1.1. Health among the Roma People
1.2. Health Condition and Educational Level
2.1. Data Collection
2.2. Data Analysis: Using Communicative Methodology to Include the Voice of Roma End-Users
3. Results and Discussion
3.1. Roma Cultural Values as Assets: Improving Health through Educative Participation
“If we Roma can be identified by something it is by this unity with this strength [as people], even more so, we are there in the moments of illness, 100%. For instance, if someone needs blood, and if I [meaning the community] can’t donate, we buy it somewhere and we provide it. And we ask each other if [my blood] is good or if yours is, and if we are 100 people, the whole 100 are tested to save the one person. This is a point that I believe identifies us very much, very, very much”.
3.2. Increased Emotional Wellbeing through Educative Participation
“To be appreciated by someone is nice, to be appreciated by many people and children, and not only children but teachers, even though the appreciation of the children is important, too (…) because before you got up without a purpose. Now you get up with another, you know, with another perspective...”.
“Well, as I said, it is because of coming here, as I said, the way of talking, the way of thinking, the way of relating to another person (…) Now I have a rhythm, I come in the morning, in the evening, but I truly like it”.
“You could see how children learned, how useful you felt… teachers ask your opinion. In the classrooms you are like if you were also a teacher; they ask you to do something with the children, and then you feel useful, you feel well, you feel valued. And now even more!”.
“It has helped me a lot! Because in addition to helping my children, I am also learning, as it’s stuff that you have forgotten and also I personally feel very useful and I feel I am a better person when I come here...”.
3.3. Raising Awareness about Health Issues
“In my class, yes I do, because [the mothers] see it. They see how many children come in very clean, and then theirs...you know? (…) So yes, they themselves notice. For instance one came and said: check their heads because there’s lice …and when they are in class participating, they see this even more”.
“I go to the doctor, or to my daughter’s doctor, and I get information with all the details; if there is anything that I don’t understand well, they’ll have to explain it well, because I’m interested in it (…) For example, I might not know a particular disease, or they would say, ‘you have to go to the otorhinolaryngologist’, and I would have said ‘yes, yes…’; I was ashamed to ask, and I’d said yes, and then once I was in the street I would tell someone that they had told me to go to the ‘otolary’ something, and they would say ‘but will you go there?’ and I’d be ‘but where?’ And now maybe I say ‘ear, throat and nose specialist’ because they have explained it to me because I have asked about it. I have asked him, ‘and what is that about, what is it for, what function does it have?’ And I don’t feel ashamed to ask.”
3.4. Caring for the Family’s Health
“There must be time for everything: to get ready, to take care of oneself, to feel well… and not be the typical Roma with the bun and the slippers and the housecoat... no, that has to change! That was in earlier times, in the first century, in the second century… one must become independent and go ahead on your own, as well (…) I used to say that women had to be at home, washing the windows and staying with the kids and nothing else. But look at me four months ago… I don’t recognize her! And some tell me, ‘you used to say that!’ and I [respond], ‘well, I used to say that last year, but this is already a new year!’ And now Dolores is not the same anymore. One has to update!”
[In a joking way, talking about healthy eating habits] “I’m an artist, in that I’m worse than my mother! The kids are disgusted by me because of the vegetables, and I say, “mummy prepares boiled things, no fried stuff, because the kitchen ends up greasy and we don’t eat well.” [Does she really call herself mummy? She’s their sister!] “I try to get my brothers not to eat chocolate pastries. And now, in school, the same - vegetables, and now with the fruit, very well. (…) Milk? No, they want Nesquik [chocolate milk]. Well, none of that! ‘You’ll eat what we have. Don’t ask me for funny things, I’m not going to buy them’… I try, I try with the vegetables.”
“[My aunt said] ‘I have received a letter from this person.’ Most of my aunts can’t read or write, so she told me, ‘the kid read it for me, and I have to go and see. You come read it for me, let’s see what it is.’ ‘Well,’ [I told her] ‘you have to go and have this test done and so...’ and [she asked] ‘what’s that for?’... of course they ask you... ‘did they find something wrong with me?’ because they are like that, because they are uneducated,… [and I said] ‘it’s just in case, nothing’s gonna happen, but it is good to have the test done.’”
