Roma Housing and Eating in 1775 and 2013: A Comparison

Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary

Introduction

Spatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities.

Aims

We used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems.

Methods

A cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI).

Results

Broad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending.

Conclusion

Adults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.

Roma Religion: 1775 and 2018 Compared over Time

The objective of the present study was to compare the religiosity of the Roma in the 18th century with the present. In 1775 and 1776, Samuel Augustini ab Hortis detailed the way of life of the Roma community in the Austro-Hungarian monarchy in his work "Von dem Heutigen Zustände, Sonderbaren Sitten und Lebensart, Wie Auch von Denen Übrigen Eigenschaften und Umständen der Zigeuner in Ungarn" (On the Contemporary Situation, Distinctive Manners and Way of Life, as Well as the Other Characteristics and Circumstances of Gypsies in Greater Hungary). A detailed content analysis of the part of his work dealing with religion was performed. Subsequently, in 2018, field research was conducted in the environment in which Samuel Augustini lived and worked. It involved six key informants, each representing a different municipality. Data collection was carried out over two periods: in the summer months of 2012-2013 and the winter period of 2018-2019. After the interviews with the key informants, more than 70 participants were included in semi-structured interviews through snowball sampling, and another 40 participants were included in two focus groups. The data was evaluated and content analysis was used to process the data. The findings confirm that both in the past and the present, the Roma community adopted the dominant religion of the host country. In the studied environments, the activities of the majority, present then and now in the Catholic Church, failed, and various other missionary movements, such as the Maranatha Mission, came to the fore. Membership in new religious movements resulted in social changes in marginalized Roma communities. However, they may not have only had positive effects. Various effects of their activities may be studied in the future.

CVD Risk Factors in the Ukrainian Roma and Meta-Analysis of Their Prevalence in Roma Populations Worldwide

The Roma population suffers from severe poverty, social exclusion, and some of the worst health conditions in the industrialized world. Herein, we report on cardiovascular disease (CVD) risk factors in the Ukrainian Roma and present a meta-analysis of the prevalence of CVD risk factors in 16 Roma populations worldwide. The meta-analyses of CVD risk factors in Roma (n = 16,552) vs. non-Roma majority population of the same country (n = 127,874) included publicly available data. Ukrainian field survey included 339 adults of both sexes and outcomes of interest were hypertension, body mass index (BMI), smoking, education, and employment status. Furthermore, 35.7% of the Ukrainian Roma were hypertensive, 69.3% unemployed, and 48.4% never went to school. Ukrainian Roma women were more likely to be underweight and more prone to be hypertensive, with odds of hypertension increasing with age, BMI, and positive smoking status. Meta-analyses showed that, in comparison with non-Roma worldwide, the Roma bear significantly higher risk factor loads related to smoking (OR = 2.850), diabetes (OR = 1.433), abdominal obesity (OR = 1.276), and metabolic syndrome (OR = 1.975), with lower loads for hypertension (OR = 0.607) and BMI ≥ 25 kg/m² (OR = 0.872). To conclude, the CVD risk factors which are more common in Roma than in the majority population may reflect their poor health-related behaviors and inadequate access to health education.

Social Structure in a Roma Settlement: Comparison over Time

The objective of the present study was to compare the social structure and internal establishment of a Roma community in two historical periods: in the 18th century and the present. We analysed Samuel Augustini ab Hortis's work, "Von dem Heutigen Zustände, Sonderbaren Sitten und Lebensart, Wie Auch von Denen Übrigen Eigenschaften und Umständen der Zigeuner in Ungarn" (On the Contemporary Situation, Distinctive Manners and Way of Life, as Well as the Other Characteristics and Circumstances of Gypsies in Greater Hungary), written in 1775-1776. Using content analysis, we subsequently compared his findings with our recent data from analogous qualitative research in a geographically-defined area of north-eastern Slovakia, the same region in which Augustini lived. Data collection was intensely conducted in 2012-2013 and once more in 2017-2019. The qualitative methods included direct observation, semi-structured interviews and focus groups. Four key informants and more than 70 participants collaborated in the study. The greatest difference we observed compared to the 18th century was the absence of a leader of the community, a "vajda", whose status was taken over by a new social class of "entrepreneurs". The most vulnerable group of the segregated and separated Roma communities are the "degesa", the lowest social class. They face a phenomenon consisting of so-called triple marginalization: they live in one of the most underdeveloped regions of the country, they inhabit segregated settlements and they are excluded by their own ethnic group. The socioeconomic status of the richest classes has changed faces, while the socioeconomic status of the lowest has not. We found a misconception among helping professionals (e.g., social workers) regarding the homogeneity of the Roma community. This calls for more attention to the erroneous use of the ethnic-based approach in the helping professions.

The cross-sectional study of Toxoplasma gondii seroprevalence in selected groups of population in Slovakia

Toxoplasma gondii is an obligate intracellular protozoan parasite with domestic or free-living members of family Felidae known as the only definitive hosts of the parasite. The study aimed to evaluate the seroprevalence of toxoplasmosis in selected population groups in Slovakia and to analyse the infection risk factors. Totally 1536 serum samples of voluntary respondents were examined by EIA Toxoplasma IgG (Test-Line Ltd., Clinical Diagnostics, Brno, Czech Republic). IgG antibodies to T. gondii were detected in 322 (21.0%) sera, with the highest seropositivity recorded among farmers (42.5%) and hunters (28.5%). According to age, the highest seropositivity was recorded in 12-18-year-old Roma children (46.2%), what confirms increased risk of infection in this minority that often lives in inadequate hygiene conditions. When only adult participants were taken into account, the highest seroprevalence was observed in the age group of ≥ 70 years. Higher risk of infection (p < 0.05) was connected with cat ownership, living in rural residency and consumption of raw meat and meat processing. The results underline the importance of preventive measures and ongoing need to improve the knowledge on toxoplasmosis in both professionals and public.

Aspects of Illness and Death among Roma-Have They Changed after More than Two Hundred Years?

Augustini studied Roma and published reports in 1775–1776 on their illnesses and death. Our intention was to compare the features of these two topics described by him in the late 18th century with those in the present time. We studied Augustini’s work on illnesses and death in the past. The present qualitative study was conducted in 2012–2013 in the same geographical area in which Augustini lived and worked more than two hundred years ago, i.e., the Tatra Region in Slovakia; our findings were evaluated in 2017–2018. We carried out semi-structured interviews with more than 70 informants and organised two sessions of focus groups. Data were analysed using content analysis (Augustini) and an open coding process. Our findings suggest that illnesses in Roma are treated differently nowadays compared with 1775–1776. For example, the traditional forms of healing have completely disappeared in the area of investigation. We did not observe any differences in dying and death perceptions between the past and nowadays. Although data and knowledge on health disparities and related mechanisms exist, and much more about perceptions of Roma regarding illnesses is now known compared with 1775–1776, so far, this knowledge has not helped to design effective interventions to overcome them. Substandard living conditions in marginalised Roma communities have not significantly improved since 1775–1776, which may contribute to their higher morbidity and mortality also nowadays. Political and social consensus should lead to a comprehensive vision for enhancing the social situation and living conditions in segregated settlements, especially providing housing for the poorest classes and overcoming health disparities.