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Whom Are We Talking About? 1 Facts beyond Figures Communi-care for Migrants and Ethnic Minorities The Health Situation of the Roma in Europe Whom are we talking about? 1 • The term Roma refers to Roma, Sinti, Kale and related groups in Europe, including Travellers and the Eastern groups (Dom and Lom) and covers the wide diversity of the groups concerned, including persons who identify themselves as « Gypsies » • There are 10 to 12 million in Europe, the larger part in Central and Eastern Europe. 1 Geographical distribution 2 • Roma – in Central and Eastern Europe • Kale and Gitanos - in Spain • Sinti – in Italy, Germany and Switzerland • Jenisch – in Switzerland • Manouches (Gens du voyage) – in France • Irish and English Travellers – In Ireland and England Common myths 3 • Nomadism has practically disappeared All sedentary in Central and Eastern Europe Slightly nomadic in Western Europe – Italy, France, Greece, Ireland, UK – with strong tendency to sedentarisation 2 Common myths 4 • Not all Roma are poor and live in miserable settlements. Many live in ordinary housing and are integrated • Not all Roma are illiterate. Many have University degrees. • The Roma do not spend their time singing and dancing Health Situation 5 • Short life expectancy Irish Travellers – 10-12 years less than majority population The Lancet, 2006 Irish Travellers – 15 years less than majority population Promoting the Social Inclusion of Roma – EU Network of Independent Experts on social Inclusion – December 2011 3 Life expectancy 6 • In Romania 3.3% of Roma reach 65 In FYROM 3.7% of Roma reach 65 UNICEF Report 2007 • Portugal, Slovak Republic – 15 years less than the majority population Italy – 20 years less than the majority population Promoting the Social Inclusion of Roma -EU Network of Independent Experts on Social Inclusion- December, 2011 . Life expectancy 7 • In Slovakia the life expectancy of Roma women is 17 years shorter than that of the female majority population Ina Zoon « On the Margins » 2001 • In Serbia, life expectancy is 16 years shorter than that of the majority population Roma Early Childhood Inclusion Report, 2011 4 Infant mortality 8 • Infant mortality amongst Irish Travellers- 14/1000 Promoting the Social Inclusion of Roma - EU Network of Independent Experts on social Inclusion, December, 2011 • Bulgaria - infant mortality is 25/1000 amongst the Roma and 9.9/1000 for the majority population Health and the Roma community :Analysis of the Situation in Europe, Dec. 2009 Infant mortality 9 • Greece – infant mortality is 11.6% Promoting the Social Inclusion of Roma -EU Network of Independent Experts on Social Inclusion –December, 2011 • Czech Republic, Slovakia, Hungary- infant mortality double that of majority population UNDP Report, 2003 5 Infant Mortality 10 • In Serbia, infant mortality is double that of the majority population • In Romania, infant mortality is six times higher than in Sweden • Roma Early Childhood Inclusion Report, 2011 Health Conditions 11 • Shift in emphasis in research from contagious to chronic illness and analysis of risk factors • Research on Roma health access to health care: state of the art and future challenges, Oct.2011 • By 2000 there were 32 papers on infectious diseases and 5 on chronic diseases Research Note on the health of Roma, Philippa Mladovsky, LSE, 2007 6 Health conditions –general 12 • In Eastern and SE Europe – higher rates of diabetes, coronary artery diseases, obesity, vitamin deficiencies, malnutrition, anaemia, dystrophy, rickets M. Schaaf:Confronting a hidden disease:TB in Roma communities, 2007 • Travellers in Ireland: high rates of heart disease, lung disease and cancer • Irish Times, 2010 Health conditions –general 13 • English travellers – 5 times more chronic bronchitis and two times more asthma Journal of Epidemiology and Community Health, 2009 • Between 2000 and 2010, 16 countries affected by measles – almost all were Roma Dr Muscat – Department of Epidemiology, Denmark, 2011 • High levels of measles, hypertension and obesity in Bulgaria, Hungary and Romania Socio-economic determinants of health status of Roma in Bulgaria, Hungary and Romania – 2010 7 Health conditions – general 14 • Roma suffering from a disability Bulgaria - 12.6% Czech Republic - 16.6% Greece - 16.1% Portugal - 19.5% Romania - 14.5% Slovak Republic - 18.8% Spain - 12.6% Health conditions – general 15 • Portugal - 22% of minors have asthma • For all the countries under study (Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovak Republic, Spain): - 1 in 4 has hearing problems - 19% had a limitation of daily activity in the previous 2 weeks - frequent ailments –migraine, headaches, hypertension Health and the Roma community :Analysis of the Situation in Europe, Dec. 2009 8 Health situation – general 16 • English Travellers Two times more asthma and five times more chronic bronchitis Journal of Epidemiology and community Health -2009 Health situation – children 17 • In Hungary, premature births are twice higher than in the