“Well, I just go there and tell them everything, from an anecdote about some child to the discussions with them, all around the clock, from when I get up until I fall asleep...it is all talking about school. Besides, I like to tell my wife, my children… while we eat I explain to them, ‘this and that has happened to me’. It’s a joy at home… we used to communicate as well before, we talked but it was more like there was nothing to talk about...”
“Even the podiatrist has come to the adult learning school (…) because maybe you think that you need to get surgery on your foot, and then this man tells you that your shoes are not right, and maybe you don’t need any surgery (…) Well, this man told us that we have to walk like this and that, and I went to see my kids and I told my daughter ‘walk, walk,’ and I said ‘you have to walk like this,’ as he showed us, about the movement, and so on (…) And after seeing the podiatrist, I came home and I said ‘let’s see whether my daughter has this curve to her feet,’ but if you don’t have this information… well, then that’s it.”
“By being involved in school... for instance, there are mothers whose children came to school very scruffy, and by coming here [to the interactive groups], you change your image completely. You take better care of them. This has happened to me. There was a time when I was very bad, I was on drugs. I was in a center for nearly seven months. And at that time I did not take care of my children. On the contrary, they got up on their own, got dressed, and came [to school]. Later on, when I left the center and I was well, it was me and my husband. And I have not fallen back into drugs, thanks to the school, coming to school, getting involved... for me, it is very important, very important.”
3.5. Caring for the Health of the Extended Roma Community
“Why are you so nervous? And Miriam answered, ‘because I don’t have chocolate milk for breakfast. My grandmother gives me coffee because she doesn’t have chocolate milk.’ So then… I will, of course, it’s the girl’s health; she is just 8 or 9 years old and drinking coffee (…) The grandmother was misinformed...”
[About health] “I am more interested… I remember it and I see it. When I arrive at the school, I see that they are also interested in the health of children. I do not have children myself, but I have other relatives in school, and I see that and whether I want it or not, I also get it there too, it’s transmitted. I mean, I also want to be interested in them, being family, mother or whatever.”
“Yes, yes, there are fewer conflicts. Yes, because the mothers come to the school, they maybe have a coffee, become more friendly, trust each other more, and when you are on the street you say, ‘hi, so-and-so.’ Maybe before we didn’t say ‘hi’ to each other and now we do, and ‘are you going to school, or have you gone?’ or ‘why didn’t you go today?’ This stuff.”
“And, well, we kept on encouraging her, saying, ‘come on, just come one day and try, if you like it, you can offer your ideas’… and from the moment she came, she liked it, and she keeps on coming. Everything improved. In school, her kid is much better, both in learning and behavior. At home, she has started to organize herself, her house is now cleaner (…). Now she has habits and routines that allow her children to get around and look for work. She is also pursuing training herself, getting involved in the education of her children and taking more care of everything. One thing led to another…”
“A girlfriend of mine has had deep depression, and I have tried to encourage her to take a course [in the school] or be a volunteer in the school, to keep her mind busy with something meaningful.”
“They caught one or two kids in the schoolyard with a cigarette, and they said to me, ‘look, Luis, what if you talk to them, as a Roma and as a man? They will not shout at you or swear at you’. So I did talk to them (…) Yes, yes, if it had been the teacher [female] they would’ve told her whatever, but if it’s me, there’s almost no need to say a word. They would get quiet, no swear words, no yelling, nothing.”
Conflict of Interest
- Mackenbach, J.P. Health Inequalities: Europe in Profile; Department of Public Health Erasmus MC, University Medical Center: Rotterdam, The Netherlands, 2006. [Google Scholar]
- World Health Organization, European Social Determinants and Health Divide Review. Interim First Report on Social Determinants of Health and the Health Divide in the WHO European Region. Executive Summary; World Health Organization: Copenhagen, Denmark, 2010.
- European Commission, EUROPE 2020. A Strategy for Smart, Sustainable and Inclusive Growth; Communication from the Commission COM (2010) 2020: Brussels, Belgium, 2010.
- European Commission, Non-Discrimination and Equal Opportunities: A Renewed Commitment Community Instruments and Policies for Roma Inclusion; Commission Staff Working Document accompanying the Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions COM(2008) 420 final: Brussels, Belgium, 2008.
- World Health Organization, How Health Systems can Address Health Inequities Linked to Migration and Ethnicity; World Health Organization: Copenhagen, Denmark, 2010.
