Healthier lives for European minority groups: school and health care, lessons from the Roma

Roma Women's Role in the Health Preservation of Their Communities during the COVID-19 Pandemic

The scientific literature has evidenced the stereotypes that affect the Roma people, which are detrimental to their access to the health systems in various countries. With the COVID-19 pandemic, this situation has been aggravated by falsely blaming, on many occasions, the Roma people as spreaders of the virus for supposedly not complying with the norms established by the health authorities. However, it has not been explored in depth what actions have been carried out by the Roma people during the pandemic to cope with this aspect. The aim of this article is to learn about the leadership of Roma women in relation to maintaining the health of their community during the pandemic. The research has been conducted through focus groups and life stories with a total of 47 Roma women and 24 Roma men participants, as well as interviews with 40 professionals from education, social services, health services, and civic organizations. The results show how the reality of the studied contexts was different to those stereotypes, that the Roma women in the contexts studied have led actions that preserved the health of their communities, that the established measures were strictly followed, breaking with the extended stereotype about the Roma people.

Effects of an educational intervention on nursing students' attitudes towards gypsy women: A non-randomized controlled trial

BACKGROUND

The cultural differences between health professionals and patients, together with the ethnocentric opinions that some health professionals sometimes hold, generate prejudice and negatively influence the experiences of these groups, for example, the Gypsy population.

METHODS

We set up a quasi-experimental study to test the efficacy of an educational intervention among 40 nursing students in Spain based on the use of positive references in order to improve the students' attitude towards gypsy women receiving health care. Analysis of comparison of means and correlation analysis were carried out according to the type of variable compared.

RESULTS

The score in all the items that make up the Prejudicial Attitude Scale (PAT) decreased after the test, which demonstrated that their attitudes had become less prejudiced. The Stereotype Content Model (SCM), the perception of the outgroup and the stereotypes regarding the Roma population as "trustworthy" all improved showing a statistically significant difference between the periods (pre and post educational intervention).

CONCLUSION

Nursing educators have the opportunity, through theoretical and practical exposure to positive references, to explore the students' experience and perceptions, analyze interventions and change their perceptions of threat, thus contributing to a more inclusive group identity.

Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary

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.

Cardiovascular risk factors in a Roma sample population from Romania

BACKGROUND

The Roma population has a high prevalence of cardiovascular risk factors, higher mortality, and shorter life expectancy. It is found in the largest number in Romania, but published data are still scarce here. We studied cardiovascular risk factors and disease along with target organ damage on a population of Roma inhabitants from Bucharest, Romania.

METHODS

This cross-sectional study enrolled 806 Roma subjects (18-83 years), in a community-based participatory research manner. Demographics included anthropometric data, a questionnaire on social status, education, medical history, and health deleterious behaviors. Medical evaluation included clinical examination, blood pressure, ankle-brachial index, pulse wave velocity measurements, blood tests (complete blood count, lipid profile, glucose, creatinine, uric acid), dip-stick microalbuminuria, dilated fundoscopy, ECG, and echocardiography.

RESULTS

Prevalence of all cardiovascular risk factors was high, peaking in abnormal lipid metabolism (82.13%), heavy smoking (63.02% including ex-smokers) and obesity (50.99%). The first and the latter were actually similar to the general population in Romania. Almost half of subjects were at high or very high risk for fatal cardiovascular disease.

CONCLUSIONS

The study shows that the Roma population in a more affluent region in Romania shares a similarly high cardiovascular burden to their surrounding community.

What do we know about the health of Spanish Roma people and what has been done to improve it? A scoping review

Objectives: This study aims to review the published literature on the health of the Roma population in Spain, particularly that which describes health interventions and outcomes. Design: A scoping review of published articles/reports on Roma population health was carried out in Spain for publications between 2002 and 2014. Articles in Spanish or English were identified from Pubmed, Scopus, Science Direct, Web of Science, Scielo, IBECS, MEDES, Dialnet, Index Foundation, a database of theses and Google Scholar. After an initial assessment of the article title and summary, genetic studies, editorials, reviews and grey literature with incomplete data were excluded. Two independent researchers followed a protocol to analyze the selected papers in terms of general information, methodology, themes, and results or conclusions. Results: Forty studies were selected for inclusion, primarily located through PubMed and Google Scholar. Most of the papers were scientific articles, published after 2007 in Spanish scientific journals (70.0%) followed by institutional reports (20.0%). The main language was Spanish (84.2%). The studies were carried out mainly by public institutions (35.0%) or universities (22.5%). Most (67.5%) followed a descriptive design and nearly half (47.5%) were concerned only with the Roma population. The main thematic areas were: child health (25%), infectious diseases (25%), health and social education context (20%), perceived health and lifestyle (15%), sexual and reproductive health (7,5%) and health services use (7,5%). We found seven intervention studies related to health, educational environment, or social services. Conclusions: There are few publications related to the health of the Roma community in Spain and even fewer related to health interventions and outcomes. Those that are available have focused on areas such as child health or infectious disease outbreaks. It is important to promote health interventions in Roma communities and longitudinal studies that include a comprehensive vision and account for the social determinants of health.

