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Special Issue "Roma Health Disadvantage"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (1 October 2020).

Special Issue Editor

Dr. Jitse P. van Dijk
E-Mail Website
Guest Editor
1. Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
2. Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic
3. Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, 040 11 Kosice, Slovakia
Interests: mental health; adolescents; Roma health; religiosity/spirituality and health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Roma ethnicity in a society where more than 5% of the population affiliates this ethnic minority gives a good opportunity for studying several health outcomes of such an ethnicity. In 2017, I was a Guest Editor of the Special Issue on Roma health; by then, it had become clear to me that a considerable number of people were working on this issue. In this new Special Issue, studies might focus on comparison, on history, on interventions, on natural experiments, on (social) epidemiology, and on time trend analyses. As the Special Issue is called ‘’Roma Health Disadvantage’’, we are most of all interested in the health outcomes of all these approaches.

Roma are a rather large minority in many Eastern and Central European countries and generally report poorer health than the majority population. However, Roma health outcomes are varied and often contradictory. For us, this is the main reason for this Special Issue, which should be seen as a more focused continuation of the previous one.

This Special Issue seeks papers on topics related to Roma health disadvantage, both historical and present, preferably including comparisons over time and with non-Roma; the prevalence of chronic disease/non-communicable diseases; associated determinants and interventions, e.g., whether unemployment worsens their health; their mortality; and their adherence to preventive measures such as vaccination.

By learning more about the opportunity presented by Roma health disadvantage, we can better target interventions to improve the lives of Roma.

Assoc. Prof. Jitse P. van Dijk
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Roma health
  • comparison over time
  • comparison with non-Roma
  • chronic disease
  • non-communicable diseases
  • interventions
  • (un-)employment
  • mortality
  • vaccination
  • prevention
  • infectious disease
  • tuberculosis

Published Papers (13 papers)

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Research

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Article
Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary
Int. J. Environ. Res. Public Health 2020, 17(23), 8998; https://doi.org/10.3390/ijerph17238998 - 03 Dec 2020
Viewed by 828
Abstract
The inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic [...] Read more.
The inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic minority in Europe) are being left out of access to medical advances. Objectives: The study aimed to describe the association between general medical practice (GMP) level of average per capita expenditure of the National Health Insurance Fund (NHIF), and the proportion of Roma people receiving GMP in Hungary, controlled for other socioeconomic and structural factors. Methods: A cross-sectional study that included all GMPs providing care for adults in Hungary (N = 4818) was conducted for the period 2012–2016. GMP specific data on health expenditures and structural indicators (GMP list size, providing care for adults only or children also, type and geographical location of settlement, age of GP, vacancy) for secondary analysis were obtained from the NHIF. Data for the socioeconomic variables were from the last census. Age and sex standardized specific socioeconomic status indicators (standardized relative education, srEDU; standardized relative employment, srEMP; relative housing density, rHD; relative Roma proportion based on self-reported data, rRP) and average per capita health expenditure (standardized relative health expenditure, srEXP) were computed. Multivariate linear regression model was applied to evaluate the relationship of socioeconomic and structural indicators with srEXP. Results: The srEDU had significant positive (b = 0.199, 95% CI: 0.128; 0.271) and the srEMP had significant negative (b = −0.282, 95% CI: −0.359; −0.204) effect on srEXP. GP age > 65 (b = −0.026, 95% CI: −0.036; −0.016), list size <800 (b = −0.043, 95% CI: −0.066; −0.020) and 800–1200 (b = −0.018, 95% CI: −0.031; −0.004]), had significant negative association with srEXP, and GMP providing adults only (b = 0.016, 95% CI: 0.001;0.032) had a positive effect. There was also significant expenditure variability across counties. However, rRP proved not to be a significant influencing factor (b = 0.002, 95% CI: −0.001; 0.005). Conclusion: As was expected, lower education, employment, and small practice size were associated with lower NHIF expenditures in Hungary, while the share of self-reported Roma did not significantly affect health expenditures according to our GMP level study. These findings do not suggest the necessity for Roma specific indicators elaborating health policy to control for the risk of widening inequalities imposed by rising health expenses. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
Conceptualization of Roma in Policy Documents Related to Social Inclusion and Health in the Czech Republic
Int. J. Environ. Res. Public Health 2020, 17(21), 7739; https://doi.org/10.3390/ijerph17217739 - 22 Oct 2020
Cited by 1 | Viewed by 786
Abstract
In the Czech Republic, a number of strategy papers and policy documents are guiding the direction of Roma inclusion, including in the area of health. The conceptualization of Roma and how mainstream political and public discourse operate with the term “Roma” contribute to [...] Read more.