- Alexopoulos, E.C.; Geitona, M. Self-rated health: Inequalities and potential determinants. Int. J. Environ. Res. Public Health 2009, 6, 2456–2469. [Google Scholar] [CrossRef]
- Feliciano, C.; Ashtiani, M. How low income origins affect postsecondary entry and degree completion. Int. J. Soc. Educ. 2012, 1, 123–156. [Google Scholar]
- European Commission, Solidarity in Health: Reducing Health Inequalities in the EU; Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, COM(2009) 567 final: Brussels, Belgium, 2009.
- Packard, J.; Callaway, L.; Dorris, C.; Suhr, E. Social ties, perceptions of disorder and distress: A qualitative examination of the protective effects of social capital in neighbourhoods. Int. Multidisc. J. Soc. Sci. 2013, 2, 27–51. [Google Scholar]
- Fobil, J.; May, J.; Kraemer, A. Assessing the relationship between socioeconomic conditions and urban environmental quality in Accra, Ghana. Int. J. Environ. Res. Public Health 2010, 7, 125–145. [Google Scholar] [CrossRef]
- Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health; WHO: Geneva, Switzerland, 2008. Available online: http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf (accessed on 19 March 2013).
- Robine, J.M.; Romieu, I.; Cambois, E. Health Expectancy Indicators. Available online: http://www.who.int/bulletin/archives/77(2)181.pdf (accessed on 19 March 2013).
- World Health Statistic. World Health Statistic. Part II Global Health Indicators; 2010. Available online: http://www.who.int/whosis/whostat/EN_WHS10_Part2.pdf (accessed on 30 March 2013).
- Huisman, M.; Kunst, A.E.; Bopp, M.; Borgan, J.K.; Borrell, C.; Costa, G.; Deboosere, P.; Gadeyne, S.; Glickman, M.; Marinacci, C.; et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet 2005, 365, 493–500. [Google Scholar]
- OECD Centre for Educational Research and Innovation and IRDES. Social Capital, Human Capital and Health. What is the Evidence? Centre for Educational Research and Innovation, and IRDES, 2010. Available online: http://www.oecd.org/edu/research/45760738.pdf (accessed on 28 March 2013).
- OECD. Education Indicators in Focus. 2013. Available online: http://www.oecd.org/edu/skills-beyond-school/EDIF%202013--N%C2%B010%20(eng)--v9%20FINAL%20bis.pdf (accessed on 28 March 2013).
- European Commission. What Works for Roma Inclusion: Policies and Model Approaches; Publications Office of the European Union: Luxembourg, 2012. Available online: http://ec.europa.eu/justice/discrimination/files/whatworksfor_romainclusion_en.pdf (accessed on 30 March 2013).
- Hajioff, S.; McKee, M. The health of the Roma people: A review of the published literature. J. Epidemiol. Commun. Health 2000, 54, 864–869. [Google Scholar] [CrossRef]
- Sepkowitz, K.A. Health of the world’s Roma population. Lancet 2006, 367, 1707–1708. [Google Scholar] [CrossRef]
- Zeman, C.L.; Depken, D.E.; Senchina, D.S. Roma health issues: A review of the literature and discussion. Ethnic Health 2003, 8, 223–249. [Google Scholar] [CrossRef]
- Human Nations Development Programme. Avoiding the Dependency Trap: The Roma Human Development Report. 2003. Available online: http://hdr.undp.org/en/reports/regional/europethecis/name,3203,en.html (accessed on 24 March 2013).
- Fundación Secretariado Gitano. Health and the Roma Community, Analysis of the Situation in Europe. Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain;Fundación Secretariado Gitano: Madrid, Spain; Fundación Secretariado Gitano: Madrid, Spain, 2009. Available online: http://www.euromanet.eu/upload/85/27/Health_and_the_Roma_Community.pdf (accessed on 23 March 2013).
- UNDP Report. At Risk: Roma and the Displaced in Southeast Europe; UNDP Regional Bureau for Europe and the Commonwealth of Independent States: Bratislava, 2006. Available online: http://europeandcis.undp.org/uploads/public/File/rbec_web/vgr/vuln_rep_all.pdf (accessed on 29 June 2013).
- Schaaf, M. Roma Health. Poverty and Social Exclusion in the WHO European Region: Health Systems Respond; WHO Regional Ofﬁce for Europe: Copenhagen, Denmark, 2010; pp. 1–226. Available online: http://www.euro.who.int/__data/assets/pdf_file/0006/115485/E94018.pdf (accessed on 24 March 2013).