majority population UNDP Report 2010 • In Serbia 20% of Roma children are stunted – the percentage is three times higher in urban areas Risk factors for childhood malnutrition in Roma settlements in Serbia, 2010 9 Health situation – children 18 • In S.E. Europe 30% of children suffer from diarrhoea UNICEF CEE/CIS -Report on Romani children in S.E. Europe, 2007 In Serbia - high rate of respiratory infection under 5 years of age Access to primary health care for Roma in Serbia – BioMed Central - August, 2011 Causes of ill-health 19 1. Poverty and malnourishment - in Kosovo 31% live in extreme poverty - in Romania 12% live in extreme poverty - in Montenegro half the Roma population lives in poverty - in Bulgaria 46% of the country’s poor are Roma World Bank Poverty Assessment ,2003 10 Causes of ill-health 20 • In S.E. Europe poverty rate is four times higher than that of the majority – in some countries ten times higher • 40% live in poverty and 40% of Roma children are permanently hungry UNICEF CEE/CIS - Report on Romani children in S.E. Europe, 2007 Causes of ill-health 21 • In Serbia 51% of women between 16 and 50 are undernourished UNICEF:Balkan Roma:shunned, illiterate and hungry, May 2007 • In the Balkans 53% of Roma are regularly hungry Surdu, L. and M. Surdu. Broadening the Agenda: The Status of Romani Women in Romania (Open Society Institute, 2006) • There are high levels of inadequate nutrition in the Czech and Slovak Republics Socio-economic determinants of health status of Roma, 2010 11 Causes of ill-health 22 2.Living conditions – Housing • Three types of habitation - integrated - concentrated in part of town - segregated in remote settlement Causes of ill-health 23 • Czech Republic – 45% no water, 20% have electricity • Greece – 265,000 Roma live in 52 shanty towns without services • Hungary – 70% live in segregated housing 26% in settlements • Lithuania - 65% live in conventional dwellings; 41% have water; 37% connected to sewer 12 Causes of ill-health 24 • Portugal – rehoused in marginalised, polluted areas without infrastructure • Slovakia - 120,000 reside in rural settlements and urban slums • Italy – unauthorised camps – isolated, no services, no transport Promoting the Social Inclusion of Roma- EU network of Independent Experts, Dec. 2011 Causes of ill-health 25 • In SE Europe - 47% have a bed for each family member - 66% have no bathroom - 61% have no toilet - 55% no sewerage - 41% no kitchen UNICEF CEE/CIS - Report on Romani children in S.E. Europe, 2007 13 Causes of ill-health 26 3. Lack of Education Lack of education of the mother is predictor of malnutrition and an indirect cause of stunting BioMed Central -Risk factors of childhood malnutrition in Roma settlements in Serbia – 2010 In Hungary twice as many infants are born prematurely - link between birth weight and mother’s education Research Note on the health of Roma, Philippa Mladovsky, LSE, 2007 Causes of ill- health 27 4.Habits and Practices linked to health 4.1 Early marriages leading to: - lack of education - numerous successive pregnancies -frequentabortions 14 Causes of Ill-Health 28 In Bulgaria, the rate of abortion amongst Roma women is 2.4% Research Note on the health of Roma, Philippa Mladovsky, LSE, 2007 In Albania 56% of Roma women had one or more abortions At risk – the social vulnerability of Roma in Albania, 2004 Causes of ill-Health 29 4.2 Marrying within the family In Spain consanguinity is 12 times higher amongst the Roma population The Health of the Roma people – a review of literature – Steve Hajioff, 2009 15 Causes of ill-health 30 4.3 Lack of family planning Lack of information on birth control In Albania, 46% know about birth control; 10% use it At Risk: the social vulnerability of the Roma in Albania, 2004 In Bulgaria 61% use contraception Research Note on the health of Roma, Philippa Mladovsky, LSE, 2007 Causes of ill-Health 31 • In Central and Eastern Europe many Roma women are unaware of HIV transmission. In Romania four times as many Roma women did not know that HIV/AIDS can be transmitted by unprotected heterosexual intercourse. • Roma men use condoms for birth control but not as an HIV protection UNDP–Romania. Social assessment of Roma and HIV/AIDS in Central and Eastern Europe. 31 16 Causes of ill-Health 32 4.4 Smoking Heavy smoking has been found in -Spain (Promoting the Social Inclusion of Roma- EU network of Independent Experts, Dec. 2011) -Slovak Republic (Socio-economic determinants of health status of the Roma , 2010) -Czech Republic – 44% of both sexes smoke (Health and the Roma community :Analysis of the Situation in Europe, Dec. 2009) Causes of ill-Health 33 • Gypsies and Travellers in England –smoke heavier than the majority population (Journal of Epidemiology and Community Health, 2009) • Serbia:almost all women in Roma settlements around Belgrade smoke, many beginning at age 11. • Surdu, L. and M. Surdu. Broadening the Agenda: The Status of Romani Women in Romania (Open Society Institute, 2006) 17 Causes of ill-Health 34 4.5.
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