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The health of the Roma people: a review of the published literature

One opportunity on the horizon is the growing interest in the Roma among international agencies and similar bodies; largely as a result of lobbying by Roma agencies. TaurisNew York. Pediatrics 54 : —

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Dear reader, online ads enable us to deliver the journalism you value. The collapse of communism had major implications for the Roma population, with an upsurge in racist attacks, often with semi-official sanction, in states experiencing re-emergent nationalism. Roma health is thought to lag behind that of majority populations, Prostitutes Natahoyo some studies suggesting a fourfold increase in infant mortality and a 10 year deficit in life expectancy 9 but research on the health of the Roma is limited and difficult to access.

This presents challenges. The paucity of literature limits the scope for international comparison, and the small number of active researchers means that, for many countries, no information is accessible. Differences in terminology are problematic; the term traveller, used in Prostitutes Natahoyo United Kingdom, is unfamiliar in countries where the Roma population is Prostitutes Natahoyo settled.

It is, however, important not to fall into the trap of equating absence of evidence on Roma health with evidence of absence of health inequalities. Publications were Prostitutes Natahoyo by a search of Medline to Prostitutes Natahoyo Platter.

Alternative keywords used were: gypsy, gipsy, gypsies, gipsies, romany, vlach, traveller. Examination of the remainder showed a proportion relating to genetic detection of Roma ancestry, Prostitutes Natahoyo to arthropods with the gypsy moth and gypsy variant of the Drosophila fruit fly Prostitutes Natahoyo cited.

After these exclusions, through multiple Boolean searches, a total of papers remained of which 65 were in English and in other languages. The abstracts were manually assessed by the researchers for relevance to the Roma people, rather than other nomadic non-Roma groups, and health or healthcare. One hundred and five citations remained and the original papers were obtained and summarised, where necessary, into English. The findings of the two searches are compared in table 1.

The 62 citations from the second search were a subset of the from the first.

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A search of the world wide web using the HotBot search engine yielded many hits but these were of limited usefulness. What research exists seems to reflect Prostitutes Natahoyo of the Roma as threats to the majority population, either through infectious disease or their contribution to the gene pool. Such research must be handled with sensitivity, recognising the social and political context of the societies concerned.

An initial question is the size of the Roma population. Estimates from different sources can vary 10 for several reasons. The history of oppression and forced assimilation in some countries may make people loath to declare Roma ethnicity. Some countries have only recently recognised the Roma as an ethnic group for Prostitutes Natahoyo purposes of census and others Prostitutes Natahoyo do not.

Roma people are often socioeconomically deprived. This, added to itinerant lifestyle and a mistrust of authority figures may contribute to under-ascertainment. Taking these issues into account, the Minority Rights Group 11 compiled estimates of the populations in various European countries in the early s table 2.

Prostitutes Natahoyo do not include recent mass movements of population in the former Yugoslavia. Prostitutes Natahoyo of Roma population in various European countries, early Prostitutes Natahoyo. Turning to the literature on health among the Roma, there is Prostitutes Natahoyo variation in the number of Prostitutes Natahoyo from each country, which bears little relation to population size. Table 3 shows the distribution of papers by the country in which they are set.

Some publications relate Prostitutes Natahoyo more than one country so are counted for each country concerned. Seventy per cent of publications relate to just four countries: Spain 24 papersCzech Republic 19 papersSlovakia 16 papers and Hungary 14 papers. Table 4 shows papers grouped by care group, disease or subject.

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These were counted Prostitutes Natahoyo all relevant subject areas. Most papers relate to child health including congenital anomalies or communicable disease. Only six were related to chronic and non-communicable disease.

The subject areas will be examined in detail below. Health of Roma children has attracted particular attention. Many studies relate to communicable disease, but other issues have also been Prostitutes Natahoyo. From birth, there seems to be a differential Prostitutes Natahoyo health between Roma and majority populations.

In Hungary, Roma infants were twice as likely to be born prematurely and there was a significant excess of births under g at most gestational ages. A Spanish study of congenital malformations 13 found that recessive syndromes were seven times more common than in the reference population, a finding attributed to consanguinity 12 times as common as the majority population. High Prostitutes Natahoyo of consanguinity have Prostitutes Natahoyo reported among Roma populations elsewhere.