- Van Hout, M.C.; Staniewicz, T. Roma and Irish traveller housing and health—A public health concern. Crit. Public Health 2012, 22, 193–207. [Google Scholar] [CrossRef]
- Krajcovicova-Kudlackova, M.; Blazicek, P.; Spustova, V.; Valachovicova, M.; Ginter, E. Cardiovascular risk factors in young Gypsy population. Bratisl. Med. J. 2004, 105, 256–259. [Google Scholar]
- UNDP. The Health Situation of the Roma Communities. Analysis of the Data from the UNDP/World Bank/EU Regional Roma Survey. Available online: http://issuu.com/undp_in_europe_cis/docs/health_web# (accessed on 18 May 2013).
- Low, M.D.; Low, B.J.; Baumler, E.R.; Huynh, P.T. Can education policy be health policy? Implications of research on the social determinants of health. J. Health Polit. Polic. 2005, 30, 1131–1162. [Google Scholar] [CrossRef]
- Fesus, G.; Ostlin, P.; McKee, M.; Adany, R. Policies to improve the health and well-being of Roma people: The European experience. Health Policy 2012, 105, 25–32. [Google Scholar] [CrossRef]
- Graham, H. Social determinants and their unequal distribution: Clarifying policy understandings. Milbank Q. 2004, 82, 101–124. [Google Scholar] [CrossRef]
- Masseria, C.; Mladovsky, P.; Hernández-Quevedo, C. The socio-economic determinants of the health status of Roma in comparison with non-Roma in Bulgaria, Hungary and Romania. Eur. J. Public Health 2010, 20, 549–554. [Google Scholar] [CrossRef]
- Council of the European Union. Council Conclusion on Advancing Roma Inclusion; 3018th Employment, Social Policy Health and Consumer Affairs, Council meeting, Luxembourg, 7 June 2010. Available online: http://ec.europa.eu/social/BlobServlet?docId=5578&langId=en (accessed on 24 March 2013).
- Williams, D.R.; Costa, M.V.; Odunlami, A.O.; Mohammed, S.A. Moving upstream: How interventions that address the social determinants of health can improve health and reduce disparities. J. Public Health Man. 2008, 14, 8–17. [Google Scholar]
- Kubzansky, L.D.; Berkman, L.F.; Glass, T.A.; Seeman, T.E. Is educational attainment associated with shared determinants of health in the elderly? Findings from the MacArthur studies of successful ageing. Psychosom. Med. 1998, 60, 578–585. [Google Scholar]
- Leganger, A.; Kraft, P. Control constructs: Do they mediate the relation between educational attainment and health behaviour? J. Health Psychol. 2003, 8, 361–372. [Google Scholar] [CrossRef]
- Miech, R.A.; Hauser, R.M. Socioeconomic status and health at midlife: A comparison of educational attainment with occupation-based indicators. Ann. Epidemiol. 2001, 11, 75–84. [Google Scholar] [CrossRef]
- Dahlgren, G.; Whitehead, M. Levelling up Part 2; World Health Organization: Copenhagen, Denmark, 2006. Available online: http://www.euro.who.int/__data/assets/pdf_file/0018/103824/E89384.pdf (accessed on 19 March 2013).
- Bambra, C.; Gibson, M.; Sowden, A.; Wright, K.; Whitehead, M.; Petticrew, M. Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. J. Epidemiol. Commun. Health 2010, 64, 284–291. [Google Scholar] [CrossRef][Green Version]
- Martín, N.; Tellado, I. Violencia de Género y Resolución Comunitaria de Conflictos en los Centros Educativos. Multidis. J. Gender Studies (GÉNEROS) 2012, 1, 300–319. [Google Scholar]
- Center of Research in Theories and Practices that Overcome Inequalities (CREA), INCLUD-ED. Strategies for Inclusion and Social Cohesion from Education in Europe; Integrated Project. Priority 7 of Sixth Framework Programme; European Commission: Brussels, Belgium; pp. 2006–2011.
- Munté, A.; Serradell, O.; Sordé, T. From research to policy: Roma participation through communicative organization. Qual. Inq. 2011, 17, 256–266. [Google Scholar] [CrossRef]
- Habermas, J. The Theory of Communicative Action; Beacon Press: Boston, USA; pp. 1984–1987.
