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Anastasaki M, van Bree EM, Brakema EA, Tsiligianni I, Sifaki-Pistolla D, Chatzea VE, Crone MC, Karelis A, van der Kleij RMJJ, Poot CC, Reis R, Chavannes NH, Lionis C. Beliefs, Perceptions, and Behaviors Regarding Chronic Respiratory Diseases of Roma in Crete, Greece: A Qualitative FRESH AIR Study. Front Public Health 2022; 10:812700. [PMID: 35493388 PMCID: PMC9051233 DOI: 10.3389/fpubh.2022.812700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The global burden of chronic respiratory diseases (CRDs) disproportionally affects Roma populations. Health interventions addressing CRD among Roma or other vulnerable groups often fail to be effective, as their implementation strategy misaligns with the local context. To design context-driven strategies, we studied CRD-related beliefs, perceptions, and behaviors among a Greek Roma population, focussing on asthma and COPD. Methods For this qualitative study in Crete, Greece, we used a Rapid Assessment Process. We conducted interviews and focus groups with purposively selected Roma community members (CMs), key informants (KIs) and healthcare professionals (HPs) serving the population. Data were triangulated using observations of households and clinical consultations. Key themes were identified using Thematic Content Analysis. The Health Belief Model, the Explanatory Model of Illness, and the Theory of Planned Behavior that are complementary is some aspects, guided our methodology with the several variables from them to be integrated to better understand CRD risk preventative behavior. Results We conducted six focus groups, seven interviews and 13 observations among 15 CMs, four KIs, and three HPs. Five themes emerged: (1) Poor CRD-awareness (smoking and household air pollution were perceived as harmful, but almost exclusively associated with acute rather than chronic symptoms); (2) Low perceived susceptibility to CRD (and CMs tended to ignore respiratory symptoms); (3) High risk exposure (smoking was common, and air pollution was perceived inevitable due to financial constraints); (4) Healthcare seeking (healthcare was sought only for persistent, severe symptoms, daily needs were a priority); (5) Perceived barriers/facilitators to care (health illiteracy, perceived discrimination and financial constraints were main barriers; established trust the main facilitator). Conclusion These five themes highlight that strategies to tackle CRD in the studied Roma setting require a multilevel approach: bridging awareness gaps at the population level, providing resources to enhance the adoption of healthy behaviors, and fighting discrimination at the societal level, whilst establishing trusted relationships at the local level. Similar methodologies to address local context may strengthen the implementation of effective interventions for similarly vulnerable and/or low-resource populations.
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Affiliation(s)
- Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
- *Correspondence: Marilena Anastasaki
| | - Egid M. van Bree
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Evelyn A. Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Vasiliki E. Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Matty C. Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Karelis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Charlotte C. Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Petraki I, Kalpourtzi N, Terzidis A, Gavana M, Vantarakis A, Rachiotis G, Karakosta A, Sypsa V, Touloumi G. Living in Roma Settlements in Greece: Self-Perceived Health Status, Chronic Diseases and Associated Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8403. [PMID: 34444153 PMCID: PMC8394944 DOI: 10.3390/ijerph18168403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
We aimed to assess the self-perceived health status and the presence of chronic diseases of adult Roma living in settlements in Greece, and to explore associated social determinants of health. Data were derived from the Hprolipsis Health Survey. Multivariable regression models were applied. In total, 534 adults, 287 women, and 247 men were recruited from twelve Roma settlements in four prefectures. Although 62% of the participants perceived their health status as good/very good, about half of them had been diagnosed with at least one chronic disease. Several structural and intermediary social determinants of health were found to be significantly associated with the health outcomes; prefecture, settlement type, sex, age group, living with a partner, presence of depression symptoms, food insecurity, and alcohol consumption were associated with self-perceived health status; settlement type, sex, age group, presence of anxiety symptoms, food insecurity and number of persons living in the house with the presence of a chronic disease. This is one of the few studies assessing the self-perceived health status and presence of chronic diseases in Roma settlements in Greece and investigating the associated social determinants of health in the world. Community-based participatory action research and health literacy programs are needed to mitigate health inequalities in Roma settlements.
