Health status of Gypsies and Travellers in England

The social class gradient in health in Spain and the health status of the Spanish Roma

OBJECTIVE

To determine the social class gradient in health in general Spain population and the health status of the Spanish Roma.

DESIGN

The National Health Survey of Spanish Roma 2006 (sample size = 993 people; average age: 33.6 years; 53.1% women) and the National Health Surveys for Spain 2003 (sample size: 21,650 people; average age: 45.5 years; 51.2% women) and 2006 (sample size: 29,478 people; average age: 46 years; 50.7% women) are compared. Several indicators were chosen: self-perceived health, activity limitation, chronic diseases, hearing and sight problems, caries, and obesity. Analysis was based on age-standardised rates and logistic regression models.

RESULTS

According to most indicators, Roma's health is worse than that of social class IV-V (manual workers). Some indicators show a remarkable difference between Roma and social class IV-V: experiencing three or more health problems, sight problems, and caries, in both sexes, and hearing problems and obesity, in women.

CONCLUSION

Roma people are placed on an extreme position on the social gradient in health, a situation of extreme health inequality.

Roma Women's Perspectives on End-of-Life Decisions

Spain's Roma community has its own cultural and moral values. These values influence the way in which end-of-life decision-making is confronted. The objective of this study was to explore the perspective of Roma women on end-of-life decision-making. It was a qualitative study involving thirty-three Roma women belonging to groups for training and social development in two municipalities. We brought together five focus groups between February and December 2012. Six mediators each recruited five to six participants. We considered age and care role to be the variables that can have the most influence on opinion regarding end-of-life decision-making. We considered the discussion saturated when the ideas expressed were repeated. Data analysis was carried out according to five steps: describing, organizing, connecting, corroborating/legitimating, and representing the account. The main ideas gleaned from the data were as follows: (1) the important role of the family in end-of-life care, especially the role of women; (2) the large influence of community opinion over personal or family decisions, typical of closed societies; (3) the different preferences women had for themselves compared to that for others regarding desired end-of-life care; (4) unawareness or rejection of advance directives. Roma women wish for their healthcare preferences to be taken into account, but "not in writing." The study concluded that the success of end-of-life healthcare in Roma families and of their involvement in the making of healthcare decisions depends upon considering and respecting their idiosyncrasy.

Interethnic differences of cytochrome P450 gene polymorphisms may influence outcome of taxane therapy in Roma and Hungarian populations

Taxanes are widely used microtubule-stabilizing chemotherapeutic agents in the treatment of cancers. Several cytochrome P450 gene variants have been proven to influence taxane metabolism and therapy. The purpose of this work was to determine the distribution of genetic variations of CYP1B1, CYP2C8 and CYP3A5 genes as the first report on taxane metabolizer cytochrome P450 gene polymorphisms in Roma and Hungarian populations. A total of 397 Roma and 412 Hungarian healthy subjects were genotyped for CYP1B1 c.4326C > G, CYP2C8 c.792C > G and CYP3A5 c.6986A > G variant alleles by PCR-RFLP assay and direct sequencing. We found significant differences in the frequencies of homozygous variant genotypes of CYP1B1 4326 GG (p = 0.002) and CYP3A5 6986 GG (p < 0.001) between Roma and Hungarian populations. Regarding minor allele frequencies, for CYP2C8 a significantly increased prevalence was found in 792G allele frequency in the Hungarian population compared to the Roma population (5.83% vs. 2.14%, p = 0.001). Our results can be used as possible predictive factors in population specific treatment algorithms to developing effective programs for a better outcome in patients treated with taxanes.

'You likes your way, we got our own way': Gypsies and Travellers' views on infant feeding and health professional support

BACKGROUND

Gypsies and Travellers are known to have poor health status and access to health services, even in comparison with other ethnic minority groups. People from this stigmatized ethnic group are rarely consulted about their health needs or health service provision. Optimal infant feeding in the first year of life has the potential to improve lifelong health.

OBJECTIVE

The aim of this study was to explore mothers and grandmothers' views on feeding in the first year of life, including the support provided by health professionals.

METHODS

Semi-structured interviews were conducted with a purposively selected sample of 22 mothers and grandmothers of English Gypsy, Irish Traveller and Romanian Roma ethnicity between November 2011 and February 2012 in a city in south-west England.

RESULTS

Few women perceived themselves as requiring help from health professionals in infant feeding, as acceptable and accessible support was available from within their own communities. Roma mothers described a tradition of breast-feeding and appropriately timed weaning, while English Gypsies and Irish Travellers customarily practised less healthy infant feeding. When mothers requested support, health service provision was often found inadequate.

CONCLUSION

Exploring the views of Gypsies and Travellers is important to gain insight into the provision of health services for this marginalized ethnic group. This study has implications for policy and the practice of health professionals, in indicating the customary feeding behaviours of some Gypsy and Travellers, and highlighting areas meriting culturally sensitive health promotion.