- Mead, G.H. Mind, Self and Society; University of Chicago Press: Chicago, IL, USA, 1934. [Google Scholar]
- Padrós, M.; García, R.; de Mello, R.; Molina, S. Contrasting scientific knowledge with knowledge from the lifeworld: The Dialogic Inclusion Contract. Qual. Inq 2011, 17, 304–312. [Google Scholar] [CrossRef]
- Puigvert, L.; Christou, M.; Holford, J. Critical communicative methodology: Including vulnerable voices in research through dialogue. Camb. J. Educ. 2012, 42, 513–526. [Google Scholar] [CrossRef]
- Creswell, J. Qualitative Inquiry and Research Design; Choosing among Five Traditions; Sage Publications: London, UK, 1998; p. 119. [Google Scholar]
- Lincoln, Y.S.; Guba, E. Naturalistic Enquiry; Sage: Beverly Hills, CA, USA, 1985. [Google Scholar]
- Denzin, N. Sociological Methods: A Sourcebook, 5th ed.; Aldine Transaction: New Brunswick, NJ, USA, 2006. [Google Scholar]
- Centers for Disease Control and Prevention (CDC). Measuring Healthy Days. CDC: Atlanta, GA, USA, 2000. Available online: http://www.cdc.gov/hrqol/pdfs/mhd.pdf (accessed on 8 July 2013).
- Benyamini, Y; Idler, E.L.; Leventhal, H.; Leventhal, E.A. Positive affect and function as influences on self-assessments of health: Expanding our view beyond illness and disability. J. Gerontol. B Psychol. Sci. Soc. Sci. 2000, 55, 107–116. [Google Scholar]
- Singh-Manoux, A.; Dugravot, A.; Shipley, M.J.; Ferrie, J.E.; Martikainen, P.; Goldberg, M.; Zins, M. The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study. Int. J. Epidemiol. 2007, 36, 1222–1228. [Google Scholar] [CrossRef]
- INCLUD-ED Consortium. Actions for Success in Schools in Europe; European Commission: Brussels, Belgium, 2009. Available online: http://www.ub.edu/includ-ed/docs/INCLUDED_actions%20for%20success.pdf (accessed on 19 March 2013).
- Sordé, T. Les reivindicacions educatives de la dona gitana; Galerada: Barcelona, Spain, 2006. [Google Scholar]
- Prieto, O.; Sordé, T. The institutionalization of panethnicity from the grassroots standpoint in a European context: The case of Gitanos and Roma immigrants in Barcelona. Ethnicities 2011, 11, 202–217. [Google Scholar] [CrossRef]
- Díez, J.; Gatt, S.; Racionero, S. Placing immigrant and minority family and community members at the school’s centre: The role of community participation. Eur. J. Educ. 2011, 46, 184–196. [Google Scholar] [CrossRef]
- Nettles, S.M. Community involvement and disadvantaged students: A review. Rev. Educ. Res. 1991, 61, 379–406. [Google Scholar] [CrossRef]
- Delgado-Gaitan, C.; Allexsaht-Snider, M. Mediating School Cultural Knowledge for Children: The Parents’ Role. In Effective Schooling of Economically Disadvantaged Students: School Based Strategies for Diverse Student Populations; Johnson, J.H., Borman, K.M., Eds.; Ablex: Norwood, NJ, USA, 1992. [Google Scholar]
- Alexiu, T.M.; Sordé, T. How to turn difficulties into opportunities: Drawing from diversity to promote social cohesion. Int. Stud. Soc. Educ. 2011, 21, 49–62. [Google Scholar] [CrossRef]
- Flecha, R.; Soler, M. Turning difficulties into possibilities: Engaging Roma families and students in school through dialogic learning. Camb. J. Educ. [CrossRef]
- Flecha, A.; García, R.; Rudd, R. Using health literacy in school to overcome inequalities. Eur. J. Educ. 2011, 46, 209–218. [Google Scholar] [CrossRef]
- Walters, S.; Suhrcke, M. Socioeconomic inequalities in health and health care access in central and eastern Europe and the CIS: a review of recent literature. 2005. Copenhagen, WHO Regional Ofﬁce for Europe, (Working paper 2005/1). Available online: http://www.euro.who.int/Document/SED/Socioecon_ineq.pdf (accessed on 19 March 2013).
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