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Affiliation(s)
- Ioanna Petraki
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Natasa Kalpourtzi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Agapios Terzidis
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, 1, Dilou & Mikras Asias Str., Goudi, 11527 Athens, Greece;
| | - Magda Gavana
- Department of Primary Health Care, General Practice, and Health Services Research, Medical School of Aristotle University, 54124 Thessaloniki, Greece;
| | - Apostolos Vantarakis
- Environmental Microbiology Unit of Public Health, Medical School, University of Patras, Rio Achaia, 26504 Patra, Greece;
| | - Georgios Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, 3, Panepistimiou Str., Viopolis, 41500 Larisa, Greece;
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
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Kasabji F, Alrajo A, Vincze F, Kőrösi L, Ádány R, Sándor J. Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238998. [PMID: 33287122 PMCID: PMC7730532 DOI: 10.3390/ijerph17238998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
The inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic minority in Europe) are being left out of access to medical advances. Objectives: The study aimed to describe the association between general medical practice (GMP) level of average per capita expenditure of the National Health Insurance Fund (NHIF), and the proportion of Roma people receiving GMP in Hungary, controlled for other socioeconomic and structural factors. Methods: A cross-sectional study that included all GMPs providing care for adults in Hungary (N = 4818) was conducted for the period 2012–2016. GMP specific data on health expenditures and structural indicators (GMP list size, providing care for adults only or children also, type and geographical location of settlement, age of GP, vacancy) for secondary analysis were obtained from the NHIF. Data for the socioeconomic variables were from the last census. Age and sex standardized specific socioeconomic status indicators (standardized relative education, srEDU; standardized relative employment, srEMP; relative housing density, rHD; relative Roma proportion based on self-reported data, rRP) and average per capita health expenditure (standardized relative health expenditure, srEXP) were computed. Multivariate linear regression model was applied to evaluate the relationship of socioeconomic and structural indicators with srEXP. Results: The srEDU had significant positive (b = 0.199, 95% CI: 0.128; 0.271) and the srEMP had significant negative (b = −0.282, 95% CI: −0.359; −0.204) effect on srEXP. GP age > 65 (b = −0.026, 95% CI: −0.036; −0.016), list size <800 (b = −0.043, 95% CI: −0.066; −0.020) and 800–1200 (b = −0.018, 95% CI: −0.031; −0.004]), had significant negative association with srEXP, and GMP providing adults only (b = 0.016, 95% CI: 0.001;0.032) had a positive effect. There was also significant expenditure variability across counties. However, rRP proved not to be a significant influencing factor (b = 0.002, 95% CI: −0.001; 0.005). Conclusion: As was expected, lower education, employment, and small practice size were associated with lower NHIF expenditures in Hungary, while the share of self-reported Roma did not significantly affect health expenditures according to our GMP level study. These findings do not suggest the necessity for Roma specific indicators elaborating health policy to control for the risk of widening inequalities imposed by rising health expenses.
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Affiliation(s)
- Feras Kasabji
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - Alaa Alrajo
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, H-1139 Budapest, Hungary;
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Correspondence:
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West Ohueri C. On Living And Moving With Zor: Exploring Racism, Embodiment, And Health In Albania. Med Anthropol 2020; 40:241-253. [PMID: 32852225 DOI: 10.1080/01459740.2020.1807539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Drawing on ethnographic research from Albania, I examine Romani and Balkan Egyptian women's health inequities. While it has been well documented that Romani people, who constitute Europe's largest socioracial minority group, experience racism and marginalization, how these forms of social exclusion shape health outcomes in the Balkans remains limited. I argue that racism is a root cause of social and health inequities, and that Romani and Egyptian women experience unique bodily fatigue marked by extreme zor ("difficulty," "constraint"). An examination of zor can potentially provide an understanding of how racism and marginalization are embodied over time.