In the Czech Republic, a number of strategy papers and policy documents are guiding the direction of Roma inclusion, including in the area of health. The conceptualization of Roma and how mainstream political and public discourse operate with the term “Roma” contribute to a mistakenly homogenous and harmful image of Roma that conforms to negative stereotypes. The aim of our study was to examine the conceptualization of Roma in policy documents related to social inclusion and health in the Czech Republic. Relevant political, strategic and project documents were selected for analysis. Emphasis is placed in them on individual responsibility in relation to health, while structural conditions and discrimination are mentioned less often. Roma are described in relation to health primarily as people who should be educated. More emphasis is placed on the economic benefits of eliminating health inequalities than on citizens’ rights and the importance of inclusion. When “participation” or “empowerment” is mentioned, it is done vaguely, usually in addition to references to completely non-participatory practices. The majority is the primary actor in the field of eliminating health inequalities, as it defines the “path” that Roma need to be shown or determines what is needed to “stimulate” citizens. Although the political discourse concerning Roma has shifted more towards human rights, equity and combating discrimination in the Czech Republic, subtle forms of anti-Gypsyism still seem to be present. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
Article
Roma Ethnicity and Sex-Specific Associations of Serum Uric Acid with Cardiometabolic and Hepatorenal Health Factors in Eastern Slovakian Population: The HepaMeta Study
Int. J. Environ. Res. Public Health 2020, 17(20), 7673; https://doi.org/10.3390/ijerph17207673 - 21 Oct 2020
Cited by 1 | Viewed by 2201
Abstract
Background: Health characteristics associated with uric acid (UA) in the Roma minority remain less well known. The study sought to determine the ethnicity- and sex-specific associations of serum UA with health factors in Eastern Slovakian Roma and non-Roma populations. Methods: Data from the [...] Read more.
Background: Health characteristics associated with uric acid (UA) in the Roma minority remain less well known. The study sought to determine the ethnicity- and sex-specific associations of serum UA with health factors in Eastern Slovakian Roma and non-Roma populations. Methods: Data from the comparative cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The study enrolled 452 Roma subjects (35.2% men) and 403 non-Roma individuals (45.9% men) aged 18–55 years. Results: All study parameters differed between the sexes in both the Roma and non-Roma participants (p < 0.05). UA was related to sex with odds ratio for female sex 0.873, 95% CI 0.853–0.893 (p < 0.0001) per 10-unit increase of UA. Average level of UA ± standard deviation was lower in Roma than in non-Roma (226.54 ± 79.8 vs. 259.11 ± 84.53 umol/L; p < 0.0001). The Roma population presented with greater levels of high-sensitivity C-reactive protein (hsCRP) (3.07 ± 4 mg/L vs. 1.98 ± 2.83 mg/L; p < 0.0001) and ferritin in Roma males (403.78 ± 391.84 vs. 302.67 ± 236.26 mg/L; p < 0.0001). Conclusions: Serum UA is sex- and ethnicity specific. Elevated levels of hsCRP and ferritin particularly in Roma males can reflect low-grade systemic inflammation and thus serve as a marker of an increased cardiovascular risk. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
Article
Social Structure in a Roma Settlement: Comparison over Time
Int. J. Environ. Res. Public Health 2020, 17(19), 7311; https://doi.org/10.3390/ijerph17197311 - 07 Oct 2020
Cited by 2 | Viewed by 1010
Abstract
The objective of the present study was to compare the social structure and internal establishment of a Roma community in two historical periods: in the 18th century and the present. We analysed Samuel Augustini ab Hortis’s work, “Von dem Heutigen Zustände, Sonderbaren [...] Read more.