A realist synthesis of the evidence on outreach programmes for health improvement of Traveller Communities

Background

Improving the health of Traveller Communities is an international public health concern but there is little evidence on effective interventions. This study aimed to explain how, for whom and in what circumstances outreach works in Traveller Communities.

Methods

A realist synthesis was undertaken. Systematic literature searches were conducted between August and November 2011. Grey literature was sought and key stakeholders were involved throughout the review process. Iterative steps of data extraction, analysis and synthesis, followed by additional searches were undertaken.

Results

An explanatory framework details how, why and in what circumstances participation, behaviour change or social capital development happened. The trust status of outreach workers is an important context of outreach interventions, in conjunction with their ability to negotiate the intervention focus. The higher the outreach worker's trust status, the lower the imperative that they negotiate the intervention focus. A ‘menu’ of reasoning mechanisms is presented, leading to key engagement outcomes.

Conclusions

Adopting a realist analysis, this study offers a framework with explanatory purchase as to the potential of outreach to improve health in marginalized groups.

UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): protocol for an exploratory, qualitative study

INTRODUCTION

Gypsies, Travellers and Roma (referred to here as Travellers) experience significantly poorer health and have shorter life expectancy than the general population. They are also less likely to access health services including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. This study has two aims: (1) Investigate the barriers and facilitators to acceptability and uptake of immunisations among six Traveller communities in the UK; (2) Identify potential interventions to increase uptake in these Traveller communities.

METHODS AND ANALYSIS

A three-phase qualitative study with six Traveller communities. PHASE 1: In each community, we will explore up to 45 Travellers' views about the influences on their immunisation behaviours and ideas for improving uptake in their community. PHASE 2: In each community, we will investigate 6-8 service providers' perspectives on barriers and facilitators to childhood and adult immunisations for Traveller communities with whom they work, and ideas to improve uptake. Interview data will be analysed using the Framework approach. PHASE 3: The findings will be discussed and interventions prioritised in six workshops, each with 10-12 phase 1 and 3-4 phase 2 participants.

ETHICS AND DISSEMINATION

This research received approval from NRES Committee Yorkshire and The Humber-Leeds East (Ref. 13/YH/02). It will produce (1) findings on the barriers and facilitators to uptake of immunisations in six Traveller communities; (2) a prioritised list of potentially feasible and acceptable interventions for increasing uptake in these communities; and (3) methodological development in undertaking research with diverse Traveller communities. The study has the potential to inform new ways of delivering services to ensure high immunisation uptake. Findings will be disseminated to participants, relevant UK organisations with responsibility for the implementation of immunisation policy and Traveller health/welfare; and submitted for publication in academic journals.

TRIAL REGISTRATION NUMBER

ISRCTN20019630.

Extreme differences in SLCO1B3 functional polymorphisms in Roma and Hungarian populations

Variants in SLCO1B3 transporter are linked to disposition and uptake of drugs and show high degree of heterogeneity between populations. A total of 467 Roma and 448 Hungarian subjects were genotyped for SLCO1B3 c.334T>G and c.1683-5676A>G variant alleles by PCR-RFLP assay and direct sequencing. We found significant differences in the frequencies of homozygous variant genotypes of SLCO1B3 334GG (41.54% vs. 8.04%, p<0.001) and 1683-5676GG (0.43% vs. 2.01%, p=0.028) between Romas and Hungarians. A significantly increased prevalence was found in SLCO1B3 1683-5676G allele frequency in Hungarians compared to the Roma population (15.07% vs. 3.43%, p≤0.001). The frequency of SLCO1B3 334G allele was significantly increased in Roma population compared to Hungarians (70.56% vs. 52.23%, p=0.001). The LD values between the examined SNPs were 80 and 90 in Roma and in Hungarian samples, respectively. Our results highlight notable pharmacogenetic differences between Roma and Hungarian populations, which may have therapeutic implications.

Attitudes of the Prekmurje Roma towards health and healthcare

BACKGROUND

Knowledge of the culture, traditions and values of the Roma is important for understanding their relationship to health and the health system. The Roma in Prekmurje, the far northeastern part of Slovenia, are a unique ethnic group and in many respects different from other Roma. The aim of the study was to determine their attitudes towards health and the healthcare system.

METHODS AND MATERIALS

We conducted 25 interviews in Roma settlements. The participants were between 18 and 64 years of age, with the average age being 23.46 years old; 48 % were men and 52 % women. We used qualitative content analysis as the data analysis technique. As a tool to facilitate the qualitative data analysis, we used the software Atlas.ti. In the study, we used a data-driving coding scheme. Two independent coders carried out the coding.

RESULTS

We determined eight logical categories that explain the attitudes of the Roma towards health, satisfaction, problems and prospects and the functioning of the health system at the local level. These are experiences with the healthcare system, personal healthcare, the perception of health and illness, suggestions for improvement, common diseases as perceived by the Roma, poverty and socioeconomic status of the Roma, discrimination and the need for a better understanding of the Roma.