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Affiliation(s)
- Chelsi West Ohueri
- Department of Slavic and Eurasian Studies, The University of Texas at Austin, Austin, TX, USA
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5
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Ádány R, Pikó P, Fiatal S, Kósa Z, Sándor J, Bíró É, Kósa K, Paragh G, Bácsné Bába É, Veres-Balajti I, Bíró K, Varga O, Balázs M. Prevalence of Insulin Resistance in the Hungarian General and Roma Populations as Defined by Using Data Generated in a Complex Health (Interview and Examination) Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134833. [PMID: 32635565 PMCID: PMC7370128 DOI: 10.3390/ijerph17134833] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
Abstract
Data mainly from one-off surveys clearly show that the health of Roma, the largest ethnic minority of Europe, is much worse than that of the general population. However, results from comprehensive exploratory studies are missing. The aim of our study was to create a complex database for comparative and association studies to better understand the background of the very unfavourable health of Roma, especially the high burden of cardiometabolic diseases. A three-pillar (questionnaire-based, physical and laboratory examinations) health survey was carried out on randomly selected samples of the Hungarian general (HG, n = 417) and Roma (HR, n = 415) populations, and a database consisting of more than half a million datapoints was created. Using selected data, the prevalence rates of metabolic syndrome (MetS) and of its components were determined, and to estimate the risk of insulin resistance (IR), surrogate measures (the homeostasis model assessment of insulin resistance index, quantitative insulin sensitivity check index, McAuley and TyG indices and the TG/HDL-C ratio) were calculated. Receiver operating characteristic curve analysis and Youden’s method were used to define the optimal cut-off values of each IR index. The prevalence of MetS was very high in both study populations (HG: 39.8%, HR: 44.0%) with no statistically significant difference between the two groups in females or males. The prevalence of MetS showed a very marked increase in the HR 35–49 years age group. Among surrogate measures, the TyG index showed the greatest power for predicting IR/MetS at a cut-off value of 4.69 (77% sensitivity, 84% specificity) and indicated a 42.3% (HG) and 40.5% (HR) prevalence of IR. The prevalence of MetS and IR is almost equally very unfavourable in both groups; thus, the factors underlying the high premature mortality burden of Roma should be further clarified by investigating the full spectrum of risk factors available in the database, with a special focus on the access of Roma people to preventive and curative health services.
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Affiliation(s)
- Róza Ádány
- MTA-DE Public Health Research Group, Public Health Research Institute, University of Debrecen, 4032 Debrecen, Hungary
| | - Péter Pikó
- MTA-DE Public Health Research Group, Public Health Research Institute, University of Debrecen, 4032 Debrecen, Hungary
| | - Szilvia Fiatal
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - Zsigmond Kósa
- Department of Health Methodology and Public Health, Faculty of Health, University of Debrecen, 4400 Nyíregyháza, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - Éva Bíró
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - Karolina Kósa
- Institute of Behavioural Sciences, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - György Paragh
- Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Éva Bácsné Bába
- Institute of Sport Management, University of Debrecen, 4032 Debrecen, Hungary
| | - Ilona Veres-Balajti
- Department of Physiotherapy, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - Orsolya Varga
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary
| | - Margit Balázs
- MTA-DE Public Health Research Group, Public Health Research Institute, University of Debrecen, 4032 Debrecen, Hungary
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6
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Pavlikova B, Freel L, van Dijk JP. To Comply or Not to Comply: Roma Approach to Health Laws. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3087. [PMID: 32365484 PMCID: PMC7246461 DOI: 10.3390/ijerph17093087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Barbara Pavlikova
- Research Agency, 831 02 Bratislava, Slovakia
- Department of Labor Law and Social Welfare Law, Faculty of Law, Comenius University, 810 00 Bratislava, Slovakia
| | - Lenka Freel
- Department of Labor Law and Social Welfare Law, Faculty of Law, Comenius University, 810 00 Bratislava, Slovakia
| | - Jitse P. van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, 040 01 Kosice, Slovakia
