Research on Roma health and access to healthcare: state of the art and future challenges

Health inequalities experienced by Roma people living in Europe presents a persisting challenge for health care programs. Research studies on Roma health conditions reveal that: (1) Roma people suffer from poorer health and unhealthier living conditions compared to majority populations, (2) better data are needed to explain the Roma health gap and design better interventions to reduce this gap, and (3) the poor health of Roma is closely linked to the social determinants of health.This editorial published in the International Journal of Public Health discusses lessons learned from recent research findings and outlines a number of challenges in exploring and addressing the various mechanisms that contribute to the health gap between Roma and majority populations.The editorial was authored by Alina Covaci of the Open Society Foundations' Roma Health Project and Maria Eva Foldes of the Tilburg Law and Economics Center in the Netherlands

Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia

OBJECTIVE: Exploring the associations of regional differences in infant mortality with selected socioeconomic indicators and ethnicity could offer important clues for designing public health policy measures. METHODS: Data included perinatal and infant mortality in the 79 districts of the Slovak population in 2004. Linear regression was used to analyse the contribution of education, unemployment, income and proportion of Roma population on regional differences in perinatal and infant mortality rates. RESULTS: All the explored socioeconomic indicators and ethnicity individually contributed significantly to both perinatal and infant mortality, with the exception of income. In the model exploring the influence of all these variables together on perinatal and infant mortality, only the effect of the proportion of Roma population remained significant. This model explained 34.9% of the variance for perinatal and 36.4% of the variance for infant mortality. CONCLUSIONS: Living in Roma settlements indicates an accumulation of socioeconomic disadvantage. Health literacy, health-related behaviour and many other factors might contribute to the explanation of the differences in infant mortality, and a better understanding of these processes might help us to design tailored interventions

The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study

Abstract Background Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been associated with healthcare utilisation and with education attainment, we sought to explore whether health literacy is related to the use of out-of-hours (OOH) Primary Care Services (PCSs). Additionally, we aimed to study whether and to what extent health literacy accounts for some of the association between education and OOH PSC use. Methods A survey including measures of education attainment, health literacy (assessed by means of the Dutch version of the nine-dimension Health Literacy Questionnaire) and use of PCS was conducted among a sample of adults diagnosed with (any) somatic chronic condition in the Netherlands (response 76.3%, n = 1811). We conducted linear and logistic regression analyses to examine associations between education level and PCS use in the past year. We performed mediation analyses to assess whether the association between education and PCS use was (partly) explained by different aspects of health literacy. We adjusted the models for patient characteristics such as age and morbidity. Results Higher education attainment was associated with higher scores on the health literacy aspects Appraisal of health information, and Navigating the healthcare system. Additionally, appraisal and navigating the healthcare system partially accounted for educational differences in PCS use. Finally, higher appraisal of health information scores were associated with higher PCS utilisation. Conclusion Several aspects of health literacy were demonstrated to relate to PCS use, and partly accounted for educational differences herein. Accordingly, developing health literacy within individuals or communities may help to reduce inappropriate PCS use among people with low education

Attempting to mainstream ethnicity in a multi-country EU mental health and social inclusion project: lessons for social work

The article will outline the logic, parameters, and methodology of an attempt at mainstreaming ethnicity within EMILIA, an EU 6th FP multi-sites project focused on mental health and social inclusion over two years. Led by two social work researchers within a large multi-disciplinary group consisting of eight sites spread across Southern, Central and Northern Europe, alongside mainstreaming gender, we will look at the findings of the baseline audit, the ensuing action plans and the changes which followed. Examining the process and its outcomes for mainstreaming across the different sites and the services they provide for people experiencing mental health problems highlights the impact of country-specific policies on disclosure of information pertaining to ethnicity as well as country and site policies and practices pertaining to recognising the existence of ethnic inequality and tackling it. Issues underlying formal mainstreaming staff and users' training will be explored. The role of social work within a multi-disciplinary group will also be looked at, and the lessons for European social work will be outlined. The lessons pertain in part to the impact of the wide ranging variation in background, scope and focus on the role social work values, knowledge and skills can play in the intersection between mental health, parameters of social inclusion and mainstreaming ethnicity