CONCLUSION

Roma culture and their customs affect the Roma's relationship with health and the healthcare services in Prekmurje. The Roma are willing to participate in health status improvement, but require special attention within the national healthcare system.

Quality of Life and Patient Satisfaction with Family Practice Care in a Roma Population with Chronic Conditions in Northeast Slovenia

OBJECTIVES

Health-related quality of life (HRQoL) measures a patient's subjective experience of his or her health status. We aimed to show how the presence of chronic diseases and satisfaction with family physicians (FPs) were associated with the HRQoL of a Roma population.

METHODS

A cross-sectional study was carried out in May 2011 on a representative sample of 650 Roma living in Prekmurje, Slovenia. The EQ-5D questionnaire was used for measuring the HRQoL of the Roma. Demographical data, 12 groups of diseases diagnosed in the last 12 months and satisfaction with FPs were included in the questionnaire.

RESULTS

The response rate was 88.3% 574), of which 56.4% were female, and the average age of the participants had a mean value of 40.2±12.7 years. The presence of cardiovascular problems with risk factors for them or presence of musculoskeletal disorders were strongly associated with the presence of pain (Cramer's V = 0.40 and 0.46 respectively). There was a strong association between the presence of mental disorders and anxiety and depression (Cramer's V = 0.58). The average satisfaction with the family physician was 3.9 (mean±1.10) on a five-point Likert scale. There was no significant association between HRQoL and satisfaction with the family physician.

CONCLUSIONS

Roma with chronic mental health problems had the lowest HRQoL in the Roma population. More attention should be paid to this subgroup of Roma in family medicine, and interventions should be provided. High satisfaction with their FPs is not associated with the observed quality of life variables.

Tuberculosis incidence in the Irish Traveller population in Ireland from 2002 to 2013

The health status of the Irish Traveller ethnic minority is low compared to the general population in Ireland in terms of infant mortality rates and life expectancies. Respiratory disease is an area of health disparity manifested as excess mortalities in Traveller males and females. In this study, we examined the available data with regard to tuberculosis (TB) notifications in Ireland from 2002 to 2013. We found an increase in TB notifications in Irish Travellers from 2010 onwards. This resulted in a crude incidence rate for TB in Irish Travellers that was approximately threefold higher than that of the white Irish-born population in 2011 and 2012. An outbreak of TB in Irish Travellers in 2013 increased this differential further, but when outbreak-linked cases were excluded, a higher incidence rate was still observed in Irish Travellers relative to the general population and to white Irish-born. The mean age of a TB patient was 26 years in Irish Travellers compared to 43 years in the general population, and 49 years in white Irish-born. Based on available data, Irish Travellers exhibit a higher incidence rate and younger age distribution of TB compared to white Irish-born and the general population. These observations emphasize the importance of routine use of ethnicity identifiers in the management of TB and other notifiable communicable illnesses in Ireland. They also have implications for the orientation of preventive services to address health disparities in Irish Travellers and other ethnic minority groups.

Mental health disparities between Roma and non-Roma children in Romania and Bulgaria

BACKGROUND

The Roma population, one of the largest minority groups in Europe, experience discrimination and stigma associated with marginalized social position. Few studies have examined mental illnesses in the Roma, and none have examined the Roma children. The present study estimates mental health and behavioral disorders among Roma children in comparison to non-Roma children in educational institutions.

METHODS

Data were drawn from the School Children Mental Health Study in Europe (SCHME) study in Romania (Roma children identified by parent report, N = 70; non-Roma, N = 925) and Bulgaria (Roma children identified by exclusively-Roma schools, N = 65; non-Roma, N = 1312). The Strengths and Difficulties Questionnaire was given to the parents and teachers to measure child mental health; children reported on their mental health through the Dominique Interactive. Control covariates included child sex and age, and parental characteristics when parent reports were available.

RESULTS

Based on the child's own report, Roma children had a higher odds of any internalizing disorder (OR = 2.99, 95% C.I. 2.07-4.30), phobias (OR = 4.84, 95% C.I. 3.19-7.35), separation anxiety disorder (OR = 2.54, 95% C.I. 1.72-3.76), generalized anxiety disorder (OR = 2.95, 95% C.I. 1.75-4.96), and major depressive disorder (OR = 3.86, 95% C.I. 2.31-6.37). Further Roma children had a higher odds of any externalizing disorder (OR = 2.84, 95% C.I. 1.78-4.54), oppositional defiant disorder (OR = 3.35, 95% C.I. 1.93-5.82), ADHD (OR = 2.37, 95% C.I. 1.26-4.46), and conduct disorder (OR = 3.63, 95% C.I. 2.04-6.46). Based on the report of teachers, Roma children had higher odds of emotional problems (OR = 2.03, 95% C.I. 1.20-3.44), peer-relational problems (OR = 2.76, 95% C.I. 1.73-4.41) and prosocial behavior (OR = 2.75, 95% C.I. 1.75-4.33).