- Theological Faculty, Olomouc University Social Health Institute, Palacky University, 771 11 Olomouc, Czech Republic
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Drobnakova S, Madarasova Geckova A, Vargova V, Schusterova I, Rosenberger J, Klein D, P van Dijk J, Reijneveld SA. Juvenile Idiopathic Arthritis: Roma Children Seem to Run More Risk than Non-Roma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072377. [PMID: 32244474 PMCID: PMC7177970 DOI: 10.3390/ijerph17072377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 11/16/2022]
Abstract
Background: Ethnic information regarding juvenile idiopathic arthritis (JIA) exists for various populations across the world but is fully lacking for Roma. We assessed the occurrence and clinical characteristics of JIA in Roma vs. non-Roma children. Methods: We obtained data on all outpatients (n = 142) from a paediatric rheumatology centre (age 3 to 18 years) in the eastern part of Slovakia (Kosice region). We assessed patients' age, gender, disease type and related extra-articular conditions by ethnicity. We obtained population data from the 2011 census. Results: The share of Roma children was higher in the clinical JIA sample than in the overall population (24.6%, n = 35, Roma in the sample vs. 10.8%, n = 142, Roma in the population, p < 0.05). Moreover, Roma children had been diagnosed more frequently with extra-articular conditions but did not differ in other symptoms. Treatments also did not differ by ethnicity. Conclusion: Roma children had been diagnosed more with JIA than their non-Roma peers. This calls for further research on the causes of this increased disease burden in Roma children.
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Affiliation(s)
- Simona Drobnakova
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic; (V.V.); (I.S.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic; (A.M.G.); (J.R.); (J.P.v.D.)
- Correspondence:
| | - Andrea Madarasova Geckova
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic; (A.M.G.); (J.R.); (J.P.v.D.)
- Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
| | - Veronika Vargova
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic; (V.V.); (I.S.)
| | - Ingrid Schusterova
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic; (V.V.); (I.S.)
| | - Jaroslav Rosenberger
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic; (A.M.G.); (J.R.); (J.P.v.D.)
- Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
- 2nd Intenal Clinic, Faculty of Medicine, University PJ Safarik, 040 01 Kosice, Slovak Republic
| | - Daniel Klein
- Institute of Mathematics, Faculty of Natural Sciences, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic;
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovak Republic; (A.M.G.); (J.R.); (J.P.v.D.)
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
- Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| | - Sijmen A. Reijneveld
- Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands;
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Stojisavljevic S, Grabez M, Stojanovski K. Unmet Health Needs of Roma Women in the Two Biggest Roma Communities in the Republic of Srpska, Bosnia and Herzegovina. Front Public Health 2020; 8:30. [PMID: 32211359 PMCID: PMC7075933 DOI: 10.3389/fpubh.2020.00030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Reasons for unmet health needs vary from individual to contextual determinants but are defined as the difference between needed health service and services actually received. Roma experience elevated health issues and challenging social conditions. Objective: The aim of this study was to explore the unmet health needs and potential risk factors among Roma women living in the two biggest Roma communities in the Republic of Srpska. Method: We conducted a health assessment of 183 adult Roma women in the Republic of Srpska. Unmet health needs were observed as the absence of needed medical supervision, despite having chronic conditions. We used logistic regression to assess the degree to which unmet health needs were related to the social determinants and the health status of Roma women. Results: The majority of Roma women were married or were in an unofficial relationship (55.2%), were without schooling (62.8%), and were unemployed (88.5%). The results showed that 94.0% had health insurance, had a health card, and were registered with a family medicine doctor. Sixty percent reported having a chronic disease; however, 68.2% reported that their chronic disease was not medically supervised. Roma women that had less education, those who were unemployed, and those who were divorced or widowed women were more likely to have unmet health needs. Conclusion: Roma women in Bijeljina and Prijedor have unmet health needs due to the circumstances they live in despite the fact that majority of them have health insurance and universal health access is legally guaranteed.
