Project

Health status of the Roma

Goal: To analyse the health status of the Spanish Roma (Kale/gitanos) and other European Roma populations.

Updates
0 new
2
Recommendations
0 new
1
Followers
0 new
25
Reads
0 new
233

Project log

Daniel La Parra
added a research item
A large part of the European Roma community faces prejudices, discrimination, and social exclusion. This situation is more visible in Roma women. This study assesses gender sensitivity in the National Roma Integration Strategies (NRIS) of the Member States of the European Union. To do so, an adapted ad hoc tool was applied to the twenty-seven NRIS documents, making it possible to identify gender sensitivity in its “symbolic dimension”—declaration of principles and values that guide the action and/or proposing reasons of the intervention; and in its “operational dimension”—formal aspects of the intervention. In addition, this tool allowed us to classify the documents according to their gender approach. A low gender sensitivity is observed, which is more developed in the symbolic part. The line of action with greater gender sensitivity is health, followed by employment and education. Gender sensitivity is nonexistent for housing.
Daniel La Parra
added a research item
Aims This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. Methods We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT’s European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma ( n=11,401), Roma neighbours ( n=5857) and the general population ( n=101,579) stratified by gender, and adjusted by age, country and educational level. Results There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. Conclusions These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population’s social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.
Daniel La Parra
added a research item
Aim: To present a protocol study directed at tackling gender discrimination against Roma girls by empowering their mattering so they can envision their own futures and choose motherhood only if—and when—they are ready. Background: Motherhood among Roma girls (RGM) in Europe impoverishes their lives, puts them at risk of poor physical and mental health and precipitates school dropouts. Overwhelming evidence affirms that the conditions of poverty and the social exclusionary processes they suffer have a very important explanatory weight in their sexual and reproductive decisions. Methods: Through a Community-based Participatory Action Research design, 20–25 Roma girls will be recruited in each one of the four impoverished communities in Bulgaria, Romania and Spain. Data collection and analysis: Desk review about scientific evidences and policies will be carried out to frame the problem. Narratives of Roma women as well as baseline and end line interviews of girl participants will be collected through both qualitative and quantitative techniques. Quantitative data will be gathered through reliable scales of mattering, socio–political agency, satisfaction with life and self. A narrative analysis of the qualitative information generated in the interviews will be carried out. Expected results: (1) uncover contextual and psychosocial patterns of girl-motherhood among Roma women; (2) build critical thinking among Roma girls to actively participate in all decisions affecting them and advocate for their own gender rights within their communities; and (3) empower Roma girls and their significant adults to critically evaluate their own initiatives and provide feedback to their relevant stakeholders. Conclusions: Roma girls will improve their educational aspirations and achievements and their social status while respecting and enhancing Roma values.
Daniel La Parra
added a research item