CONCLUSION

Roma children experience a higher burden of mental health problems compared with their non-Roma counterparts. Attention to child health and mental health among the Roma is urgently needed, as these children experience a constellation of health problems associated with poverty as well as experiences of stigma and discrimination.

Genetic polymorphisms in promoter and intronic regions of CYP1A2 gene in Roma and Hungarian population samples

The purpose of this study was to determine the interethnic differences of four CYP1A2 drug metabolizing enzyme variants. A total of 404 Roma and 396 Hungarian healthy subjects were genotyped for -163C>A, -729C>T, -2467delT and -3860G>A variants of CYP1A2 by RT-PCR and PCR-RFLP technique. The -3860A and -729T allele were not detectable in Roma samples, while in Hungarian samples were present with 2.02% and 0.25% prevalence, respectively. There was a 1.5-fold difference in presence of homozygous -163AA genotype between Hungarian and Roma samples (49.5% vs. 31.9%, p<0.001). The -163A allele frequency was 68.6% in Hungarians and 56.9% in Romas (p=0.025). The -2467delT allele frequency was 6.81% in Roma group and 5.81% in Hungarians. The most frequent allelic constellation was -3860G/-2467T/-729C/-163A in both populations. In conclusion, Hungarians have markedly elevated chance for rapid metabolism of CYP1A2 substrates, intensified procarcinogen activation and increased risk for cancers.

Socioeconomic characteristics of the population living in Roma settlements and their association with health and health-related behaviour

BACKGROUND

The aim of this study was to compare socioeconomic characteristics of the Roma population living in Roma settlements with the majority population. Moreover, it was aimed to assess socioeconomic differences in health and health-related behaviour within the population living in Roma settlements.

METHODS

Data from the cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. Roma in selected settlements were recruited by local Roma community workers. Respondents from the major population were randomly selected from a list of patients from general practitioners. Data were collected via questionnaire, anthropometric measures and analysed blood samples. Differences in socioeconomic characteristics between the population living in Roma settlements and the majority population were tested using the chi-square test. The contribution of selected socioeconomic characteristics on health and health-related behaviour of the population living in Roma settlements was assessed by logistic regression models adjusted for age and gender.

RESULTS

The population living in Roma settlements is characterised by significantly lower socioeconomic standards, and the living conditions are significantly worse compared with the majority. With few exceptions, the study did not confirm any significant association between socioeconomic indicators and health and health-related behaviour within the population living in Roma settlements.

CONCLUSIONS

The deteriorating effect of living in Roma settlement on health and health-related behaviour seems to be immense regardless differences in socioeconomic characteristics or living condition within the settlement population.

Assessment of clinical biochemical parameters in Roma minority residing in eastern Slovakia compared with the majority population

Roma constitute the largest ethnic minority in Europe and the second largest minority in Slovakia. Their health problems originate mainly from their low socioeconomic status, certain cultural aspects and their health-threatening lifestyle as well as the psycho-social burden arising from poverty and frequent migration. Evaluation of glucose, albumin, triacylglycerol (TAG) and low density lipoprotein cholesterol (LDL-C) concentrations did not reveal any clue about the presumed deteriorated health of the Roma population. Higher proportions of subjects with elevated serum total cholesterol were found in Roma women as compared to both control groups of women (p = 0.027, p = 0.006) and in Roma men as compared to the male control group living in standard conditions. Only the low level of HDL-cholesterol gives a glimpse of their deteriorated health. Significantly lower levels of serum HDL-C were reported in Roma men and women compared to the respondents in both control groups with a p value of p < 0.001. Comparing the ratio of LDL-C/HDL-C yielded significant differences between the number of physiological values in Roma men and men from the control group 1 (p = 0.022) in favour of the control group. When comparing the number of people with physiological values of cholesterols and with worsening TAG parameters at the same time, the increased risk of Roma men compared with men from the control group 1 became evident, with a level of significance of p = 0.023. Evaluation of urine samples pointed to significantly higher concentrations of urinary protein in Roma women compared with women in the control group 1 (p = 0.012).

Perception of mental health in Pakistani nomads: an interpretative phenomenological analyses

The study was conducted to explore the mental health issues of Pakistani nomads and to uncover their concept, ideation, and perception about mental health and illnesses. It was an exploratory study situated in the qualitative paradigm. The research strategy used was Interpretative Phenomenological Analysis (IPA), as the study was planned to explore the lived experiences of nomads regarding mental health and coping strategies and how they interpret those experiences. For data collection, focus group discussions (FGDs) were conducted. Seven participants were included in the FGDs, and two FGDs were conducted composed of both genders. The responses were recorded, and data were transcribed and analysed using IPA. Data verification procedures of peer review, which help to clarify researcher bias and rich thick description, were used. The major themes were lack of resources and myriad unfulfilled needs, specifically the basic needs (food, shelter, and drinking and bathing water). Moreover, a strong desire to fulfil the secondary needs of enjoyment and having luxuries was also reflected. A list of recommendations was forwarded for policy making of this marginalized community and to create awareness regarding mental health.