There was little research on common disorders of childhood. One study from Spain 16 found excess morbidity from secretory otitis media in Prostitutes Natahoyo children. This was thought to be explained by socioeconomic status, not ethnic factors.

Other research is eclectic. A study of childhood Prostitutes Natahoyo tumours in Hungary 17 found a lower incidence than in the general population. Both lead poisoning Prostitutes Natahoyo and burns 19 have been shown to be more common in Roma children, findings that are consistent with environmental exposure.

Roma adolescents, even where drug use is prevalent, Prostitutes Natahoyo a low rate of substance misuse 20 but a case-control study 21 seems to show an increase in neonatal abstinence syndrome in the offspring of young Roma mothers in Mexico between and Any discussion of the reproductive health of Roma people must take account of the practice of forced sterilisation of Roma women, prevalent in some countries, and its possible effect on present day help seeking behaviour.

J Infect Dis.

A more Prostitutes Natahoyo study of contraceptive practices among Roma women in Spain found significantly lower levels of knowledge about barrier methods of contraception, vasectomy and tubal occlusion and periodic abstinence. The primary contraception was coitus interruptus.

They were less likely to seek contraceptive advice than non-Roma women and had more pregnancies; leading both to more live births and terminations of pregnancy. A Bulgarian study 24 found nearly half of pregnancies where the mother was aged Prostitutes Natahoyo to be among women of Prostitutes Natahoyo origin.

A study of commercial sex workers attending a sexually transmitted disease clinic in Plovdiv, Bulgaria 25 found more Prostitutes Natahoyo half to be of Roma origin. Sero-surveys among pregnant women in Spain have indicated Prostitutes Natahoyo rates of hepatitis A 26 and hepatitis B 27 in the Roma population. Non-communicable disease in Roma adults has received little attention.

This review yielded only three citations relating to adult disease the remainder Prostitutes Natahoyo to paediatric conditions. Of these only one was available. A study of cultural factors among Prostitutes Natahoyo children found a high prevalence of diabetes mellitus and hypertension in family histories obtained.

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A few studies have examined mental health, finding an excess of suicide and parasuicide over the general population. A large proportion of the literature on Roma health is devoted to communicable disease. Many papers are reports of outbreaks or cases and not the epidemiology of disease, although some draw attention to low immunisation coverage. There seems to an increased incidence and seroprevalence of many classic epidemic diseases as well as more newly identified infections.

Mycobacterial infection is reported more common Prostitutes Natahoyo Roma than Prostitutes Natahoyo other populations, and increasing at a faster rate. Viral hepatitis has attracted much attention.

Seroprevalence surveys in pregnancy Prostitutes Natahoyo 27 show high levels Prostitutes Natahoyo infection with hepatitis A and B which can be transmitted vertically. In another Spanish study, 35 three groups were compared; non-Roma children, Roma children, and children in orphanages. From seven upwards there was an excess in age specific seroprevalence of hepatitis A virus of Roma children over other groups. Overcrowding seemed to be a factor, as did poverty and sanitary Prostitutes Natahoyo.

The excess in seroprevalence of hepatitis B in pregnant Roma women was also described in A seroprevalence survey of the prison Prostitutes Natahoyo in north east Spain 38 found an excess over Prostitutes Natahoyo prisoners. There is evidence for an excess of hepatitis E morbidity among the Roma, with a study in Bohemia 39 showing a doubling in the seroprevalence of hepatitis E antibodies over non-Roma STD clinic attenders.

With increased rates of other blood borne virus infections and low use of barrier contraception, one might expect a high rate Prostitutes Natahoyo HIV infection. Two studies, however, one among a prison population in Spain 40 and another limited to intravenous drug users, 41 showed a significantly lower seroprevalence of HIV among Roma than non-Roma inmates.

In recent decades infection attributable to wild poliomyelitis, rather than vaccine associated viruses has been concentrated among Roma populations in some countries. Several studies have found differential access to health care by Roma people. Health care is, in some instances, seen as divided: with some diseases generally being dealt with within the community and others requiring the services of the Prostitutes Natahoyo health care system.

For some Roma a stay in hospital other than for childbirth is associated with death. Health care professionals may, without understanding the context, view this as irresponsible.

Ironically, in pre-industrial times Roma played an important part in the delivery of health care to much of Europe, acting as folk healers in the absence of trained physicians.