The objective of the present study was to compare the social structure and internal establishment of a Roma community in two historical periods: in the 18th century and the present. We analysed Samuel Augustini ab Hortis’s work, “Von dem Heutigen Zustände, Sonderbaren Sitten und Lebensart, Wie Auch von Denen Übrigen Eigenschaften und Umständen der Zigeuner in Ungarn” (On the Contemporary Situation, Distinctive Manners and Way of Life, as Well as the Other Characteristics and Circumstances of Gypsies in Greater Hungary), written in 1775–1776. Using content analysis, we subsequently compared his findings with our recent data from analogous qualitative research in a geographically-defined area of north-eastern Slovakia, the same region in which Augustini lived. Data collection was intensely conducted in 2012–2013 and once more in 2017–2019. The qualitative methods included direct observation, semi-structured interviews and focus groups. Four key informants and more than 70 participants collaborated in the study. The greatest difference we observed compared to the 18th century was the absence of a leader of the community, a “vajda”, whose status was taken over by a new social class of “entrepreneurs”. The most vulnerable group of the segregated and separated Roma communities are the “degesa”, the lowest social class. They face a phenomenon consisting of so-called triple marginalization: they live in one of the most underdeveloped regions of the country, they inhabit segregated settlements and they are excluded by their own ethnic group. The socioeconomic status of the richest classes has changed faces, while the socioeconomic status of the lowest has not. We found a misconception among helping professionals (e.g., social workers) regarding the homogeneity of the Roma community. This calls for more attention to the erroneous use of the ethnic-based approach in the helping professions. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
Prevalence of Insulin Resistance in the Hungarian General and Roma Populations as Defined by Using Data Generated in a Complex Health (Interview and Examination) Survey
Int. J. Environ. Res. Public Health 2020, 17(13), 4833; https://doi.org/10.3390/ijerph17134833 - 04 Jul 2020
Cited by 11 | Viewed by 1252
Abstract
Data mainly from one-off surveys clearly show that the health of Roma, the largest ethnic minority of Europe, is much worse than that of the general population. However, results from comprehensive exploratory studies are missing. The aim of our study was to create [...] Read more.
Data mainly from one-off surveys clearly show that the health of Roma, the largest ethnic minority of Europe, is much worse than that of the general population. However, results from comprehensive exploratory studies are missing. The aim of our study was to create a complex database for comparative and association studies to better understand the background of the very unfavourable health of Roma, especially the high burden of cardiometabolic diseases. A three-pillar (questionnaire-based, physical and laboratory examinations) health survey was carried out on randomly selected samples of the Hungarian general (HG, n = 417) and Roma (HR, n = 415) populations, and a database consisting of more than half a million datapoints was created. Using selected data, the prevalence rates of metabolic syndrome (MetS) and of its components were determined, and to estimate the risk of insulin resistance (IR), surrogate measures (the homeostasis model assessment of insulin resistance index, quantitative insulin sensitivity check index, McAuley and TyG indices and the TG/HDL-C ratio) were calculated. Receiver operating characteristic curve analysis and Youden’s method were used to define the optimal cut-off values of each IR index. The prevalence of MetS was very high in both study populations (HG: 39.8%, HR: 44.0%) with no statistically significant difference between the two groups in females or males. The prevalence of MetS showed a very marked increase in the HR 35–49 years age group. Among surrogate measures, the TyG index showed the greatest power for predicting IR/MetS at a cut-off value of 4.69 (77% sensitivity, 84% specificity) and indicated a 42.3% (HG) and 40.5% (HR) prevalence of IR. The prevalence of MetS and IR is almost equally very unfavourable in both groups; thus, the factors underlying the high premature mortality burden of Roma should be further clarified by investigating the full spectrum of risk factors available in the database, with a special focus on the access of Roma people to preventive and curative health services. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
Appropriate Employment for Segregated Roma: Mechanisms in a Public–Private Partnership Project
Int. J. Environ. Res. Public Health 2020, 17(10), 3588; https://doi.org/10.3390/ijerph17103588 - 20 May 2020
Cited by 1 | Viewed by 1041
Abstract
Our earlier article showed that increased employability of segregated Roma may improve their well-being and health. To achieve that, appropriate employment based on a public–private partnership could be the key. For optimal design of such a partnership, we need insight into its potential [...] Read more.