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Affiliation(s)
- Stela Stojisavljevic
- Department of Social Medicine, Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- *Correspondence: Stela Stojisavljevic
| | - Milkica Grabez
- Department of Social Medicine, Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Kristefer Stojanovski
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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9
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Why don't health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices. Soc Sci Med 2020; 246:112739. [DOI: 10.1016/j.socscimed.2019.112739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/14/2019] [Accepted: 12/14/2019] [Indexed: 11/21/2022]
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10
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Bosakova L, Madarasova Geckova A, van Dijk JP, Reijneveld SA. Increased Employment for Segregated Roma May Improve Their Health: Outcomes of a Public-Private Partnership Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162889. [PMID: 31412549 PMCID: PMC6719200 DOI: 10.3390/ijerph16162889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Lucia Bosakova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia.
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia.
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic.
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Belak A, Madarasova Geckova A, van Dijk JP, Reijneveld SA. What Roma nonadherence is likely and what drives it? Reply to Broz and Nunes. Int J Public Health 2019; 64:805-807. [PMID: 31143964 DOI: 10.1007/s00038-019-01250-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Andrej Belak
- Faculty of Medicine, Kosice Institute for Society and Health, P.J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia.
- Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia.
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of General Anthropology, Faculty of Humanities, Charles University, Prague, Czech Republic.
| | - Andrea Madarasova Geckova
- Faculty of Medicine, Kosice Institute for Society and Health, P.J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia
- Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jitse P van Dijk
- Faculty of Medicine, Kosice Institute for Society and Health, P.J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Filakovska Bobakova D. Challenges for research, policy and practice in the field of Roma health. Int J Public Health 2019; 64:645-646. [PMID: 31119304 DOI: 10.1007/s00038-019-01254-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Daniela Filakovska Bobakova
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia. .,Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic.
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Why don't segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia. Int J Public Health 2018; 63:1123-1131. [PMID: 29909522 PMCID: PMC6245243 DOI: 10.1007/s00038-018-1134-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/11/2018] [Accepted: 06/05/2018] [Indexed: 01/05/2023] Open
Abstract
Objectives The health status of segregated Roma is poor. To understand why segregated Roma engage in health-endangering practices, we explored their nonadherence to clinical and public health recommendations. Methods We examined one segregated Roma settlement of 260 inhabitants in Slovakia. To obtain qualitative data on local-level mechanisms supporting Roma nonadherence, we combined ethnography and systematic interviewing over 10 years. We then performed a qualitative content analysis based on sociological and public health theories. Results Our explanatory framework summarizes how the nonadherence of local Roma was supported by an interlocked system of seven mechanisms, controlled by and operating through both local Roma and non-Roma. These regard the Roma situation of poverty, segregation and substandard infrastructure; the Roma socialization into their situation; the Roma-perceived value of Roma alternative practices; the exclusionary non-Roma and self-exclusionary Roma ideologies; the discrimination, racism and dysfunctional support towards Roma by non-Roma; and drawbacks in adherence. Conclusions Non-Roma ideologies, internalized by Roma into a racialized ethnic identity through socialization, and drawbacks in adherence might present powerful, yet neglected, mechanisms supporting segregated Roma nonadherence. Electronic supplementary material The online version of this article (10.1007/s00038-018-1134-2) contains supplementary material, which is available to authorized users.