Anxiety and sense of coherence in Roma and non-Roma coronary heart disease patients

OBJECTIVE

Morbidity and mortality among Roma due to coronary heart disease (CHD) is high, but evidence on potential psychosocial pathways is lacking. This study aimed to assess the differences in the severity of anxiety symptoms and in the sense of coherence (SOC) between Roma and non-Roma CHD patients, crude and adjusted for age, sex, functional status and socio-economic status (SES).

DESIGN

We examined 607 CHD patients (mean age 58.0 ± 7.4, 28.7% female) scheduled for coronary angiography, 98 (16.1%) of whom were Roma. Anxiety symptoms were measured using the Hospital Anxiety and Depression Scale and SOC using the 13-item Orientation to Life Questionnaire. Data were analysed using hierarchical regression.

RESULTS

Roma ethnicity was associated with more severe anxiety (B = 1.89; [95% confidence interval (CI) = 0.79; 2.98]) adjusted for age, sex, functional status and SES. Roma ethnicity was also associated with lower SOC (B = -4.77; [95% CI = -7.85; -1.68]) adjusted for age, sex and functional status. The latter association lost statistical significance after adjustment for SES.

CONCLUSION

Roma ethnicity is associated with more anxiety symptoms and lower SOC among CHD patients. Our findings indicate that Roma CHD patients have a worse position regarding psychosocial factors that increase mortality and thus require additional attention.

Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003-2012

OBJECTIVES

To conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012.

METHODS

Systematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria.

RESULTS

We found evidence for lower self-reported health and significantly higher mortality risk for Roma compared to non-Roma, and greater prevalence of health risk factors for Roma children, including environmental risks, low birth weight, and lower vaccination coverage. Studies of non-communicable and infectious disease remain insufficient to make firm conclusions on disparities. Barriers to care include lack of documentation and affordability of care, though more studies on health care utilization are needed.

CONCLUSIONS

Roma youth and adults are in need of programs that reduce health disparities and their increased mortality risk. Reducing exposure to risk factors such as smoking, obesity, and poor living conditions may be a target for interventions. More intervention studies and rigorous evaluations are needed.

Ethical issues in communication of diagnosis and end-of-life decision-making process in some of the Romanian Roma communities

Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor-patient relationship. The study aims to explore the Roma's beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from two Romanian counties participated in semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the "silence conspiracy" being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient's autonomy. We identified ethical dilemmas concerning autonomy, lack of patients' real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient's right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community.

Age trends in prevalence of cardiovascular risk factors in Roma minority population of Croatia

The Roma (Gypsy) are the largest European minority population characterized by poverty, social exclusion as well as by numerous life-style and cultural specificities, which all could have an adverse impact on their cardiovascular health. This study assesses the prevalence of cardiovascular diseases (CVD) risk factors in community-based sample of 430 adult Roma, living in rural area of Croatia, by providing the actual and age-adjusted estimates using the European standard population. The most prominent classical CVD risk phenotypes (blood pressure, obesity, smoking, glucose and lipid profile) were selected, and the standard risk cut-offs were applied. The study has shown that compared to general population of Croatia, the Roma population bears a high CVD risk factors load related to smoking and high glucose level. The CVD risk factors prevalence in Roma also showed important sex and age patterns, the most imposing of which are the findings of higher prevalence of CVD risks in women (especially obesity and triglyceride levels) and the trend of higher body mass index (BMI) level in younger age group (18-34 years) which both stand in contrast to the trends characterizing the general population of Croatia. These findings are complemented by the trend of decreased risk in the oldest age group (65+ years) for all investigated CVD risk factors (with exception of triglycerides level) compared to the 50-64 age group. We conclude that the age and sex CVD risks pattern point to the health transition of this rural Roma population. As we expect the proportion of CVD in the Roma minority of Croatia to increase in the future along with further modernization of their lifestyle, the CVD prevention measures in this population are urgent and should be primarily targeted at women and at the younger segment of this population.

Assessing the health needs of vulnerable children, are the data fit for purpose?

Purpose

The purpose of this paper is to assess whether current routinely available population level data are adequate for assessing the health needs of vulnerable children.

Design/methodology/approach

The paper presents a review of routinely available population level data relating to 23 vulnerable child groups.

Findings

Data were available to measure how many children may be affected locally for seven groups (30 per cent) (looked after children, care leavers, absent or excluded pupils, children in poverty, young offenders, children in need and children assessed to be at risk of social services). Partial data were available for 11 (48 per cent) groups and no data were identified for five (22 per cent) groups. At least one measure of health and well being status was identified for three groups (13 per cent) (care leavers, children assessed to be in need of social services and children assessed to be at risk by social services). For seven groups (30 per cent), a measure of health status was identified for some children in the group. No measure of health status was identified for 13 groups (57 per cent).