As part of the EU's social policy, the National Roma Integration Strategies (NRIS) have been in force until 2020. It was a pending task to systematically observe how these strategies define the Roma population and what element of the definition is prioritised. This is useful in understanding the limits of a unitary policy within the European Union concerning the Roma and also to analyse the orientation of said policies in each country. In this sense, we have previously defined what the Roma heteroidentification components are and we have selected the terms and lexemes that are associated with them. By using content analysis techniques, we have pinpointed the components in the NRIS and we have conducted a statistical analysis with the obtained data. The majority of EU countries define the Roma in their strategies as an ethnocultural, disadvantaged and discriminated group and, to a lesser extent, as foreigners or nomads. This heteroidentification is established based on the geopolitical bloc (East and West) to which the country belongs and the department in charge of the NRIS (mainly social departments or specific departments for minorities).
Daniel La Parra
added a research item
The aim of this study is to analyse the impact that COVID-19 has had on the Roma population, showing results of a telephone interview on a sample of 592 Roma households in phase 0 of confinement. This study has been developed by means of an alliance in which researchers from the public universities of Alicante and Navarre and the Health Institute Carlos III have participated, as well as several Roma associations. The results reflect the significant impact that the pandemic has caused in households that were already affected by social exclusion and inequality. This impact goes beyond health and affects all dimensions of social inclusion, from employment to education, including income, meeting basic needs and discrimination.
Daniel La Parra
added a research item
Background In 2011, the European Commission adopted the European framework for the National Roma Integration Strategies (NRISs) 2020, which focussed on four areas: education, employment, health and housing. In 2012 Spain approved its Strategy 2012–20, one of the central aims of which is to reduce social inequalities in health that affect the Roma population. Our objective was to analyze changes in health inequalities between the Roma population and the general population in Spain in the years 2006 and 2014. Methods The Spanish National Health Surveys (NHSs) 2006 (n = 29 478) and 2012 (n = 20 884) and the NHS of the Spanish Roma Population 2006 (n = 933) and 2014 (n = 1155) were compared. This study considered the variables included in NRIS 2012–20: self-perceived health, tobacco use in men, traffic accidents in men and women, obesity in women and gynaecological visits. Results Despite the adoption of the NRIS 2012–20, there were no observed improvements in health between 2006 and 2014 in the Roma population. Nor was there a reduction in inequalities in health concerning the general population in Spain. Also, there was no reduction in the health inequalities by gender for the two populations. Conclusions Health is determined in part by social factors including education, employment, housing and also by anti-Roma discourses and discrimination. Improving the health of the Roma population requires a multi-sectoral approach with a gender perspective.
Daniel La Parra
added a research item
Objectives: The Roma population in Spain makes up about two percent of the population and has worse health indicators than the general population. We analyzed both populations in 2006 and 2014 to discover whether there are differences in terms of gynecological visits and preventive services for breast and cervical cancer in Spain. Methods: Cross-sectional study is based on the Spanish National Health Survey (SNHS) of 2006 and 2012 and the National Health Survey of the Roma Population (NHSRP) of 2006 and 2014. Results: Roma women used gynecological visits less than the general population in 2006 (ORa 0.5 [0.4; 0.6] and in 2014 (ORa 0.2 [0.2; 0.3)]. In addition, use of the mammogram was lower in Roma women (ORa 0.7 [0.6; 0.8]), especially in the ages of the screening tests, and they had lower probability of receiving cervical examinations in 2006 (ORa 0.5 [0.4; 0.6]) and in 2014 (ORa 0.7 [0.6; 0.9]). Conclusions: This study shows that the inequality gap in gynecological visits and preventive services for breast and cervical cancer in Roma women has persisted during the years studied (2006 and 2014), despite Spanish prevention policies.
Daniel La Parra
added an update
I'm pleased to share the latest from the Romomatter Project, a collaborative of 11 institutions working to empower Roma girls through reproductive justice. Follow our work and read our latest newsletter [link to newsletter: https://bit.ly/2OtWKw3]
 
