Health needs of the Roma population in the Czech and Slovak Republics

Abstract

In the growing literature on the human rights of Roma people in Central Europe, their relatively poor health status is often mentioned. However, little concrete information exists about the contemporary health status of the Roma in this region. We sought information on the health of the Roma in two of countries with significant Roma minorities, the Czech and Slovak Republics, by means of systematic searches for literature on the health of Roma people published in Czech or Slovak or by authors from the two countries. Published research on health of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. What limited evidence exists indicates that the health needs of the Roma population are considerable. With very few exceptions, the health status of Roma is worse than that of non-Roma population in both countries. The burden of communicable disease among Roma is high and diseases associated with poor hygiene seem to be particularly important. Evidence on health care suggests poor communication between Roma and health workers and low uptake of preventative care. The health needs of Roma lack visibility, not only because of the absence of research but also the absence of advocacy on their behalf. Since 1989, Czech and Slovak researchers have largely turned away from health research on particular ethnic groups. This probably reflects a growing sensitivity about stigmatising Roma, but it also makes it difficult to know how their circumstances might be improved. There is a need for further research into the health of Roma people with particular emphasis on non-communicable disease and for interventions that would improve their health.

Introduction

The recent attempts by groups of Roma families from the Czech Republic and Slovakia to seek asylum in Canada and Britain have focused attention of the media, governments and international agencies on the needs of Roma people. Specifically, the rights of the Roma people have become an issue in negotiations for accession to the European Union. Whilst it is widely believed that the health of Roma people is poorer than the majority population, these inequalities remain largely unresearched. In view of the pressing needs of the Roma people and the emergence of a favourable political environment, it is timely to initiate a comprehensive programme of research on the health problems of the Czech and Slovak Roma populations.

Information on social variation in health of people in Central and Eastern Europe is generally limited. The available data suggests that considerable differences do exist and that the process of economic and political transition generally tends to lead to an increase in health inequality within countries (Shkolnikov, Leon, Adamets, Andreev, & Deev, 1998). We have previously reported an increase in social variation in birth outcomes in the Czech Republic and Estonia during the period of transition, as the groups with lowest education fail to benefit from the changes brought about by the transition. In both countries, there were also considerable differences in mean birth outcomes by marital status and nationality (Koupilova, Bobak, Holcik, Pikhart, & Leon, 1998; Koupilova, Rahu, Rahu, Karro, & Leon, 2000).

Average real income in the Czech Republic decreased by almost 20% between 1989 and 1993, and was still 10% lower in 1995 than in 1989; real wages followed a similar trend. In 1997, real wages in the Czech Republic were at the level of 102% of year 1989. The decline in real income and real wages in Slovakia was even more dramatic. Real wages declined by more than 30% between 1989 and 1993, and in 1997 were still 13% lower than in 1989 (UNICEF, 1999).

Although registered unemployment remained relatively low in the Czech Republic (around 4% in 1997), socio-economic differentials in society clearly increased, as documented by an increase in the Gini coefficient from 20.4 in 1989 to 25.9 in 1997. Registered unemployment is substantially higher in Slovakia (nearly 13% in 1997) (UNICEF, 1999).

The income advantage of education is clearly becoming of increasing importance in both countries in recent years. Although income differences are still smaller than in the West, their appearance at a time of declining average real income has almost certainly increased vulnerability of some, especially the less well educated. This, together with the decline in social benefits, might have produced substantial hardship with a potential to affect health.