Access to care is not simply a matter of culturally insensitive provision.

She describes several examples of outright discrimination. This review is subject to the limitations facing any literature review: incomplete ascertainment of papers and publication bias. It is limited to research published in journals indexed by major bibliographic databases. These are known to provide partial coverage, which is likely to be an especial problem here, where relevant studies are likely to have been published in journals that may be difficult to obtain.

Elsewhere we will be reporting on the Prostitutes Natahoyo from a hand search of Czech and Prostitutes Natahoyo literature on health of Roma populations, in which we found this to be so. There is a need to ensure that material that we were unable Prostitutes Natahoyo review be accessible to a wider international audience.

We also recognised that some of the published research may have Prostitutes Natahoyo carried out Prostitutes Natahoyo reasons Prostitutes Natahoyo than altruism. It was nevertheless decided to report findings fully, and not to editorialise results. The research examines health needs of a people that has been dispersed to countries as diverse as Jordan, Mexico, and the United Kingdom.

The health of the Roma people: a review of the published literature

Although the Roma populations in many places have adhered to traditional ways of life and share many common beliefs, the literature encompasses tremendous heterogeneity, making it difficult to generalise. Although the literature overall is fragmentary, the most striking finding is the almost complete Prostitutes Natahoyo of research on non-communicable diseases. Several possible explanations exist but Prostitutes Natahoyo has different implications.

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Some may reflect the difficulties of undertaking research in marginalised populations Prostitutes Natahoyo well developed sets of health beliefs. Classic risk factor epidemiology is difficult among Roma populations who, as well as being Prostitutes Natahoyo to access, may regard researchers with hostility: often appropriately in view of their experiences with authorities.

There are, however, more problematic issues relating to values underlying the research.

The focus on communicable disease may reflect less a concern about the health needs of the Roma but more Prostitutes Natahoyo of the majority population. This concentration on communicable disease also resonates, uncomfortably, with the Social Darwinist agenda, which viewed excess communicable disease in certain populations as a means of reducing those Prostitutes Natahoyo to be constitutionally weak and socially undesirable.

It is in the context of this climate that one must take a view on the appropriateness of different forms of intervention. Notwithstanding the evidence from the UK of the usefulness of targeted interventions, 44 52 Prostitutes Natahoyo intervention that Prostitutes Natahoyo ideas of difference from the majority community may be divisive and cause net harm.

What limited evidence exists indicates that the health needs of Prostitutes Natahoyo Roma population are considerable. Recognising the need for sensitivity because of the dangers arising from nationalism in some countries, there is a need to Prostitutes Natahoyo this issue higher up the public health agenda. Such action faces a wide range of obstacles. The health needs of the Roma population lack visibility, not only because of the absence of research but also the absence of advocacy on their behalf.

In many of the Prostitutes Natahoyo with large numbers of Roma, the public health services that, in the West, might be expected to act as agents to promote policies focusing on the Prostitutes Natahoyo needs of minorities, do not exist. Neither do the non-governmental organisations that Prostitutes Natahoyo been effective in the West in raising the profile of otherwise ignored issues.

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Similarly there is little tradition of the inter-sectoral action that would be required to mount Prostitutes Natahoyo effective policy response. One opportunity on the horizon is the growing interest in the Roma among international agencies Prostitutes Natahoyo similar bodies; largely as a result of lobbying by Roma agencies.

Agencies active in reform of health and social care, such as the World Prostitutes Natahoyo and the Open Society Institute, have taken an increasing interest in this issue.

Prostitutes Natahoyo rights of minorities are increasingly the focus of discussions with countries hoping to accede to the European Union and are also a major issue for the Council of Europe, of which many countries in central and eastern Europe are now members.

The health of the Roma population presents a Prostitutes Natahoyo challenge to public health professionals, especially in some countries where they are a significant minority and where there may be discrimination, social exclusion and even overt racism.

There is a need to explore locally sensitive mechanisms that can begin to understand their health needs and ways of tackling them.

To encourage involvement Prostitutes Natahoyo public Prostitutes Natahoyo research by those Roma people who have transcended discriminatory barriers to access to become health professionals may help to develop relationships with community leaders, based on trust, and pursue agendas that reflect the needs of the Roma rather than the majority population.

Funding: this review was performed as Prostitutes Natahoyo of a project funded by the World Bank.

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