Our earlier article showed that increased employability of segregated Roma may improve their well-being and health. To achieve that, appropriate employment based on a public–private partnership could be the key. For optimal design of such a partnership, we need insight into its potential mechanisms. Evidence on this is lacking, however. This paper builds on the previously published article by focusing on mechanisms for achieving better health. Therefore, our aim was to identify the potential mechanisms by which a public–private Roma employment project could increase employability. We investigated a Roma employment project called Equality of Opportunity established by a private company, U.S. Steel Kosice in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain key stakeholders’ perspectives on the potential mechanisms of a public–private Roma employment project in terms of increased employability. We found three types of mechanisms. The first type regarded formal job mechanisms, such as an appropriate employment and salary offer and a bottom-up approach in capacity building. The second type involved sustainability mechanisms, such as the personal profile of project and work-shift coordinators, the continuous offer of training and cooperation with relevant stakeholders (municipalities, community centers, etc.). The third type was cultural mechanisms, such as personal contact with project participants, attention to less-voiced groups like children, the motivation of project participants, a counter-value reciprocity approach and respect for the specifics of Roma history. Our findings imply that policymakers could consider public–private partnerships for increasing the employability of segregated Roma, as they have the potential to address a wider range of social needs simultaneously. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
To Comply or Not to Comply: Roma Approach to Health Laws
Int. J. Environ. Res. Public Health 2020, 17(9), 3087; https://doi.org/10.3390/ijerph17093087 - 29 Apr 2020
Viewed by 861
Abstract
According to the general public in Slovakia, compliance with the law is problematic when it comes to Roma and health. Roma compliance with laws has not yet been studied. The aim of this is study was to explore the determinants of Roma behavior [...] Read more.
According to the general public in Slovakia, compliance with the law is problematic when it comes to Roma and health. Roma compliance with laws has not yet been studied. The aim of this is study was to explore the determinants of Roma behavior in the field of health laws. We used the concept of a semi-autonomous field proposed by Moore (1973) and the theory of planned behavior by Ajzen (1985). We found that Roma (non-)compliance with health laws was influenced by many different factors, such as beliefs, traditions, living conditions and culture. Group beliefs overrule national laws and also individual preferences, which tend to be subordinate to the group view. The less contact Roma from settlements have with non-Roma, the stronger their own rules are in the field of health. Roma health status is influenced by many factors: group beliefs and community traditions are stronger and overrule individual and state behavioral influence. A community-based participatory approach together with improvement of living conditions in cooperation with Roma is desirable. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
Juvenile Idiopathic Arthritis: Roma Children Seem to Run More Risk than Non-Roma
Int. J. Environ. Res. Public Health 2020, 17(7), 2377; https://doi.org/10.3390/ijerph17072377 - 31 Mar 2020
Viewed by 912
Abstract
Background: Ethnic information regarding juvenile idiopathic arthritis (JIA) exists for various populations across the world but is fully lacking for Roma. We assessed the occurrence and clinical characteristics of JIA in Roma vs. non-Roma children. Methods: We obtained data on all outpatients [...] Read more.
Background: Ethnic information regarding juvenile idiopathic arthritis (JIA) exists for various populations across the world but is fully lacking for Roma. We assessed the occurrence and clinical characteristics of JIA in Roma vs. non-Roma children. Methods: We obtained data on all outpatients (n = 142) from a paediatric rheumatology centre (age 3 to 18 years) in the eastern part of Slovakia (Kosice region). We assessed patients’ age, gender, disease type and related extra-articular conditions by ethnicity. We obtained population data from the 2011 census. Results: The share of Roma children was higher in the clinical JIA sample than in the overall population (24.6%, n = 35, Roma in the sample vs. 10.8%, n = 142, Roma in the population, p < 0.05). Moreover, Roma children had been diagnosed more frequently with extra-articular conditions but did not differ in other symptoms. Treatments also did not differ by ethnicity. Conclusion: Roma children had been diagnosed more with JIA than their non-Roma peers. This calls for further research on the causes of this increased disease burden in Roma children. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
Article
Aspects of Illness and Death among Roma—Have They Changed after More than Two Hundred Years?
