Slovak Roma Health Needs Assessment September, 2016
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Slovak Roma Health Needs Assessment September, 2016 Lerleen Willis Research and Development Manager, Public Health Intelligence, Policy Performance & Communications, Room 302, Town Hall, Pinstone Street, Sheffield S1 2HH Tel: 0114 2057458 Confidential 1 Version History Title Slovak Roma Health Needs Assessment Reference Status (Draft / Final Issued) Version Version 22.9.16. Date Created 1st June 2016 Approved By Supporting the Integration of New Arrivals Programme Board Audience Clinicians in primary and secondary health care and service providers who will implement the findings. Distribution To be overseen by the Page Hall Silver Command Group FOI Category Confidential Author Lerleen Willis Owner (if different) New Arrivals Health Needs Group Amendment History Review date Comments Acknowledgements: The team of Roma community researchers whose interviews enabled the voices of Roma patients to be heard. Members of the Roma community in Sheffield who shared their stories and experiences, enabling us to develop a better understanding of their health and wellbeing needs. GP practice staff who provided detailed data Health care practitioners and other service providers who gave time for interviews, to answer questions and provide follow-up data. The Sheffield Commissioning Support Unit for their advice and guidance. 2 Index Page 1. Purpose 5 2. Introduction 2.1. Historical Background 2.2. The social Determinants of Health Inequalities in Slovakia 6 2.3 Housing 7 2.4 Unemployment 2.5. Education in Slovakia 8 2.6 Migration to Sheffield 9 2.7. The Health of the Roma Population in Slovakia 2.7.1. Access to Healthcare in Slovakia 10 2.7.2. Obesity and Co-Morbidities 11 2.7.3. Smoking Behaviour 12 2.7.4. Infectious Diseases 2.7.5. Genetic Disorders 13 2.8. Previous Health Needs Assessments 15 3. Methods 3.1.1. 3.1. Qualitative interviews and Group Discussions 16 3.1.1. Service Provider Interviews 3.1.2. Roma Community Interviews 3.1.3. Demographic Overview 3.2. Quantitative Data 17 3.2.1. Health Data 3.2.2. Schools’ Data 18 4. Findings 5. The Roma Population of Sheffield 5.1. A growing Population 5.2. A young Community 19 6. Measures of Roma Health Needs 20 6.1. Long-term Health Conditions 6.1.1. Obesity 6.1.2. Gender Differences in Obesity 22 6.1.3. Co-Morbidities of Obesity 23 6.1.4. Mental Health 24 6.1.5. Chronic Kidney Disease 25 6.1.6. Cancer Screening 26 6.1.7. Smoking and Respiratory Disease 27 6.1.8. Asthma 6.1.9. Substance Misuse 28 6.2. Infectious Diseases 6.2.1. Tuberculosis 29 6.2.2. Hepatitis B 30 7. Healthcare Usage 7.1. Use of Emergency Care Services 31 7.2. DNAs in Primary and Secondary Healthcare 33 7.3. Roma Patient Experiences of Healthcare 34 7.3.1. Experiences of Healthcare in Slovakia 7.3.1.1. Coercive Rationing of Good Healthcare 3 7.3.1.2. Lack of Respect towards Roma Patients and excessive Control 35 7.3.1.3. Poverty and Segregation 36 7.3.2. Healthcare Experiences in the UK 7.4. Interpretation Services 37 8. Maternal Health 38 8.1. Conception Rates 39 8.1.1.Teenage Pregnancies 40 8.2. Contraception 41 9. The Health of Children and Young People 42 9.1. Hearing Loss 43 9.2. Schools Hearing Support Services 44 9.3. Roma Pupils in Sheffield Schools – An Overview 45 9.3.1. Key Health Issues reported by Schools 9.3.1.1. Exclusion 9.3.1.2. Special Educational Needs 46 9.3.1.3. Attainment 9.3.1.4. Free School Meals 47 9.4. Learning Disabilities 9.5. Incontinence 49 9.6. Dental Health 50 10. Housing and Health 11. Interventions which improve Roma Health 51 11.1. Roma Health Mediators in Romania 11.2 An EU-driven Roma Health Mediator Programme, ROMED 53 11.3. Local Roma Health Mediator Initiatives 54 11.4. Beyond Health Mediation 55 12. Discussion 56 13. Recommendations 58 14. References 60 15. Appendices 66 4 1. Purpose To gather information about the needs of recently-arrived Roma groups. To better understand the health needs and behaviours of this group in comparison with non-Roma patient groups so services can be designed to meet their needs in an effective and efficient manner. To promote better sharing of intelligence and collaboration between agencies and service providers. To identify interventions which require additional resources from central government and European structural and investment funding to promote Roma inclusion in light of recent migration trends and the extreme deprivation of this community. To support the development of business cases for a series of community development interventions within the communities under analysis. 