the economic crisis, Roma health status and access to health services is deteriorating further in several areas. In line with the EPHA position on Roma Health, this latest report reinforces the worries of the public health community about the Roma health situation, and that urgent policy actions are needed to tackle the Roma public health emergency.

– Methodology and health indicators

The study covered 31 countries, the EU-28 and EEA Member States, with in-depth country reports for Member States with large Roma populations, such as Bulgaria, Greece, Hungary, Romania, Slovak Republic and the United Kingdom.

In order to cover the health status of Roma, the study examined the following health status indicators:

1. Mortality and life expectancy
2. Prevalence of major infectious diseases
3. Healthy life styles and related behaviours
4. Access and use of health services and prevention programmes
5. Prevalence of major chronic diseases
6. Health factors related to the role of women in the Roma community
7. Environmental and other socio-economic factors.

– Key findings

While the report acknowledges the lack of appropriate data in all examined health indicators, the data available does reveal some important and alarming aspects of Roma health:

1.) Mortality and life expectancy

• Roma experience substantially lower (up to 20 years) life expectancy compared to non-Roma
• Higher rates of infant mortality are reported in some Roma populations (those living in poor housing, with low educational levels and migrant Roma) compared to non-Roma in countries, including Bulgaria, the Czech Republic, Hungary, Italy and Slovakia

2.) Prevalence of major infectious diseases

• Some of the available studies show higher rates of infectious diseases or risk of infectious disease outbreaks amongst Roma (including measles and Hepatitis A), particularly among segregated Roma, compared to the majority population
• There is a lack of data on vaccination uptake in the Roma population
• Available evidence suggests that with some exceptions (Croatia, Hungary, and the Czech Republic) the Roma population, particularly migrant Roma, have lower childhood vaccination rates.

3.) Healthy life styles and related behaviours

• The Roma suffer disproportionately from illnesses that are associated with the social determinants of health
• Available data on diet and physical activity consistently suggest that a healthy diet and physical activities to stay healthy are less common in the Roma population
• Available data on smoking prevalence from Austria, Croatia, the Czech Republic, Slovakia, Bulgaria, Hungary, Ireland, Portugal and Romania consistently shows tha smoking is more common in the Roma population

4.) Access and use of health services and prevention programmes

• Where data is available it provides sufficient evidence that there are numerous barriers to health care across the majority of countries
• Evidence consistently suggests that barriers to access are closely linked to social exclusion factors, and specifically include the following factors:

– Language and literacy barriers
– A lack of knowledge of available health care systems
– Discrimination by health care professionals
– A lack of trust in health professionals
– Physical barriers – mobility and distance
– A lack of identification and/or insurance.

5.) Prevalence of major chronic diseases

• A range of small scale studies highlight dramatically higher and more complex cases of chronic disease amongst Roma across a number of European Countries: Germany, Finland, Poland, the UK (migrant Roma), Romania, Ireland, Italy, Spain and France.

6) Health factors related to the role of women in the Roma community

• Available evidence suggests a range of additional barriers to improved health amongst Roma women, including expectations to fulfil traditional gender roles, limited educational and employment opportunities, physical and social isolation and poor living conditions
• Evidence suggests that Roma women are at a higher risk of domestic violence and associated mental health risks

7.) Environmental and other socio-economic factors.

• The housing situation of Roma families is generally worse than the housing situation of non-Roma citizens, though in a minority of countries some evidence suggested that access to social housing and standards were comparable to the general population (Germany, Lithuania, and Sweden)
• Roma usually have a lower level of education than non-Roma. Comparatively low educational attendance (Bulgaria, Greece and Romania) and segregation remain challenges (Estonia and Germany).

Main conclusions

In line with previous findings, the evidence demonstrates that Roma populations in Europe generally:

• Suffer greater exposure to wider risks of ill health (for socio-economic and environmental reasons)
• Live less healthy lifestyles
• Have poorer access to and lower uptake of primary care and preventive health services
• Suffer from poorer health outcomes, in terms of morbidity from both infectious and chronic diseases and shorter life expectancy

Furthermore, there are some indications that, as a result of the economic crisis and subsequent recessions in European countries, Roma health status and health access is deteriorating further in a number of places as a result of cutbacks.

Underlying reasons are that Roma are more exposed to broader environmental conditions, have lower childhood vaccination rates, are less physically active and have less healthy diets. Furthermore, the Roma culture, including the traditional role of women, has a further negative impact.

The barriers to health access are closely linked to social exclusion factors. Roma often do not speak the language, do not understand the health care system or are not even registered or insured. They also experience discrimination by health care professionals which in turn makes the Roma less trusting of the health care system.

– Study Recommendations

Due to these worrisome findings, the countries featured in the report are urged to take urgent actions as regards:

• Better access to education and employment
• Improvement of living conditions
• Tailored health information materials and
• Tailored disease prevention programmes

Any adopted measures should be adapted to national circumstances as considerable variations exist between the countries.

The study also revealed that comprehensive data on the health status of Roma is lacking. It is crucial that better data be available, so it is recommended that the Commission takes action to start to systematically collect the relevant data in the European Union.

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– Roma Health Report – Health status of the Roma population – Data collection in Member States of the European Union FULL REPORT (pdf)
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– Roma public health emergency

As far as EPHA’s position on Roma health is concerned, this report is yet another alarming sign that we are facing a Roma public health emergency which requires appropriate policy decisions and immediate follow-up actions both at EU and Member States level.

FULL EPHA Position on Roma Health in Europe (pdf)