Int. J. Environ. Res. Public Health 2019, 16(23), 4796; https://doi.org/10.3390/ijerph16234796 - 29 Nov 2019
Cited by 2 | Viewed by 1340
Abstract
Augustini studied Roma and published reports in 1775–1776 on their illnesses and death. Our intention was to compare the features of these two topics described by him in the late 18th century with those in the present time. We studied Augustini’s work on [...] Read more.
Augustini studied Roma and published reports in 1775–1776 on their illnesses and death. Our intention was to compare the features of these two topics described by him in the late 18th century with those in the present time. We studied Augustini’s work on illnesses and death in the past. The present qualitative study was conducted in 2012–2013 in the same geographical area in which Augustini lived and worked more than two hundred years ago, i.e., the Tatra Region in Slovakia; our findings were evaluated in 2017–2018. We carried out semi-structured interviews with more than 70 informants and organised two sessions of focus groups. Data were analysed using content analysis (Augustini) and an open coding process. Our findings suggest that illnesses in Roma are treated differently nowadays compared with 1775–1776. For example, the traditional forms of healing have completely disappeared in the area of investigation. We did not observe any differences in dying and death perceptions between the past and nowadays. Although data and knowledge on health disparities and related mechanisms exist, and much more about perceptions of Roma regarding illnesses is now known compared with 1775–1776, so far, this knowledge has not helped to design effective interventions to overcome them. Substandard living conditions in marginalised Roma communities have not significantly improved since 1775–1776, which may contribute to their higher morbidity and mortality also nowadays. Political and social consensus should lead to a comprehensive vision for enhancing the social situation and living conditions in segregated settlements, especially providing housing for the poorest classes and overcoming health disparities. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
A Community-Based Participatory Action Research for Roma Health Justice in a Deprived District in Spain
Int. J. Environ. Res. Public Health 2019, 16(19), 3722; https://doi.org/10.3390/ijerph16193722 - 02 Oct 2019
Cited by 11 | Viewed by 1727
Abstract
Addressing health disparities and promoting health equity for Roma has been a challenge. The Roma are the largest disadvantaged ethnic minority population in Europe and have been the victims of deep social and economic injustices, institutional discrimination, and structural antigypsyism over many centuries. [...] Read more.
Addressing health disparities and promoting health equity for Roma has been a challenge. The Roma are the largest disadvantaged ethnic minority population in Europe and have been the victims of deep social and economic injustices, institutional discrimination, and structural antigypsyism over many centuries. This has resulted in a much worse health status than their non-Roma counterparts. Current strategies based on ameliorative and top-down approaches to service delivery have resulted in paradoxical effects that solidify health disparities, since they do not effectively address the problems of vulnerable Roma groups. Following a health justice approach, we present a community-based participatory action research case study generated by a community and university partnership intended to address power imbalances and build collaboration among local stakeholders. This case study involved a group of health providers, Roma residents, researchers, Roma community organizations, and other stakeholders in the Poligono Sur, a neighborhood of Seville, Spain. The case study comprises four phases: (1) identifying Roma health assets, (2) empowering Roma community through sociopolitical awareness, (3) promoting alliances between Roma and community resources/institutions, and (4) building a common agenda for promoting Roma health justice. We highlighted best practices for developing processes to influence Roma health equity in local health policy agendas. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
Prevalence of Chronic Diseases and Activity-Limiting Disability among Roma and Non-Roma People: A Cross-Sectional, Census-Based Investigation
Int. J. Environ. Res. Public Health 2019, 16(19), 3620; https://doi.org/10.3390/ijerph16193620 - 26 Sep 2019
Cited by 4 | Viewed by 1345
Abstract
The lack of recommended design for Roma health-monitoring hinders the interventions to improve the health status of this ethnic minority. We aim to describe the riskiness of Roma ethnicity using census-derived data and to demonstrate the value of census for monitoring the Roma [...] Read more.