Research limitations/implications

The review only considered routinely published data that can be reported for all counties or unitary authorities in England. Although every effort was taken to ensure complete identification, it is still possible that some data sources may have been missed.

Practical implications

The gaps in available data to monitor vulnerable children's health will make the task of ensuring their needs are appropriately represented in local needs assessment and health strategies more difficult. The current service reforms offer an opportunity to address the data gaps.

Originality/value

Data relating to some vulnerable child groups was reviewed in 2006 when a number of recommendations were made. This paper updates and broadens that review and reports on progress made against the 2006 recommendations. The findings of the paper have implications for policy makers and commissioners of children's services.

The health care experiences of Travellers compared to the general population: The All-Ireland Traveller Health Study

Objectives:

Travellers are a minority population in Ireland and Great Britain, who have poorer health status than the general population. This study aims to investigate Traveller health service utilization and experiences of health service quality.

Methods:

Community-based census survey of all Traveller households on the island of Ireland in 2008 and 2009. Comparisons were made with survey data from a nationally representative sample of the Irish general public entitled to means-tested general medical services from the INSIGHT ′07 survey.

Results:

Valid responses were provided by 1,947 Traveller respondents (32.5% males). Travellers reported significantly higher use of hospital services including Emergency Room services (sex- and age-adjusted relative risk (RR) 2.37, 95% CI 1.99-2.82) and mental health services (adjusted RR 2.89, 95% CI 2.02-4.14). They described significantly poorer quality health care experiences than did the comparator population, with fewer Travellers expressing trust in caregivers (adjusted RR 0.51, 95% CI 0.47-0.55) and rating the quality of health service they received as being very good or excellent (adjusted RR 0.59, 95% CI 0.55-0.64). After multivariable adjustment for the dimensions of service quality, population (Traveller or INSIGHT ′07) was not associated with an overall rating of health service quality.

Conclusions:

Travellers report greater use of and adequate access to health services, but describe a consistently poorer quality health care experience. This quality gap has implications for Traveller engagement with health care professionals.

Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries

BACKGROUND

Socially marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. This study explored the experiences and views of experts in 14 European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sex workers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities.

METHODS

Two highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed for each of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to explore experiences of good practice and analysed using thematic analysis.

RESULTS

In a total of 154 interviews, four components of good practice were identified across all six groups: a) establishing outreach programmes to identify and engage with individuals with mental disorders; b) facilitating access to services that provide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c) strengthening the collaboration and co-ordination between different services; and d) disseminating information on services both to marginalised groups and to practitioners in the area.

CONCLUSIONS

Experts across Europe hold similar views on what constitutes good practice in mental health care for marginalised groups. Care may be improved through better service organisation, coordination and information.

Cardiovascular Health in the Irish Traveller Community

Irish Travellers are a minority group exposed to a range of social and health inequalities. Traveller men and women live 9.9 and 11.9 years less, respectively, than men and women in the general population. One of the major causes of death is cardiovascular disease (CVD). Information concerning CVD risk factor assessment in this population is lacking. Our pilot study assesses the point prevalence of diabetes, pre-diabetes and the metabolic syndrome in a sample population of Irish Travellers living along the Irish Atlantic seaboard. To date, 187 Travellers have completed the study. The prevalence of diabetes was found to be 2.7%, pre-diabetes 11.2 % and metabolic syndrome 40% compared with 4.3%, 6.4% and 21.0% respectively in the background population. Targeted screening for glucose abnormalities and traditional CVD risk factors is needed in this minority group. Appropriate culturally sensitive interventions to reduce CVD risk factors are expected to lower morbidity and increase life expectancy.

Health status of Roma women in Spain

BACKGROUND

The objective of the present study is to describe the health status of Roma women in Spain. Population-based health data have become available for this group, and we can now identify differences with non-Roma women.

METHODS

Cross-sectional, epidemiological study from the 2006 Spanish National Health Survey and the first National Health Survey in the Romany population (2006). We analyzed 527 Spanish Roma women aged 16 years and over and 1054 Spanish non-Roma women, age and region matched.

RESULTS

Our sample comprised 527 Spanish Roma women and 1054 Spanish non-Roma women. Roma women are more likely to suffer from obesity [odds ratio (OR) 1.91; 95% confidence interval (CI) 1.05-3.50], depression and migraine. Roma women have significantly higher values for alcohol consumption than non-Roma women (OR, 3.77; 95% CI, 2.32-6.13). The percentage of Roma women, who have had a smear test and a mammography, is significantly lower than that of non-Roma women.

CONCLUSIONS

Our comparison showed that Spanish Roma women have a poorer health profile, worse lifestyles and more inequality in the use of health-care resources than non-Roma women, especially with respect to prevention.

Risk factors and severity of obstructive sleep apnoea in central European Roma and non-Roma patients referred for a diagnostic polysomnography [corrected]

OBJECTIVE

Obesity and metabolic syndrome are common among Roma subjects in Slovakia. We hypothesised that Roma subjects are at high risk to suffer from severe obstructive sleep apnoea (OSA).

