Equality, Health and ther Roma Community

Madrid (Spain), 26-27 October 2006

Conclusions and Recommendations

As we have seen throughout this report, the Roma community, a socially and economically disadvantaged minority, is one of the population groups which is most susceptible to suffer from health deficits; life expectancy, for example, is 8 to 9 years less than that of the rest of the Spanish population. The Roma people are affected by many of the aforementioned health risk factors as a consequence of social exclusion and the fact that they are not able to take advantage of mainstream health resources on an equal footing and with the same rights as the rest of the population. Moreover, cultural aspects of the Roma population and health-care providers’ ignorance of these means that said aspects frequently hinder access to the health-care system.

For all of the foregoing, public authorities must put a priority on implementing specific measures with the Roma community with a view to eliminating existing inequalities and creating a situation in which Roma men and women may enjoy the same opportunities as the majority population when it comes to taking care of their health and improving their standard of living. The health issue should be addressed from a bio-psycho-social point of view. In the past it was believed that health policy consisted basically in offering a series of medical services with little attention to anything else. While it is obviously important to strive towards universal access to health-care services, when addressing the subject of health one cannot forget that economic and social conditions have a very significant influence on the health of the population in general. Poverty, social exclusion, housing, employment, education… are all factors contributing to a healthy life. Health policies cannot lose sight of the importance of also focusing on the social and economic factors which have a bearing on health.

Reducing this inequality has become one of the overarching objectives of all entities taking part in the seminar. In the case of Soain and more specifically of Fundacion Secretariado Gitano, this objective has been bolstered considerably with the signing of the 2003-2008 Collaboration Agreement with the Ministry of Health and Consumer Affairs. This Agreement is being successfully implemented and bears witness to the special sensitivity shown by this Ministry towards groups, like the Roma community, which find themselves in vulnerable situations. The common goal of the actions set out in this Agreement is to improve the health and living standard of the Roma community and to encourage more pro-active social policies which compensate for the inequalities endured by this group in the area of health.

The International Seminar “Equality, Health and the Roma Community” is one of the awareness-raising activities within the framework of this Agreement and the European project Reduction of Health Inequalities in Roma Community.

Moreover, and in light of the fact that the Roma community is an ethnic-cultural group with transnational roots whose presence in Europe numbers in the vicinity of 8,000,000 (data from the Enlarged Europe), a large percentage of which finds itself in a situation of social exclusion and marked inequality in the area of health, it is of the essence to analyse the common factors, the strategies being applied in each country and possible cooperation mechanisms. That is why the FSG has coordinated the European Project Reduction of Health Inequalities in Roma Community.  financed by the European Commission’s Health and Consumer Protection Directorate-General and co-financed by the Spanish Ministry of Health and Consumer Affairs, and has held this international seminar as one of the awareness-raising activities within the framework of the Agreement with the Ministry of Health and Consumer Affairs and the European project mentioned above.

The following could be highlighted as the conclusions and recommendations from the international seminar and therefore from the project:

1.

Presentations and discussion gave evidence from all participated countries that the living conditions, social status and resulting health status of the Roma communities are dramatically lower than those in the mainstream population. One of the main reasons of this situation is long term social exclusion. This situation is relatively similar to the ones suffered by other vulnerable groups such as inmigrants as it has been mentioned in some of the presentations from project’s partners. In this sense, the most disadvantaged socio-economic groups exhibit characteristics making them susceptible to poor health. Other variables such as gender, age, ethnic background, social class or geographical area are also risk factors when it comes to health.

The broad concept of health affecting different aspects of human life is gradually becoming more and more accepted: physical, psychological and socio-cultural aspects and not only absence of disease When approaching health, it is therefore clear that we cannot do it separately from other areas, just from a biological approach.  We need to work on health from a comprehensive approach and activities or programs should be part of general programs focusing on other aspects that are determinant to health such as housing, employment, education, etc. This is the only way we will be able to work effectively on the improvement of access to health system in particular, and the improvement of health situation in general.

