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Health and the Roma Community, Analysis of the Situation in Europe

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Health and the Roma Community, Analysis of the Situation in Europe Health and the Roma Community, FSG Cuaderno Técnico nº 97 Técnico FSG Cuaderno analysis of the situation in Europe Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain Slovakia, Romania, Portugal, Greece, Bulgaria, Czech Republic, Financed by: Health and the Roma Community, analysis of the situation in Europe. in Europe. of the situation analysis Health and the Roma Community, Health and the Roma Community, analysis of the situation in Europe Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain Title: HEALTH AND THE ROMA COMMUNITY, ANALYSIS OF THE SITUATION IN EUROPE. Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain Published by: • EFXINI POLI – Local Authorities for Social, Cultural, Tourist, Environmental and Agricultural Development. Greece. • FSG – Fundación Secretariado Gitano. Spain. • OFFICE OF THE COUNCIL FOR ROMA COMMUNITY AFFAIRS. Czech Republic. • PDCS – Partners for Democratic Change Slovakia. • REAPN – Rede Europeia Anti-Pobreza/Portugal . • ROMANI CRISS – Roma Center for Social Interventions and Studies. Romania. • THRPF – The Health of Romany People Foundation. Bulgaria. Coordinated by: Fundación Secretariado Gitano Health Area. Nuria Serrano Rodriguez. Nuria Rodríguez Derecho. Edited by: Fundación Secretariado Gitano C/ Ahijones s/n 28018 Madrid (Spain) Tel-0034914220960 www.gitanos.org [email protected] Designed and printed by: A.D.I. Depósito legal: GU-464/2009 ©FSG Madrid 2009 Cuadernos Técnicos Nº 97 This document arises from the project HEALTH AND THE ROMA COMMUNITY: ANALYSIS OF THE SITUATION IN EUROPE which received funding from the European Union, in the framework of the Public Health Programme. The views expressed herein are those of individual authors and can therefore in no way be taken to refl ect the offi cial opinion of the Executive Agency for Health and Consumers. Table of Contents Presentation . 5 Health and the Roma Community, comparative analysis of the situation in Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia and Spain . 7 Methodology . 11 Part 1. Socio-demographic characteristics . 17 Part 2. Health status . 31 Part 3. Use of health-care services . 43 Part 4. Lifestyles. 59 Summary and conclusions . 69 Recommendations for the improvement of the health situation of the Roma Community and the reduction of health inequalities in the European Union . 75 General recommendations. 78 From the macro- to the micro-level in healthcare provision . 82 Summary and conclusions . 93 Annexes. Executive summaries of the national reports on health and the Roma Community . 95 Analysis of the situation in Bulgaria . 97 Analysis of the situation in the Czech Republic . 109 Analysis of the situation in Greece . 119 Analysis of the situation in Portugal . 131 Analysis of the situation in Romania. 147 Analysis of the situation in Slovakia . 153 Analysis of the situation in Spain . 165 Bibliography . 177 Presentation Presentation The Roma community is the largest ethnic minority in Europe and is characterised primarily by the situ- ation of social exclusion and wide-ranging poverty experienced by a signifi cant proportion of its mem- bers. Inadequate access to housing, education, employment and other needs, along with the existence of barriers to Roma access to health services and an ineff ective use of these services due to their lack of adaptation and even to discrimination, all contribute to a range of avoidable injustices suff ered by this community with regard to their health situation. These health inequalities are not refl ected in reliable and up-to-date statistics or data, a fact which further hinders the planning of targeted interventions designed to reduce and ultimately eliminate inequality. The European project “Health and the Roma Community, Analysis of the Situation in Europe”, promoted by the Fundación Secretariado Gitano, was implemented in 2007 to analyse the health situation of Eu- rope’s Roma community, to address social inequalities in the area of health and to suggest policies and actions based on reliable knowledge designed to improve the health status of Europe’s Roma commu- nity and to reduce inequality. This project, funded by the European Union within the framework of the Public Health Programme, was implemented in seven European Union countries (Greece, Spain, the Czech Republic, Slovakia, Portugal, Romania and Bulgaria) with the participation of public and private entities from the diff erent participat- ing countries1 and under the coordination of the Fundación Secretariado Gitano. On 1 November 2007 the European project “Health and the Roma Community, Analysis of the Situation in Europe” was