Daniel La Parra
added a research item
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.
Daniel La Parra
added a research item
Tobacco consumption is unequally distributed in society. The objective was to identify trends in tobacco use among the General and Spanish Roma populations in 2006 and 2014, years characterized by strengthening of anti-smoking policy in Spain. We calculated prevalences and logistical regression models based on the Spanish National Health Survey (2006/2012) and the National Health Survey of the Roma population (2006/2014). Smoking decreased only in men in the General population (OR 0.885). In the Roma population, there were no significant changes observed for the 2 years studied (OR: men 1.095, and women 1.147). In fact, Roma men smoke 4.2 cigarettes more, and they have a younger age of initial tobacco use. Smoking behavior of the Roma population has not changed, and there has been no reduction in inequalities in tobacco use among the two populations, despite public policies designed to reduce tobacco use in Spain.
Daniel La Parra
added a research item
Acceptability of violence against women (VAW) is a key dimension in addressing this social problem, given its influence on both the violent conduct of aggressors and the decisions of affected women. This study analyzes, for the first time, the magnitude of acceptability of VAW and associated factors in the Roma population in Spain. The Roma population is the largest ethnocultural minority in Europe. Data were analyzed from the Spanish National Health Survey of the Roma Population of 2014, a survey of 1,167 people identified as members of the Roma community. The results indicate that 70.9% of those surveyed completely reject VAW, with lower probability of acceptability among women than men (odds ratio [OR]: 0.66; 95% confidence interval [CI]: [0.51, 0.86]). There is also a decrease in probability as income increases, in people who identify themselves as evangelical (OR: 0.5; 95% CI: [0.36, 0.71]) and among those who report being acquainted with a battered woman (OR: 0.68; 95% CI: [0.48, 0.97]), similarly in women and men. It has to be highlighted that the observed associations between socioeconomic conditions and acceptability of VAW should be considered when designing strategies for raising awareness about the consequences of VAW for the Roma population.
Daniel La Parra
added a research item
The present working document aims to provide support to and additional background for the European Commission in its process of reviewing the health components of the National Roma Integration Strategies during the first quarter of 2012. It is for a targeted audience (specifically, DG SANCO technical staff working on Roma health). This document contains an expanded and adapted version of the “criteria for the evaluation of the health component of the National Roma Integration Strategies” that were presented at the “Roma health resource workshop” in Istanbul on 26-27 October 2011. The workshop, which was co-organized by UNFPA and WHO, provided input and facilitated country-to-country exchange for developing or revising the health component of National Roma Integration Strategies or related sets of policy measures. The aforementioned criteria were presented in plenary and subsequently reviewed in breakout groups that comprised more than 40 representatives from governments, NGOs/civil society, the Roma community, academia, international organizations and UN system agencies. A full workshop Report of Proceedings is available upon request
Daniel La Parra
added a research item
This qualitative study identifies health professionals’ dominant, adaptive, and liberating narratives regarding inter-ethnic relations when talking about intimate partner violence (IPV) and the health system responses to the way it affects Roma women. Dominant narratives are oppressive internalized stories that shape social perceptions of members of both dominant and minority groups, adaptive narratives refer to those that acknowledge asymmetry and inequality, and liberating narratives directly challenge oppression with resistant views of stereotypes and negative interpretations. A total of 25 in-depth interviews were carried out with healthcare professionals in Spain in 2015. A discourse analysis of the interview transcriptions was conducted, showing the way in which different narratives about Roma people and IPV are combined among health providers. Dominant narratives were more salient: they were used by health providers to reflect prejudicial social perceptions in Spain that depict the Roma as a marginalized and traditional group, to construct Roma women in negative and prejudicial terms as patients, and to explain the existence of the cultural normalization of IPV among Roma women. Adaptive and liberating narratives showed a prevailing ideology in terms of the tendency to socially discriminate against Roma people. Using liberating narratives to train and raise awareness among health professionals about IPV among Roma women could facilitate a positive change in their treatment of Roma women who could be affected by IPV, helping to ameliorate the maintenance of existing prejudices.
Daniel La Parra
added 2 research items
To describe how health agents and professionals working in a community project perceive the changes related to the population health status and their use of health-care services after the RIU intervention in an urban area of socioeconomic disadvantage.