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Halánová M, Veseliny E, Kalinová Z, Jarčuška P, Janičko M, Urbančíková I, Pella D, Dražilová S, Babinská I. Seroprevalence of Hepatitis E Virus in Roma Settlements: A Comparison with the General Population in Slovakia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E904. [PMID: 29751522 PMCID: PMC5981943 DOI: 10.3390/ijerph15050904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/25/2018] [Accepted: 04/28/2018] [Indexed: 02/07/2023]
Abstract
Hepatitis E infection is one of the most frequent causes of acute hepatitis in the world. Currently five human genotypes with different geographical distributions and distinct epidemiologic patterns are identified. In Slovakia, only rare cases of hepatitis E have been reported in past years. Because the most important risk factors associated with HEV infection include consumption of contaminated pork meat and poor hygienic standards, the aim of the study was to evaluate the prevalence of anti-HEV total antibodies and the main risk factors for HEV in the population living in separated and segregated Roma settlements (n = 195), which represent places with increased risk of infection in Slovakia and to compare it with the prevalence in the general population (n = 69). Of 264 respondents included in the study, 47 (17.8%) showed positivity for anti-HEV antibodies, 42 of whom were Roma (21.5%, n = 195) and 5 (7.2%, n = 69) non-Roma. The population living in Roma settlements lives in poorer conditions and are at higher risk of HEV in comparison to the general population. However, differences in living conditions within the settlements do not contributed to lower risk of HEV antibody prevalence between Roma living in settlements.
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Affiliation(s)
- Monika Halánová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04180 Košice, Slovakia.
| | - Eduard Veseliny
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia.
| | - Zuzana Kalinová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04180 Košice, Slovakia.
| | - Peter Jarčuška
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia.
| | - Martin Janičko
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia.
| | - Ingrid Urbančíková
- Department of Pediatrics, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04011 Košice, Slovakia.
| | - Daniel Pella
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia.
| | - Sylvia Dražilová
- Department of Internal Medicine, University Hospital Poprad, 05801 Poprad, Slovakia.
| | - Ingrid Babinská
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04180 Košice, Slovakia.
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Kozubik M, van Dijk JP, Odraskova B. Roma Housing and Eating in 1775 and 2013: A Comparison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E588. [PMID: 29587393 PMCID: PMC5923630 DOI: 10.3390/ijerph15040588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022]
Abstract
We compared housing and the eating habits of Roma. Contemporary findings (2013) were compared with those from the first monothematic work on Roma (1775), which depicts their housing and eating habits, especially regarding the differences between social classes. Data were obtained from a journal (1775) and from semi-structured interviews (2013) with more than 70 Roma women and men who live in segregated and excluded settlements at the edges of villages or scattered among the majority. Data were collected in two villages and one district town in the Tatra region, where the data from the 1775 measurements originated. We used classical sociological theory to interpret the obtained data. The main findings showed differences between specific social classes then and now regarding housing, as well as the eating habits related to both conditions among the Roma in the Tatra region. The houses of rich Roma families did not differ from the houses of the majority population. The huts of the poorest inhabitants of settlements did not meet any hygiene standards. Typical Roma foods such as gója or marikľa were the traditional foods of Slovak peasants living in poverty in the country. We concluded that the housing and eating habits of the citizens of poor settlements located in the eastern parts of Slovakia are still similar to those of two centuries ago. The existing social exclusion may be explained partly from this finding.
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Affiliation(s)
- Michal Kozubik
- Department of Social Work and Social Sciences, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovak Republic.
| | - Jitse P van Dijk
- Department of Community & Occupational Medicine, University Medical Centre Groningen, University Groningen, 9713 GZ Groningen, The Netherlands.
- Olomouc University Society and Health Institute, Palacký University, 771 47 Olomouc, Czech Republic.
- Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University, 771 47 Olomouc, Czech Republic.
| | - Barbora Odraskova
- Institute of Romany Studies, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovak Republic.
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How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121569. [PMID: 29236067 PMCID: PMC5750987 DOI: 10.3390/ijerph14121569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/08/2017] [Accepted: 12/10/2017] [Indexed: 12/03/2022]
Abstract
In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP’s agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program’s merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP’s everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs’ impact on SDH, their theories and procedures should be adapted according to the programs’ more promising actual practice regarding SDH.
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