Roma Health Mediators: A Neocolonial Tool for the Reinforcement of Epistemic Violence?

Scientific articles in medical journals regarding Roma have produced a type of problematic consensus narrative that is reinforced through its formulaic repetition. Roma health mediator (RHM) programs seem to have evolved from and currently be part of this consensus narrative. In this article I examine the potential use of RHMs, even if unintended, as a neocolonial tool for the reinforcement of epistemic violence against Roma, using a critical analysis of four empirical stories from the field. I explore the above hypothesis through critical reflexive anthropology, and postcolonial and intersectional studies, as well as by using elements of the self-ethnographic approach. I argue that the epistemic violence can be seen as resulting from the interplay between the Subject (i.e., health professional or researcher), the Object (i.e., Roma as “Other”), and the practices that result (i.e., discourse or consensus narrative production through the interpretation of the scientific data). I conclude with tools that could help reduce the epistemic violence against Roma within the health sector, suchas cross-disciplinary collaboration, participatory action research (PAR), (self-)reflection, critical theory, and the dialogic creation of scientific knowledge.

Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe

The Roma are Europe’s largest minority. They are also one of its most disadvantaged, with low levels of education and health and high levels of poverty. Research on Roma health often reveals higher burdens of disease in the communities studied. This paper aims to review the literature on communicable diseases among Roma across Eastern and Central Europe. A PubMed search was carried out for communicable diseases among Roma in these parts of Europe, specifically in Romania, Bulgaria, Hungary, Serbia, Slovakia, the Czech Republic and North Macedonia. The papers were then screened for relevance and utility. Nineteen papers were selected for review; most of them from Slovakia. Roma continue to have a higher prevalence of communicable diseases and are at higher risk of infection than the majority populations of the countries they live in. Roma children in particular have a particularly high prevalence of parasitic disease. However, these differences in disease prevalence are not present across all diseases and all populations. For example, when Roma are compared to non-Roma living in close proximity to them, these differences are often no longer significant.

Organizational Change in the Sphere of Health Protection of the Roma Community in Poland Seen From Different Perspective

Purpose: The intent of this study is to get insight into the different views on Roma health in Poland to improve health, access to healthcare and broaden the understanding of the limitations for the Roma inclusion in the mainstream of organizational behaviour of health and well-being institutions. Design/methodology/approach: The lack of institutional success up to date in the conduct of policies supporting the Roma on the path to an even standard of living, including health, suggests seeking new organizational approaches. To find the answers to these questions “What views do the Roma/Roma experts/Polish society have on Roma health?” qualitative research was done: six semi-structured openended interviews were conducted in the Roma community in Ochotnica Górna village in the Carpathian Mountains (across three generations), one structured and two semi-structured open-ended interviews with experts, observations of the living environments of the Roma interviewees and collection of newspaper articles as well as an analysis of different statistical data. Findings: The main insights that were provided by the views of Roma experts are the differences of approaches to health issues between Roma groups in Poland. The main insights that the newspaper articles give into the views of the society on Roma health are that the denigrating view on the Roma is still present in society, as some statements created a narrative of ‘othering’. This study also shows the change of views in time, as conformation to Romanipen principles is being relaxed among younger generations so their view on health and health care is changing. The policy in Poland that addresses the health issue of Roma is the National Roma Integration Policy 2014–2020, targeted to the whole Polish Roma population, homogeneously, although the target population is rather heterogeneous. This should be changed in the coming years. Research limitations/implications: A serious limitation in the research was the lack of willingness of both of the Roma people and Roma experts to participate in the study, and especially to share their insights on health, the protection of which follows the restrictive tradition of Romanipen. Generally, conducting research only in Ochotnica Gorna narrows the scope of this study to one particular village, even if the organizational solution is similar all over Poland. Originality/value: The value of the obtained results is increased by their uniqueness, as the separate issues of Roma health are not raised in Polish literature.

To Comply or Not to Comply: Roma Approach to Health Laws

According to the general public in Slovakia, compliance with the law is problematic when it comes to Roma and health. Roma compliance with laws has not yet been studied. The aim of this is study was to explore the determinants of Roma behavior in the field of health laws. We used the concept of a semi-autonomous field proposed by Moore (1973) and the theory of planned behavior by Ajzen (1985). We found that Roma (non-)compliance with health laws was influenced by many different factors, such as beliefs, traditions, living conditions and culture. Group beliefs overrule national laws and also individual preferences, which tend to be subordinate to the group view. The less contact Roma from settlements have with non-Roma, the stronger their own rules are in the field of health. Roma health status is influenced by many factors: group beliefs and community traditions are stronger and overrule individual and state behavioral influence. A community-based participatory approach together with improvement of living conditions in cooperation with Roma is desirable.

Roma populations and health inequalities: a new perspective

Purpose The purpose of this paper is to explore the emergence of “Roma health and wellbeing” as a focus of attention in European research and in policy and the possible detrimental consequences of action founded on a generic representation of “Roma health.” Design/methodology/approach Based on discussions with and research conducted by scholars who work directly with Roma communities across European regions from a wide range of academic disciplines it suggests how future research might inform: a more nuanced understanding of the causes of poor health and wellbeing among diverse Roma populations and; actions that may have greater potential to improve the health and wellbeing among these populations. Findings In summary, the authors promote three types of research: first critical analyses that unpick the implications of current and past representations of “Roma” and “Roma health.” Second, applied participatory research that meaningfully involves people from specific self-defined Roma populations to identify important issues for their health and wellbeing. Third, learning about processes that might impact on the health and wellbeing of Roma populations from research with other populations in similarly excluded situations. Originality/value The authors provide a multidisciplinary perspective to inform research that does not perpetuate further alienation and prejudice, but promotes urgent action to redress the social and health injustices experienced by diverse Roma populations across Europe.