The lack of recommended design for Roma health-monitoring hinders the interventions to improve the health status of this ethnic minority. We aim to describe the riskiness of Roma ethnicity using census-derived data and to demonstrate the value of census for monitoring the Roma to non-Roma gap. This study investigated the self-declared occurrence of at least one chronic disease and the existence of activity limitations among subjects with chronic disease by the database of the 2011 Hungarian Census. Risks were assessed by odds ratios (OR) and 95% confidence intervals (95% CI) from logistic regression analyses controlled for sociodemographic factors. Roma ethnicity is a risk factor for chronic diseases (OR = 1.17; 95% CI: 1.16–1.18) and for activity limitation in everyday life activities (OR = 1.20; 95% CI: 1.17–1.23), learning-working (OR = 1.24; 95% CI: 1.21–1.27), family life (OR = 1.22; 95% CI: 1.16–1.28), and transport (OR = 1.03; 95% CI: 1.01–1.06). The population-level impact of Roma ethnicity was 0.39% (95% CI: 0.37–0.41) for chronic diseases and varied between 0 and 1.19% for activity limitations. Our investigations demonstrated that (1) the Roma ethnicity is a distinct risk factor with significant population level impact for chronic disease occurrence accompanied with prognosis worsening influence, and that (2) the census can improve the Roma health-monitoring system, primarily by assessing the population level impact. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Article
Increased Employment for Segregated Roma May Improve Their Health: Outcomes of a Public–Private Partnership Project
Int. J. Environ. Res. Public Health 2019, 16(16), 2889; https://doi.org/10.3390/ijerph16162889 - 13 Aug 2019
Cited by 4 | Viewed by 1514
Abstract
Increasing employment opportunities for segregated Roma might prevent major economic losses and improve their health. Involvement of the private sector in Roma employment, on top of intensified governmental actions, is likely to be a key to sustainable improvement, but evidence on this is [...] Read more.
Increasing employment opportunities for segregated Roma might prevent major economic losses and improve their health. Involvement of the private sector in Roma employment, on top of intensified governmental actions, is likely to be a key to sustainable improvement, but evidence on this is scarce. Our aim was to determine the potential outcomes of such a partnership regarding increased employability and the resulting improved well-being and health. We therefore investigated a Roma employment project called Equality of Opportunity, run since 2002 by a private company, U.S. Steel Kosice, in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain the perspectives of key stakeholders on the outcomes of this project. We found that they expected the employability of segregated Roma to increase in particular via improvements in their work ethic and working habits, education, skills acquisition, self-confidence, courage and social inclusion. They further expected as the main health effects of increased employability an improvement in Roma well-being and health via a stable income, better housing, crime reduction, improved hygienic standards, access to prevention and improved mental resilience. Social policies regarding segregated Roma could thus be best directed at increasing employment and at these topics in particular to increase their effects on Roma health. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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Review

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Review
Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe
Int. J. Environ. Res. Public Health 2020, 17(20), 7632; https://doi.org/10.3390/ijerph17207632 - 20 Oct 2020
Cited by 3 | Viewed by 755
Abstract
The Roma are Europe’s largest minority. They are also one of its most disadvantaged, with low levels of education and health and high levels of poverty. Research on Roma health often reveals higher burdens of disease in the communities studied. This paper aims [...] Read more.
The Roma are Europe’s largest minority. They are also one of its most disadvantaged, with low levels of education and health and high levels of poverty. Research on Roma health often reveals higher burdens of disease in the communities studied. This paper aims to review the literature on communicable diseases among Roma across Eastern and Central Europe. A PubMed search was carried out for communicable diseases among Roma in these parts of Europe, specifically in Romania, Bulgaria, Hungary, Serbia, Slovakia, the Czech Republic and North Macedonia. The papers were then screened for relevance and utility. Nineteen papers were selected for review; most of them from Slovakia. Roma continue to have a higher prevalence of communicable diseases and are at higher risk of infection than the majority populations of the countries they live in. Roma children in particular have a particularly high prevalence of parasitic disease. However, these differences in disease prevalence are not present across all diseases and all populations. For example, when Roma are compared to non-Roma living in close proximity to them, these differences are often no longer significant. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
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