launched on the basis of the National Health Survey of the Roma population in Spain conducted in 2006 by the Ministry of Health and Consumer Aff airs and the Fundación Secretariado Gi- tano. Four clear and concise objectives were pursued: • To gather objective data on the health status of the Roma population living in the participating countries and their use of health-care resources. • To make a diagnosis, based on objective data, of the health situation of the Roma community in each of the countries. • To implement eff ective strategies designed to enhance the health of the Roma community and reduce inequality and to make recommendations in this connection at all levels. • To raise the awareness of stakeholders (politicians, technical decision-makers, representatives of the Roma community, etc.) regarding the need to implement measures and strategies to im- prove the health situation of Europe’s Roma community and reduce inequality 1 EFXINI POLI – Local Authorities for Social, Cultural, Tourist, Environmental and Agricultural Development. Greece. FSG – Fundación Secretariado Gitano. Spain. OFFICE OF THE COUNCIL FOR ROMA COMMUNITY AFFAIRS. Czech Republic. PDCS – Partners for Democratic Change Slovakia. REAPN – Rede Europeia Anti-Pobreza/Portugal. ROMANI CRISS – Roma Center for Social Interventions and Studies. Romania. THRPF – The Health of Romany People Foundation. Bulgaria. 5 Health and the Roma Community, analysis of the situation in Europe The work was based on a survey of the Roma population in Europe regarding their health status and access to health-care resources. A total of 7,604 Roma of all ages from the seven participating countries were interviewed. Information regarding households and household members was also gathered. A group of experts was created in each country composed of professionals with diff erent backgrounds: experts on health and the Roma community, representatives of public administrations, representatives of Roma organisations, experts in research and the interpretation of statistical data, etc. These profes- sionals played an active role in the implementation of the project from the very beginning and, once all of the statistical information was processed (undertaken by the Spanish fi rm EDIS), they were entrusted with analysing the results obtained and preparing a report on the situation facing the Roma population in participating countries and, where possible, comparing it with that of the overall population. They also formulated recommendations for intervention based on the information gathered. In order to provide a global overview of the health status of the Roma population in the countries that participated in the project, this document shows the main results of each of the seven national surveys conducted and draws comparisons between countries. As already mentioned, the ultimate objective of this document is not merely to generate knowledge on the health inequalities aff ecting the Roma popu- lation in Europe, but to contribute to their reduction. Therefore, this document makes a series of action proposals targeting each of the key agents involved in the health-Roma community nexus, focusing on correcting existing inequalities. Our wish is to raise the awareness of stakeholders as to the need to im- plement measures targeting health promotion among the Roma community and reducing inequality. Lastly, it ought to be reiterated that only through the development of studies and research can we expect to accumulate suffi cient knowledge of the reality facing the Roma population so as to be able to design and set up specifi c action programmes to palliate and ultimately resolve the inequalities that persist to this day between the Roma community and the European society as a whole. 6 Health and the Roma Community, comparative analysis of the situation in Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia and Spain Introduction Introduction The present analysis, elaborated on the basis of the information collected in the surveys realised in each one of the seven countries that participated in the European project “Health and the Roma Community: Analysis of the situation in Europe”, aims at shedding light on aspects that have been overlooked or neglected, at least in empirical terms, on the state of health of the Roma population at the European level. The following chapters address the health of the Roma community from diverse angles. They endeavour to facilitate an understanding of the situation of Roma persons with regard to their health (both objectively and subjectively), their access to and use of the principal health services, prevalent diseases and promi- nent aspects of their lifestyles, by systematically comparing the data obtained in the seven participating countries. In this sense, it provides statistics
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