METHODS

137 non-Roma and 23 Roma subjects referred for a diagnostic polysomnography were consecutively recruited. Overnight polysomnography, anthropometric variables and standard biochemical analyses were analysed.

RESULTS

Obstructive sleep apnoea was diagnosed in 91% Roma and 65% non-Roma subjects (p < 0.001). Roma subjects had higher apnoea-hypopnoea index (AHI) (61.2 ± 7.9 vs. 22.8 ± 2.3 events/h, p < 0.001), lower dip oxygen saturation (56.7 ± 4.9 vs. 79.3 ± 1.3%, p < 0.001), and higher waist circumference as compared to non-Roma subjects (121.3 ± 3.1 vs. 105.2 ± 2.4 cm, p < 0.001). In multiple regression analysis, Roma background (p < 0.001) and waist circumference (p < 0.001) were independent predictors of AHI (R (2) = 0.330). Roma background was associated with significantly higher risk of severe OSA (odds ratio 3.73; 95% confidence interval 1.20-11.65, p = 0.023), independently of age, gender and waist circumference.

CONCLUSIONS

Among subjects referred for polysomnography, Roma background is associated with significantly higher risk of severe OSA. Knowledge of common OSA pattern in Roma patients may help in identifying high risk individuals and guide early therapy of this disease.

Social exclusion of Gypsies and Travellers: health impact

There are striking inequalities in the health of Gypsies and Travellers, even when compared with people from other ethnic minorities or from socio-economically deprived White UK groups. In this paper we explore the long-term health impact associated with a history of persecution, social pathologisation and social exclusion of Gypsies and Travellers. A society that has demonstrated entrenched and widespread hostility towards Gypsies and Travellers has contributed to wariness about trust in outsiders and contributes to the communication barriers with health staff that are implicated in their poor access to healthcare. Many of the problems identified by health staff mirrored those identified by Gypsies and Travellers, particularly with regards to mismatched expectations and resulting conflicts. Whilst the Department of Health has recognised the extreme health inequalities experienced by Gypsies and Travellers and the need for specific action to reduce them and improve access to health care, this paper emphasises the need for an associated improved effort at all levels to seriously tackle the wider determinants of health, including societal attitudes towards Gypsies and Travellers, as well as focusing on delivery of health services. Nurses are identified as needing to play a key part as role models in challenging prejudice and discrimination.

Does farm worker health vary between localised and globalised food supply systems?

Significant environmental benefits are claimed for local food systems, but these biophysical indicators are increasingly recognised as inadequate descriptors of supply chain ethics. Social factors such as health are also important indicators of good practice, and are recognised by the organic and local food movements as important to the development of rounded sustainable agricultural practices. This study compared the self-reported health status of farm workers in the United Kingdom, Spain, Kenya and Uganda who were supplying distant markets with fresh vegetables. Workers on Kenyan export horticulture farms reported significantly higher levels of physical health than did Kenyan non-export farm workers and workers in the other study countries. Mean health levels for farm workers in the United Kingdom were significantly lower than relevant population norms, indicating widespread levels of poor health amongst these workers. These results suggest that globalised supply chains can provide social benefits to workers, while local food systems do not always provide desirable social outcomes. The causal mechanisms of these observations probably relate more to the social conditions of workers than directly to income.

A measles outbreak in the Irish traveller ethnic group after attending a funeral in England, March-June 2007

Between 3 April and 18 May 2007, 21 confirmed cases of measles were reported in members of the Irish traveller ethnic group who attended a funeral in London, England. The Health Protection Agency conducted an investigation to determine the extent of this outbreak in order to inform prevention of future outbreaks. From 23 March to 30 June, 173 outbreak-associated cases from seven regions throughout England were identified; 156 cases were in Irish travellers and 17 were epidemiologically linked to cases in that community. In total, 124 cases were laboratory confirmed (IgM or RNA); none were vaccinated against measles. MMR vaccination was offered on traveller sites. Low vaccination coverage and the movement of traveller communities present particular challenges for measles elimination in Europe. We recommend parallel approaches to improve integration of Irish travellers within routine health services whilst offering targeted interventions to increase vaccine uptake in this marginalized community.

To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia?

The Roma make up one of the largest ethnic groups in Europe. The few studies that are available report health among the Roma as considerably worse than that of the majority population, and virtually nothing is known about the health status of Roma adolescents. The purpose of this study was to compare the self-reported health outcomes of Roma adolescents living in Roma settlements with adolescents from the majority population and to assess the impact of socioeconomic status on the results obtained. We conducted a survey among Roma adolescents (N=330, mean age=14.5) and non-Roma adolescents (N=722, mean age=14.9) living in eastern Slovakia. We gathered data on sociodemographic position, self-rated health (using the SF-36), the occurrence of accidents and injuries during the past year, healthcare utilization during the past year, health complaints, mental health and social desirability. Roma adolescents reported poorer self-rated health, more accidents and injuries during the past year and more frequent use of healthcare during the past year, though fewer health complaints. Furthermore, they reported more prosocial behaviour than non-Roma. No differences appeared in total difficulties. Socioeconomic status decreased the association of ethnicity with health outcomes. Adjustment for social desirability had a significant effect on the differences for all outcomes, except for accidents and injuries during the past year.