2. Introduction 2.1. Historical Background The Roma people migrated from Northern India over a thousand years ago, arriving in Europe in the early Middle Ages. The largest areas of Roma settlements were in central and eastern Europe (Warnke, 1999). When they first arrived in Europe Roma populations were largely welcomed as this was a period of labour shortage. Their transient lifestyle and traditional trades which included seasonal work such as agricultural labouring, selling low-cost items to isolated, rural communities, knife- sharpening, pot mending, basketware etc. meant that they were able to meet demands in the labour market which sedentary populations were unable to fulfil (Warnke, 1999). Roma skills were so highly prized that in societies such as Romania Roma were actually deprived of their liberty over several hundred years and forced to work for the benefit of the local population. This period of subjugation reinforced the perception of Roma as an inferior people as well as creating a deep mistrust among many Roma towards the groups which had subjugated them. An extreme example of racially motivated discrimination towards Roma is evident in the quarter of a million Roma who were exterminated during the Nazi occupation of Czechoslovakia during the Second World War (Warnke, 1999). Roma people in Slovakia are descended from 2 main groups, the Ungrika Roma who have been settled in Slovakia for many generations. However, the Vlachika Roma are descended from Roma who migrated to Slovakia from Romania in the second half of the 19th century after being released from subjugation. They remained itinerant until the 1950s. Small numbers of Sinti also still live in Slovakia and Roma languages and dialects reflect these historical differences (ERRC, 2013). The largest Roma communities in present day Slovakia are found in the East of the 5 country around Prešov, Košice and the Banská Bystrica regions. Given the historical context mentioned above, many Roma people across the Balkans are reluctant to identify themselves as ‘Roma’, preferring instead to self-identify as ‘Slovak’ or ‘Czech’ etc. As a result, estimates of the size of the Slovak Roma population vary widely from 2% of the 5.2 million population of Slovakia (Census, 2011) to more recent estimates of up to 480,000 (8%). These population estimates may have been affected by large scale outward migration since 2004 (ERRC, 2013). Slovakia Fig. 1. Present Day Slovakia Source: https://commons.wikimedia.org/w/index.php?curid=89553 2.2. The Social Determinants of Health Inequalities in Slovakia Previously itinerant Roma communities were required to make radical changes to their way of life post 1945, during the communist era, to comply with policies which aimed to assimilate them. The communist regime provided Roma with homes within mainstream society and social benefits, but also forced them to give up their migratory way of life and sell their vehicles. The requirement to settle, take up regular work, often in unskilled, low-paid jobs and to send their children to school regularly to avoid facing fines or imprisonment (Csepeli & Simon, 2004), was an attempt to forcibly integrate Roma households into Czechoslovakian society. However, since they could see the benefits of a regular income, a dramatic rise in literacy rates and life expectancy through access to universal healthcare as well as protection under the law from race hate crimes, some Roma still lament the social benefits that communism provided, as their standard of living and safety had increased significantly (Barany, 1998). Many Roma did however lose aspects of their rich linguistic and cultural heritage as well as traditional skills and trades as a consequence. Other traditional practices such as the marrying of children at age 14 were also criminalised. The result was that many Roma groups lost their traditional 6 self-reliance and entrepreneurship and consequently became more dependent on the state to meet their needs (Warnke, 1999). 2.3. Housing The post-communist era saw the separation of Czechoslovakia into Slovakia and the Czech Republic in 1993, which brought with it the privatisation of national industries and a resurgence of the openly anti-Roma sentiments from which they had been protected during the communist era. It also led to the marginalisation and exclusion of Roma communities from many aspects of Slovakian society. Many Roma families lost the homes allocated to them during the communist era due to insufficient state protection once they lost their jobs and were unable to pay their rent, meaning they had to make build their own makeshift homes on remote settlements which often lacked basic services such as drinking water, sewerage systems, gas, electricity and paved roads with adequate bus services. Whilst the majority of Roma people live in villages and towns alongside the Slovak population, 40% live on the margins of society, on the outskirts of towns, villages or in remote, makeshift settlements with no access to utilities and often close to toxic waste dumps which endanger health (ERRC, 2013:9; Veselská, 2004).