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Reports on the health status of the Roma population in the EU

& data collection in the Member States

David Murray - Head of Public Health, Optimity Matrix, London, UK

Consumer Health and Food Executive Agency - European Commission

Expert Group on Social Determinant of Health & Health Inequalities: 22 October 2014 Luxembourg

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Project scope, concept & structure

Objectives & methods

Indicator findings

Conclusions & recommendations

Presentation overview


• Roma health issues are widely acknowledged

• The project & report considers 2 Roma health

issues:

–Health status (Part 1)

–Health data collection (Part 2)

• Full & executive summary versions of the reports

are available http://ec.europa.eu/health/social_determinants/docs/2014_roma_health_report_en.pdf

• The presentation provides an overview of both

Scope & structure

http://ec.europa.eu/health/social_determinants/docs/2014_roma_health_report_en.pdf

http://ec.europa.eu/health/social_determinants/docs/2014_roma_health_report_en.pdf


Source: WHO Regional Office for Europe (2010). ”How health system can address health inequities linked to migration and ethnicity”.

Copenhagen, WHO Regional Office for Europe. (p.14)

Concept




Indicator findings

Conclusions, recommendations & challenges



• Study objectives: provide the most up-to-date picture about Roma health status and data collection in this area

• Methodology:

o Evidence review of literature on Roma health, covering 2008-2013 o Interviews with experts o Delphi survey with stakeholders and national contact points

• We considered study findings relating to both: – Determinants of health & health status the outcomes of the studies (7 main

indicators (all countries) & 19 granular indicators (11 countries) – Data collection mechanisms & strategies

• 31 countries analysed (EU-28 plus Iceland, Liechtenstein and Norway) on the

basis of 7 indicators. • Focus on 11 countries with large (indigenous and migrant) Roma populations:

Bulgaria, Croatia, the Czech Republic, France, Greece, Italy, Hungary, Romania, Slovakia, Spain, and the United Kingdom.

• Implemented in collaboration with:

– Centre for the Study of Democracy, European Public Health Alliance & individual national researchers



Methods: health indicators




Indicator findings




• Life expectancy data is very limited on a national and regional level. Most data is

based upon estimates. The most widely cited data stems from the Council of

Europe.

• The Roma population is noticeably younger than non-Roma across Europe.

• Roma experience substantially lower (up to 20 years) life expectancy compared

to non-Roma.

• Shorter life expectancy for Roma occurs as a result of the broader environmental

conditions they experience.

• 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 (Bulgaria, the Czech Republic, Hungary, Italy and Slovakia).

Mortality & life expectancy


Mortality & life expectancy

Country Estimated Roma life expectancy compared

to non-Roma Austria Estimated but not quantified Belgium Estimated but not quantified Bulgaria -10 years Croatia -10 years The Czech Republic -5 to -10 years Finland Estimated but not quantified Hungary -9 years Ireland -5 to -10 years Italy -20 years The Netherlands -12 years Poland Estimated but not quantified Romania -12 years Slovakia -5 to -10 years Slovenia Estimated but not quantified

Spain -7 years The United Kingdom -2 to -10 years

Estimates of Roma life expectancy years compared to non-Roma by country


• Barriers to access health care services are closely linked to social exclusion

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.

• Patterns of health care utilisation among Roma differ from the general population.

– higher levels of use of acute hospital services, because of lower levels of

engagement with access to preventive primary care.

• The economic crisis is disproportionately impacting on Roma populations’ access

to health care.

Access to and use of health services and prevention programmes


Access to and use of health services and prevention programmes

Respondents aged 18 and above with medical insurance (%)


• Recent comprehensive data on infectious diseases within Roma communities is not readily available

• Data obtainable are: – often old

– small-scale research

– collected during disease outbreaks.

• Higher rates of infectious diseases or risk of infectious disease outbreaks amongst Roma (including Measles and Hepatitis A)

• Evidence relating to rates of HIV/Aids is more mixed, though some reports find faster disease progression.

• Roma have lower or much lower childhood vaccination rates (exceptions are Croatia, Hungary and Czech Republic)

Prevalence of major infectious disease & immunization uptake

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Prevalence of major infectious disease & immunization uptake

Percentage of Roma measles cases compared with the general population and GDP, by region, 2010, Bulgaria


• Data on health lifestyles and behaviours among Roma populations are limited

• Roma people have poorer health related lifestyles.

• Healthy diet and physical activities to stay healthy are less common in the Roma population.

• Data on smoking from Austria, Croatia, the Czech Republic, Slovakia, Bulgaria, Hungary, Ireland, Portugal and Romania consistently show smoking is more common in the Roma population.

• Evidence on alcohol and illicit drug consumption amongst Roma communities reports conflicting findings.

• Limited interventions for specifically targeting the health behaviours of Roma

(exceptions include drug rehabilitation programmes in Croatia, Finland, Ireland, Latvia and Lithuania).