Health behaviors, nutritional status, and anthropometric parameters of Roma and non-Roma mothers and their infants in the Czech Republic

OBJECTIVE

To compare maternal health behaviors, maternal nutritional status, and infant size at birth of Romas and non-Romas in the Czech Republic.

DESIGN

Maternal interviews and food frequency questionnaire, maternal blood samples, physical measurements of mothers and infants.

SETTING

Hospital, maternal/child care center; 2-4 days postpartum.

PARTICIPANTS

76 Roma mothers and 151 mothers from the majority population.

MAIN OUTCOME MEASURES

Infant length/weight; maternal height/weight; weight gain during pregnancy; duration of pregnancy; maternal smoking habits; dietary intake; use of food supplements during pregnancy; and maternal blood levels of folate, beta-carotene, retinol, and alpha-tocopherol.

ANALYSIS

Comparison of ethnic groups by 2-sample Wilcoxon test, chi-square, Fischer's exact test, relative risk, and analysis of variance (ANOVA).

RESULTS

Pregnancy duration was about 1 week shorter in Roma women (P < .001), and their infants had lower birth weight (P < .001) and shorter length (P < .001). Prevalence of smoking was significantly higher among Roma mothers (P < .001). Roma women used food supplements less frequently than non-Roma women (P < .001) and had significantly lower mean blood concentrations of folate (P < .001), beta-carotene (P < .001), retinol (P < .02), and alpha-tocopherol (P < .02).

CONCLUSIONS AND IMPLICATIONS

The nutritional status of Roma mothers is worse than that of mothers from the majority Czech population. The dietary and smoking habits of pregnant Roma women should be of special concern to family doctors, obstetricians, nutrition educators, and social workers.

Seroprevalence and risk factors for hepatitis A, B, and C among Roma and non-Roma children in a deprived area of Athens, Greece

The prevalence and risk factors of hepatitis A, B, and C (HAV, HBV, and HCV) markers were compared in non-Roma and Roma children who lived in a deprived suburb of Athens, Greece. The study included 216 children, 118 Roma and 98 non-Roma of 9 years median age (range 5-15 years). Among Roma children 98.3% had detectable antibodies to HAV, compared with 32.7% among non-Romas (P < 0.0001). Regarding HBV, 22% Roma children were identified with evidence of past infection (anti-HBc(+)), among whom five (4% of the total) were chronic carriers (HBsAg(+)), whereas no past infection was detected among the non-Romas (P < 0.0001). Markers of past HBV vaccination (anti-HBs(+), anti-HBc(-)) were detected in only 14% Roma but 96% non-Roma children (P-value < 0.0001). There was some indication for intrafamilial transmission of HAV and HBV in Roma school children. Unfavorable living conditions, frequent residency change, lack of child insurance and primary healthcare delivery were significantly associated with seroprevalence of HBV infection among Romas. No child in either group was found positive for HCV markers. These findings document high socioeconomic differentials with regards to preventable communicable diseases, such as HAV and HBV and underline the need for enhancing health policy action targeting pockets of minority childhood populations. Whereas, uptake of HBV vaccination is rather optimal in this general population, the high seroprevalence of HAV among Romas, also calls for implementing general vaccination for HAV, early in life.

Health-related beliefs and experiences of Gypsies and Travellers: a qualitative study

OBJECTIVE

To illuminate findings of the survey of the health status of Gypsies and Travellers by exploring their health-related beliefs and experiences.

DESIGN

Qualitative study of a purposive subsample from in-depth interviews using framework analysis.

SETTING

The homes or alternative community settings of the participants in five geographically dispersed study locations in England.

PARTICIPANTS

27 Gypsies and Travellers with an experience of ill health, purposively sampled from a larger population participating in an epidemiological survey of health status.

RESULTS

The experience of poor health and daily encounters of ill health among extended family members were normalised and accepted. Four major themes emerged relating to health beliefs and the effect of lifestyle on health for these respondents: the travelling way; low expectations of health; self-reliance and staying in control; fatalism and fear of death. These themes dominated accounts of health experience and were relevant to the experience. These themes add richness to the health status data and inform our understanding.

CONCLUSIONS

Among Gypsies and Travellers, coherent cultural beliefs and attitudes underpin health-related behaviour, and health experiences must be understood in this context. In this group, ill health is seen as normal, an inevitable consequence of adverse social experiences, and is stoically and fatalistically accepted. The provision of effective healthcare and improvement of poor health in Gypsies and Travellers will require multi-agency awareness of these issues.