How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study

Abstract

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP’s agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program’s merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP’s everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs’ impact on SDH, their theories and procedures should be adapted according to the programs’ more promising actual practice regarding SDH.

Conceptualization of Roma in Policy Documents Related to Social Inclusion and Health in the Czech Republic

“…Access to health care is frequently mentioned (and often as the only determinant of health), even if it is a factor that only partially explains health inequalities. Furthermore, this topic relates to those who are already trying to find a doctor because of a health condition (except for preventive examinations), so it only affects a certain and specifically defined issue related to health status, which is preceded by many other determinants [ 28 ]. Moreover, health care accessibility itself is perceived narrowly, as it does not seem to take into account the more complex theories of health care accessibility, as already described in 1978 by Tanahashi or more recently by Levesque [ 29 , 30 ].…”

The health of segregated Roma: first-line views and practices: a case study in Slovakia using ethnographic methods

“…Ford et al 2010b;Griffith et al 2007) our findings suggest that care professionals need to become supported in skills and tools to better understand and manage racism, culture-bound-and structural vulnerabilities of their patients (Bourgois et al 2017;Kleinman et al 2006), as well as related elated expectations. In addition, with respect to Roma use of health-mediation programs for segregated communities (Belak et al 2017b; OSF 2011) and employment of more Roma clinical professionals should be considered wherever present (Phillips 2011;Thornton 2017).…”

“…The main strengths of our study regard our use of ethnographic methods. Our preceding long-term ethnographic research on related Roma practices and perspectives (Belak et al 2018;Belak et al 2017b) supported a well-informed sampling strategy. Our careful rapport-building with and open-ended, non-judgmental attitude towards supposed discrimination perpetrators in the initial fieldwork phase enabled personal trust and sincere openness of many of the visited professionals, including regarding their own double-standard practices and related feelings.…”

Aspects of Illness and Death among Roma—Have They Changed after More than Two Hundred Years?

“…Our intention was to compare illnesses and the process of dying among Roma as described by Augustini in 1775–1776 and as they occur presently. Current studies are mostly oriented towards the characterization of Roma health, behavior and determinants and their comparison with non-Roma [13,14,15,16,17,18,19,20,21,22,23,24,25,26]. The comparison of the states of these topics over time is missing.…”

“…Distinct health beliefs and practices among Roma related to illnesses and death have attracted attention from various fields of research [1,2,3,4,5,6,7,8,9,10,11,12]. The current research interest mostly focuses on topics such as the description of Roma health [13], Roma health behaviour [14,15], understanding Roma health [16] and its determinants [17] from the management of most common illnesses among the Roma population [18] and health-mediation programs [19] to comparisons with the non-Roma population regarding specific chronic illnesses [20,21,22,23,24,25,26]. Seemingly, some beliefs and practices are more stable than others, and some are more prone to change over time.…”