Target Organ Damage and Cardiovascular Risk in a Hypertensive Roma Sample Population in Romania

BACKGROUND

The largest European Roma community resides in Romania, but there is still little published data on cardiovascular (CV) risk factors and disease in this group. This study addresses the prevalence of arterial hypertension, associated CV disease risk, and target organ damage (TOD) in a Roma community from Bucharest, Romania.

METHODS

This is a cross-sectional community-based participatory research to assess for CV risk factors, TOD and CV disease, including 806 Roma ethnics (18-83 years) integrated in the local community, 36.16% males. Evaluation included physical examination with blood pressure, pulse wave velocity and anklebrachial measurements, laboratory tests, ECG, echocardiography and fundoscopy.

RESULTS

Prevalence of hypertension was 33.62%, awareness 76.38%, higher in females (p>0.01), and control rate 44.39%. Compared to age-matched normotensives, hypertensives had more left ventricle hypertrophy and more frequently increased pulse pressure. Differences in TOD were attenuated between newly and previously diagnosed, controlled and uncontrolled, hypertensives. Cardiovascular disease was almost absent in normotensives. Ten-year risk for fatal CV disease followed an increasing trend from normotension to long standing hypertension.

CONCLUSION

This is the first dedicated study to thoroughly assess TOD and risk for fatal CV disease in a Romanian Roma population. Hypertension was less prevalent than in the general population, with similar awareness, possibly as a consequence of integration in the surrounding community. Fatal CV disease risk followed the trend of increasing prevalence of risk factors, and hypertension played an important role in its modulation.

A survey of quality of life indicators in the Romanian Roma population following the 'Decade of Roma Inclusion'

Background: This study explores how the Roma in Romania, the EU's most concentrated population, are faring in terms of a number of quality of life indicators, including poverty levels, healthcare, education, water, sanitation, and hygiene. It further explores the role of synthetic populations and modelling in identifying at-risk populations and delivering targeted aid. Methods: 135 surveys were conducted across five geographically diverse Romanian communities. Household participants were selected through a comprehensive random walk method. Analyses were conducted on all data using Pandas for Python. Combining land scan data, time-use survey analyses, interview data, and ArcGIS, the resulting synthetic population was analysed via classification and regression tree (CART) analysis to identify hot-spots of need, both ethnically and geographically. Results: These data indicate that the Roma in Romania face significant disparities in education, with Roma students less likely to progress beyond 8 th grade. In addition, the Roma population remains significantly disadvantaged with regard to safe and secure housing, poverty, and healthcare status, particularly in connection to diarrheal disease. In contrast, however, both Roma and non-Roma in rural areas face difficulties regarding full-time employment, sanitation, and water, sanitation, and hygiene infrastructure. In addition, the use of a synthetic population can generate information about 'hot spots' of need, based on geography, ethnicity, and type of aid required. Conclusions: These data demonstrate the challenges that remain to the Roma population in Romania, and also point to the myriad of ways in which all rural Romanians, regardless of ethnicity, are encountering hardship. This study highlights an approach that combines traditional survey data with more wide-reaching geographically based data and CART analysis to determine 'hot spot' areas of need in a given population. With the appropriate inputs, this tool can be extrapolated to any population in any country.

A survey of quality of life indicators in the Romanian Roma population following the 'Decade of Roma Inclusion'

Background: This study explores how the Roma in Romania, the EU's most concentrated population, are faring in terms of a number of quality of life indicators, including poverty levels, healthcare, education, water, sanitation, and hygiene. It further explores the role of synthetic populations and modelling in identifying at-risk populations and delivering targeted aid. Methods: 135 surveys were conducted across five geographically diverse Romanian communities. Household participants were selected through a comprehensive random walk method. Analyses were conducted on all data using Pandas for Python. Combining land scan data, time-use survey analyses, interview data, and ArcGIS, the resulting synthetic population was analysed via classification and regression tree (CART) analysis to identify hot-spots of need, both ethnically and geographically. Results: These data indicate that the Roma in Romania face significant disparities in education, with Roma students less likely to progress beyond 8 th grade. In addition, the Roma population remains significantly disadvantaged with regard to safe and secure housing, poverty, and healthcare status, particularly in connection to diarrheal disease. In contrast, however, both Roma and non-Roma in rural areas face difficulties regarding full-time employment, sanitation, and water, sanitation, and hygiene infrastructure. In addition, the use of a synthetic population can generate information about 'hot spots' of need, based on geography, ethnicity, and type of aid required. Conclusions: These data demonstrate the challenges that remain to the Roma population in Romania, and also point to the myriad of ways in which all rural Romanians, regardless of ethnicity, are encountering hardship. This study highlights an approach that combines traditional survey data with more wide-reaching geographically based data and CART analysis to determine 'hot spot' areas of need in a given population. With the appropriate inputs, this tool can be extrapolated to any population in any country.