2

Lack of data is another common problem when we refer to Roma community all over Europe and therefore this has to be approached. It is important to carry out researchs which gives us data in regard to Roma community and health and confirms if the programs and projects that are being organized are adapted to the current situation and reality. Most of the entities and experts are working with hypothesis and these should be confirmed. Hetereogenity of Roma community, not between countries but also within the same country should be had in mind. Generalization of data should be avoided.

3

It is very important to implement programs on health that are part of larger programs, that have a continuity and are evaluated with instruments that can be used to demonstrate the feasibility of these types of programmes and to make headway in improving their effectiveness. This observation does not refer exclusively to programmes implemented by government administrations but also to those launched by the associative world.

We already have good examples of long-standing programmes that are being carried out and serve as vehicles to raise awareness among professionals and other administrations. These programmes produce a group of trained and aware professionals thus providing an important opportunity for the furthering of specific actions in the area of health. We believe the administrations should have this in mind when allocating funds to the implementation of programs and we ask the European Commission and national administrations to help the continuation of projects such this.

4

The figure of the professional mediator or Roma mediator is not very widespread and the health system is quite unaware that it even exists. Their role as the link between the Roma community and mainstream health-care resources is also an element that should be optimised. The presence of Roma mediators or Roma professionals working in other fields at least somewhat related with health (medicine, social work, nursing, etc.) are an  opportunity for an ongoing cumulative process contributing to a decrease in inequality in the area of health.

However there are some aspects that have to be taken in mind:

• Professional mediation is a resource bridging the gap between the Roma community and the majority society in order to promote constructive change in relations between the two. It is, therefore, a process and not a “fire extinguishing” tool to be used only when conflicts arise.

• Training of mediators is anything but standardised. Some receive ample training before going out into the field while others may have only attended brief capacity-building courses. The topics covered at the different training initiatives also lack standardisation. Moreover, many mediators are also subject to precarious working conditions (part-time, seasonal, etc.) which has a negative influence on the quality of their efforts. These aspects should be improved for the benefit of all.

5

In regard to the health care system the following has been stressed:

• flexibility of the system and ability to adapt to the “difference” is essential. Meassures to achieve this should be taken. The essential challenge lies in including the consideration of difference in the organisation and operation of the health-care system, as well as in the laws and development or enforcement of regulations concerning health-care activities.

• Mutual prejudice, between professionals and Roma community exists in many cases, which generally leads to a relationship based on defensiveness and mistrust. Actions in both directions should be taken, in order to overcome and prevent stereotypes and prejudices.

• A lack of awareness on the part of health-care professionals is observed regarding the characteristics and culture of this minority and in many cases diversity characterizing the Roma community is overlooked. Regular training of professionals is a good practice to improve this situation. The trainings should include topics such as: Roma culture; how Roma community understand health; internal diversity of Roma community; etc.

• The lack of a “culture of health” in the Roma community is also visible, so it is important to work continually with this community on different aspects such as: health promotion/ prevention and to give them information on the functioning of health system.

6.

Roma community has been victim of historic discrimination provided for under legal regulations for centuries. Unfortunately, in some countries more than other, Roma population is still victim of violence of its human rights. Some measures have to be taken into force, such as the new European Directive 2000/43/EC, which sets up a new legislative framework among member countries with respect to the enforcement of the principle of equal treatment among persons regardless of ethnic or racial origin should be a good starting point to fight against discrimination of Roma. This Directive, which presents an opportunity for the establishment of intervention strategies,  the purpose of which is to diminish health inequalities affecting the Roma population. The transposition of this directive has special significance and scope for Roma.

Policies and actions have to be taken to fight against these discrimination actions. Equal treatment is an attempt to advance towards a more just society by means of greater legal guarantees and non-discrimination against minority ethnic groups.