The decade of Roma Inclusion: did it make a difference to health and use of health care services?

Abstract

ObjectivesWe investigated whether the severely disadvantaged health of Hungarian Roma adults living in segregated settlements changed by the Decade of Roma Inclusion program.MethodsWe compared the results of two paired health interview surveys that we carried out using the same methodology before and after the Decade, on the general Hungarian and Roma populations.ResultsSelf-perceived health status of younger Roma worsened, while it improved among older Roma. Reported experience of discrimination reduced considerably and health care utilization improved in general. Positive changes in smoking and nutrition, and negative changes in alcohol consumption and overweight were observed. Many of observed changes can plausibly be linked to various government policies, including a quadrupling of public works expenditure, banning smoking in public places, restricting marketing of tobacco products, increasing cigarette prices, and a new tax on unhealthy foods. Liberalization of rules on alcohol distillation coincided with worsening alcohol consumption.ConclusionsWe have shown that Roma remain severely disadvantaged and present an innovative sampling method which can be used to monitor changes in groups where identification is a challenge.Electronic supplementary materialThe online version of this article (doi:10.1007/s00038-017-0954-9) contains supplementary material, which is available to authorized users.

Special Health Care Utilization Pattern with Elevated Costs and High Risk of Premature Death Among Adults Living in Segregated Roma Settlements

“…The elevated risk of premature death among Roma adults living in SRS is also consistent with the Hungarian observations of the poor health status and poor self-rated health of adults living in SRS [16,21,22].…”

“…All the SRSs have been mapped in the towns and villages of the study area using a method described in detail elsewhere [15] and applied in different Roma surveys [16,21,22]. Briefly, the SRS was defined as part of a settlement with at least four residential units having lower housing and environmental quality than other parts of the same settlement.…”

“…This may reflect either the lower quality of health care or the worse health status caused by unhealthier life styles or disadvantageous socio-economic status [16,21]. The exploration of the association between poor quality of care and premature death needs further investigation.…”

Changing the current health system's vision for disease prevention and health promotion

“…Targeted health promotion and disease prevention services for pregnant women, mothers and their young children are well established in many countries, including in Australia (Schmied & Bick ), Canada (Marcellus ), Hungary (Sandor et al. ), the Netherlands (Baas et al. ) and Israel (Ein‐Gal et al.…”

“…Targeted health promotion and disease prevention services for pregnant women, mothers and their young children are well established in many countries, including in Australia (Schmied & Bick 2014), Canada (Marcellus 2018), Hungary (Sandor et al 2017), the Netherlands (Baas et al 2017) and Israel (Ein-Gal et al 2014). Tracing its origins back to 1912 before Israel became a nation, the primarily nurse-operated, Tipat Halav (literally translated as 'drop of milk') clinics have continued to provide free health promotion and disease prevention services for all pregnant and parenting women and their young children (including non-citizens) (Palti 1996).…”