Roma health mediators in Serbia – good example of multisectoral cooperation in health promotion

Issue Within the framework of the JA CHRODIS plus participants of the WP5 worked on identification of factors that contribute to collaboration within healthcare and between the broader health system and other sectors, as well as their enablers and barriers. In Serbia, practice that was identified and elaborated was aimed at improvement of health of Roma population. Description of the problem Based on available data, health indicators among Roma population in Serbia were two to three times worse than national averages. In order to tackle this issue, government of the Republic of Serbia, started with implementation of the project of education and inclusion of Roma health mediators in the health system. This project has been implemented in Serbia since 2009. Roma Health mediators (Roma ethical minority females) were trained for fast and efficient provision of support to Roma families. Results As a result of the project there was increased number of visits to health institutions and preventive check-ups of target population. Established cooperation between Roma health mediators and other health professionals in centers for primary health care, social care, and local self-government helped them in fulfilling their tasks, but also built capacity of other service providers to work in Roma communities. Through trainings they increase knowledge on various health, social and child care topics. Lessons Capacity building and inclusion of memebrs of vulnerable population into health promotion of the own to this population in terms of better acceptance of specific population population is useful to access groups as they can better understand and adapt to the needs of groups they want to reach. They should have opportunity to share their experience and lessons learned with experts involved in planning interventions for other vulberable groups. Key messages Building capacity of Roma mediators empowers them for integration into society beyond the scope of the Project. Lessons learned should be used for planning further actions for vulnerable groups.

A Community-Based Participatory Action Research for Roma Health Justice in a Deprived District in Spain

Addressing health disparities and promoting health equity for Roma has been a challenge. The Roma are the largest disadvantaged ethnic minority population in Europe and have been the victims of deep social and economic injustices, institutional discrimination, and structural antigypsyism over many centuries. This has resulted in a much worse health status than their non-Roma counterparts. Current strategies based on ameliorative and top-down approaches to service delivery have resulted in paradoxical effects that solidify health disparities, since they do not effectively address the problems of vulnerable Roma groups. Following a health justice approach, we present a community-based participatory action research case study generated by a community and university partnership intended to address power imbalances and build collaboration among local stakeholders. This case study involved a group of health providers, Roma residents, researchers, Roma community organizations, and other stakeholders in the Poligono Sur, a neighborhood of Seville, Spain. The case study comprises four phases: (1) identifying Roma health assets, (2) empowering Roma community through sociopolitical awareness, (3) promoting alliances between Roma and community resources/institutions, and (4) building a common agenda for promoting Roma health justice. We highlighted best practices for developing processes to influence Roma health equity in local health policy agendas.

Prevalence of Chronic Diseases and Activity-Limiting Disability among Roma and Non-Roma People: A Cross-Sectional, Census-Based Investigation

The lack of recommended design for Roma health-monitoring hinders the interventions to improve the health status of this ethnic minority. We aim to describe the riskiness of Roma ethnicity using census-derived data and to demonstrate the value of census for monitoring the Roma to non-Roma gap. This study investigated the self-declared occurrence of at least one chronic disease and the existence of activity limitations among subjects with chronic disease by the database of the 2011 Hungarian Census. Risks were assessed by odds ratios (OR) and 95% confidence intervals (95% CI) from logistic regression analyses controlled for sociodemographic factors. Roma ethnicity is a risk factor for chronic diseases (OR = 1.17; 95% CI: 1.16–1.18) and for activity limitation in everyday life activities (OR = 1.20; 95% CI: 1.17–1.23), learning-working (OR = 1.24; 95% CI: 1.21–1.27), family life (OR = 1.22; 95% CI: 1.16–1.28), and transport (OR = 1.03; 95% CI: 1.01–1.06). The population-level impact of Roma ethnicity was 0.39% (95% CI: 0.37–0.41) for chronic diseases and varied between 0 and 1.19% for activity limitations. Our investigations demonstrated that (1) the Roma ethnicity is a distinct risk factor with significant population level impact for chronic disease occurrence accompanied with prognosis worsening influence, and that (2) the census can improve the Roma health-monitoring system, primarily by assessing the population level impact.

Increased Employment for Segregated Roma May Improve Their Health: Outcomes of a Public–Private Partnership Project

Increasing employment opportunities for segregated Roma might prevent major economic losses and improve their health. Involvement of the private sector in Roma employment, on top of intensified governmental actions, is likely to be a key to sustainable improvement, but evidence on this is scarce. Our aim was to determine the potential outcomes of such a partnership regarding increased employability and the resulting improved well-being and health. We therefore investigated a Roma employment project called Equality of Opportunity, run since 2002 by a private company, U.S. Steel Kosice, in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain the perspectives of key stakeholders on the outcomes of this project. We found that they expected the employability of segregated Roma to increase in particular via improvements in their work ethic and working habits, education, skills acquisition, self-confidence, courage and social inclusion. They further expected as the main health effects of increased employability an improvement in Roma well-being and health via a stable income, better housing, crime reduction, improved hygienic standards, access to prevention and improved mental resilience. Social policies regarding segregated Roma could thus be best directed at increasing employment and at these topics in particular to increase their effects on Roma health.