Healthy lifestyles & behaviours


• European institutions (the FRA and Eurofound) publish the most comprehensive data on environmental and other socio-economic factors.

• The housing situation of Roma worse than the housing situation of non-Roma citizens

• In Germany, Lithuania and Sweden access to social housing and standards were comparable to the general population (Germany, Lithuania, and Sweden).

• Accommodation overcrowding is most severe in Slovakia and Hungary

• Roma usually have a lower level of education than non-Roma.

• Comparatively low educational attendance (Bulgaria, Greece and Romania) and Segregation remain challenges in Estonia and Germany

• Unemployment rates of Roma are higher than those of non-Roma. Particularly in Bulgaria, Croatia, Ireland, Lithuania, and Hungary.

Environmental and socio-economic determinants of health


• Higher rates of chronic disease (i.e. asthma, diabetes, cardiovascular

disease, and hypertension) and the associated disability and limitations

on daily activities.

• Small scale studies highlight dramatically higher and more complex

cases of chronic disease amongst Roma across a range of European

Countries (Germany, Finland, Poland, the UK (migrant Roma), Romania,

Ireland, Italy, Spain and France).

• There is link between higher rates of chronic disease and:

- higher prevalence of risk factors (e.g. diet, exercise, stress),

- poor access to and uptake of primary care

- preventive health programmes among Roma.

Prevalence of major chronic diseases


• Roma women are generally in worse health and more disadvantaged than Roma men and non-Roma alike.

• Expectations to fulfil traditional gender roles:

– limited educational and employment opportunities,

– physical and social isolation and

– poor living conditions

• Maternal health risks (i.e. early and late pregnancies, large families, poor access to and low uptake of antenatal care) and poor outcomes (i.e. miscarriage and still birth) are more common in Roma women.

• Roma women are at higher risk of domestic violence and associated mental health risks.

• A Spanish study reported:

– position of Roma women had improved as a result in part due to lower birth rates, but

– they suffer from obesity, depression, metabolic diseases, and sexual health problems;

– they exercise less

– had lower uptake of breast and cervical cancer screening.

• Mediation Programmes in France is effective to engage with Roma women about health issues

Factors related to the role of women in the Roma community


Scope, concept & structure


Indicator findings




• In line with previous findings, the evidence currently available for the comprehensive indicators included in this project continue to demonstrate that, notwithstanding some variation between countries, Roma populations in Europe generally:

– Suffer greater exposure to wider determinants of ill health (e.g. socio-economic and environmental).

– Live less healthy lifestyles.

– Have poorer access to and lower uptake of primary care and preventive health services.

– Suffer 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.

Overall conclusions


• Public health interventions continue to be required across Europe to improve the

health of Roma.

• Wider determinants of health

– Access to and engagement with educational systems;

– Improvement of employment opportunities;

– Reductions in segregation and marginalisation;

– Improvements in the provision of facilities with improved living conditions.

• Healthy lifestyles and behaviour

– Provision of tailored health information materials;

– Community initiatives to improve health engagement in Roma communities.

• Disease prevention

– Improved information provision and marketing of disease prevention opportunities and services to Roma communities;

– Adequate provision of tailored disease prevention programmes and services acceptable to Roma communities and meeting their particular needs (e.g. mobility and living circumstances).

Recommendations I


• Improving accessibility to high-quality services that are acceptable to Roma communities – Provision of tailored health services that are acceptable to Roma communities

– Adherence to good practice standards (including discrimination) in the provision of health services to Roma by universal health care providers and professionals.

• Knowledge underpinning programmes: – Improving generation of consistent information on the health risks and outcomes

experienced by Roma communities to monitor progress, tailor action and target resources.

– Monitoring and evaluation of interventions to improve Roma health (i.e. European Structural Fund Technical Assistance).

– Translating effective interventions into best practice guidelines for policy-makers and programme mangers

– Primary research into key obstacles in improving Roma health

– Conclu the debate on the collection of data on the base of ethnicity (i.e. poverty mapping)

– Roma population should be compered with non Roma population in the same socio-economic conditions

• Investment and Funding – Investment in Roma health issues should be reviewed through systematic processes

examining the size and needs of Roma communities

Recommendations II


• Meaningfully characterising the diversity of Roma

communities across & within EU countries

• Political commitment – EU, national, & local

• Austerity & legitimacy of investment

• Effective community engagement

• Sensitivity to risks of alienation

• Prejudice & education of health professionals

• Data collection

• Engagement beyond the health sector (i.e. holistic

approach)

Challenges


For questions or comments please contact:

David Murray - Senior Associate: Head of Public Health

[email protected]

Laura Todaro - Consultant

[email protected]

Thanks!

Optimity Matrix

Kemp House, 152-160 City Road

London EC1V 2NP

+44 (0)20 7553 4800

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Annex

Additional findings indicators

This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.

Documents

Reports on the health status of the Roma population in the ...ec.europa.eu/health/sites/health/files/social_determinants/docs/ev... · ... – Centre for the ... other context and