Kósa et al. | Peer Reviewed | Research and Practice | 853 RESEARCH AND PRACTICE  Objectives. We compared the health of people living in Roma settlements with that of the general population in Hungary.Methods. We performed comparative health interview surveys in 2003 to 2004 in representative samples of the Hungarian population and inhabitants of Roma settlements.Results. In persons older than 44 years, 10% more of those living in Roma settlements reported their health as bad or very bad than did those in the lowest income quartile of the general population. Of those who used any health services, 35% of the Roma inhabitants and 4.4% of the general population experienced some discrimination. In Roma settlements, the proportion of persons who thought that they could do much for their own health was 13% to 15% lower, and heavy smoking and unhealthy diet were 1.5 to 3 times more prevalent, than in the lowest income quartile of the general population.Conclusions. People living in Roma settlements experience severe social exclusion, which profoundly affects their health. Besides tackling the socioeconomic roots of the poor health of Roma people, specific public health interventions, including health education and health promotion programs, are needed. (Am J Public Health.

Background: Several models have been proposed to explain the association between ethnicity and health. It was investigated whether the association between Roma ethnicity and health is fully mediated by socioeconomic status in Hungary. Methods: Comparative health interview surveys were performed in 2003-04 on representative samples of the Hungarian population and inhabitants of Roma settlements. Logistic regression models were applied to study whether the relationship between Roma ethnicity and health is fully mediated by socioeconomic status, and whether Roma ethnicity modifies the association between socioeconomic status and health. Results: The health status of people living in Roma settlements was poorer than that of the general population (odds ratio of severe functional limitation after adjustment for age and gender 1.8 (95% confidence interval 1.4 to 2.3)). The difference in self-reported health and in functionality was fully explained by the socioeconomic status. The less healthy behaviours of people living in Roma settlements was also related very strongly to their socioeconomic status, but remained significantly different from the general population when differences in the socioeconomic status were taken into account, (eg odds ratio of daily smoking 1.6 (95% confidence interval 1.3 to 2.0) after adjustment for age, gender, education, income and employment). Conclusion: Socioeconomic status is a strong determinant of health of people living in Roma settlements in Hungary. It fully explains their worse health status but only partially determines their less healthy behaviours. Efforts to improve the health of Roma people should include a focus on socioeconomic status, but it is important to note that cultural differences must be taken into account in developing public health interventions.The association between ethnicity and health is well established. Though it is generally accepted that interpreting ethnicity as an independent determinant of health is a simplification, present knowledge of the complex causal network of ethnicity, socioeconomic status (SES), health behaviour, environment and health status is rather limited.

Census data cannot be used for policy design aiming at those Roma who are in greatest need of help; that is, living in segregated settlements (colonies). Colonies constitute disadvantaged living conditions of varying severity which can be quantified by a composite score based on indicators of access to services and presence of environmental dangers. The proportion of colony-dwelling Roma is approximately one-fifth to one-quarter of the estimated number of Roma people in Hungary.

Psychological distress was significantly greater in our sample of Hungarian medical students than in the same age group of the general population. Psychological distress is strongly related to SOC and can be estimated by our proposed models. Both SOC and psychological distress can be used to characterize the mental health of future medical doctors, the improvement of which needs attention even during their training.