Objetivo: Describir los cambios percibidos por la población y los profesionales en relación con la salud y el uso de servicios tras la intervención RIU con agentes comunitarios en un barrio vulnerable. Diseño: Estudio descriptivo cualitativo con entrevistas individuales y grupales y observación participante de octubre de 2008 a julio de 2009. Emplazamiento: Barrio Raval (Algemesí-Valencia). Participantes: Selección por muestreo opinático de 7 mujeres agentes de salud, todas las que finalizaron la intervención, y 10 profesionales implicados en la misma. Método: Con las mujeres se mantuvo una entrevista grupal a los 6 meses, y una entrevista grupal y 7 individuales a los 9 meses de intervención. Se realizó un análisis temático de tipo descriptivo desde el modelo de promoción de salud. Con los profesionales se utilizó observación participante en una reunión a los 9 meses, analizándose las notas de campo según: valoración del proyecto, cambios detectados, dificultades y recomendaciones. Resultados: Las mujeres adquirieron información sobre salud, anticoncepción, embarazo y servicios sanitarios; señalaron cambios en autocuidados y habilidades sociales y liderazgo; interiorizaron el rol de agente de salud difundiendo lo aprendido y manifestando mejor autoestima y reconocimiento social. Provocaron cambios en su entorno relativos al cuidado de la salud y el acceso a los servicios. Los profesionales no incorporaron a su trabajo la perspectiva comunitaria; valoraron el proyecto, coincidieron con las mujeres en la mejora del acceso y uso de servicios y en el acercamiento población-profesionales. Conclusiones: RIU aumenta las capacidades de las personas participantes, su reconocimiento social y mejora el acceso y uso de servicios sanitarios.
Daniel La Parra
added 2 research items
The toolkit on social participation was developed to help various stakeholders to promote social participation in the design, implementation, monitoring and evaluation of strategies, programmes and/or activities to improve the health of the population. This book is intended for use by policy-makers, project coordinators, professionals and nongovernmental organizations involved in promoting social participation of the general population, including Roma and other social groups (with the understanding that social participation processes must explicitly include Roma, but not exclusively). The toolkit comprises a detailed list of methods and techniques (tools) for promoting social participation throughout the policy process, providing examples and case studies mainly based on experiences of promoting social participation of Roma populations in Europe.
This paper explores whether the principles of horizontal and vertical equity in healthcare are met by the Spanish national health system in the case of the Roma and general populations. The 2011/2012 Spanish National Health Survey (n = 21,650) and the 2014 National Health Survey of the Spanish Roma Population (n = 1167) were analyzed. Use of healthcare services was measured in terms of visits to a general practitioner (GP), visits to an emergency department, and hospitalizations. Healthcare need was measured using (a) self-rated health and (b) the reported number of chronic diseases. The Roma reported worse self-rated health and a higher prevalence of chronic diseases. A redistributive effect (increased healthcare service use among Roma and those in lower socio-economic classes) was found for hospitalizations and emergency visits. This effect was also observed in GP visits for women, but not for men. Vertical inequity was observed in the general population but not in the Roma population for GP visits. The results suggest the existence of horizontal inequity in the use of GP services (Roma women), emergency department visits (Roma and general population), and hospitalizations (Roma population) and of vertical inequity in the use of GP services among the general population.
Daniel La Parra
added 2 research items
We analyzed vision and hearing health status in the Spanish Roma population compared with the general population and its influence on mental health and social participation. We conducted a Cross-sectional study on Roma population (n = 1.167) compared to general population in Spain (n = 21.007). We analyzed the use of optical and hearing aids, vision and hearing limitations and associations with mental health, diagnosed depression and social participation; through prevalence, odds ratio adjusted by age (AOR), Chi square independence test and contrast of proportions (p < 0.05). The Roma population are more likely to present vision limitations—far sight AOR = 3.76 (3.13–4.55), near sight AOR = 3.18 (2.33–4.35)-, hearing difficulties—AOR = 1.41 (1.15–1.72)-, and lower use of corrective aids than the general population. These findings were associated with poor mental health and lower social participation (p < 0.01). Vision and hearing limitations affect unequally in Spain. Addressing avoidable vision and hearing impairment among Roma population is needed to reduce health inequities.
Daniel La Parra
added an update
A new issue of the Roma Inclusion Newsletter (june 2017) was published
 
Daniel La Parra
added a project goal
To analyse the health status of the Spanish Roma (Kale/gitanos) and other European Roma populations.