Reducing health inequalities through an integrated policies to improve Roma health conditions

By Zoltán Massay-Kosubek, Policy Coordinator at EPHA

Although the EU has the competence and the mandate to include health in all EU policies and considerable actions have been taken so far to improve public health, policy actions often remained fragmented. As a result, Europe is still suffering from significant health inequalities between and within member states. The recent Marmot report on health inequalities in the EU¹ confirmed that there has been no sign of a decline in inequalities in life expectancy between EU regions.

Why did Europe fail to stop that trend? Partially because the wide range of causes of those inequalities requires an integrated policy response is missing so far. Social inequalities in health arise because of inequalities in the conditions of daily life and there is a significant link between poor health and risk factors such as tobacco and alcohol use, obesity and socio-economic factors like work, food, education, urban environment and the level of participation in society.

Evidence shows that the most vulnerable and the poorest suffer the most from poor health linked to the uneven distribution of the aforementioned social determinants of health. Among the most vulnerable there is a group of 10-12 million people in Europe who are the most universally disadvantaged in Europe: the Roma. The Roma population suffer worse health than the other populations and really highlights the need for combating the social determinants of health across the board. Improving the health of the Roma people through an integrated policy could create a good case study and set a leading example for other excluded and vulnerable groups.

Three long years have already passed since 2011 after the adoption of the EU Framework on Roma Integration strategies², progress has been and still is slow. member states have prepared National Roma Strategies which focus on four selected social determinants of health: education, employment, housing and health care. Although the results are subject to assessment by the European commission and the scrutiny of the civil society, real impact on the ground and tangible improvements in the lives of the Roma are still missing despite some good examples. However, Roma integration is a long term process which calls for the sustained political commitment of all stakeholders to make a difference in the life of Roma people by 2020.

Access to health care is just one element of the social determinants of health in the Roma framework. The recent 2014 Commission assessment³ pointed out that adequate access to health care, social services and preventive measures are still not available for all Roma, especially for Roma children and women. No health coverage often means no vaccinations and both infectious diseases and promotion of healthy lifestyles need more attention from member states. Even the Commission recognises that the training of health professionals and the systematic involvement of Roma health mediators could be a way to address the better access to health care.

The example of the joint efforts made by European institutions, member states and civil society to address the complex problem of Roma integration shows that an integrated policy response to health inequalities through addressing the social determinants of health could be a good model to be replicated for other vulnerable groups. But since many of the core determinants of health lie outside of health care, we can only create real improvements in the lives of the Roma by integrating other sectors outside of the health sector.

At the European Public Health Alliance (EPHA) Annual Conference on 4 September, we will discuss what kind of integrated approaches could be used to tackle framework conditions for health outcomes and the European policy answers to the needs of the Roma. Hopefully, the fruitful discussion will lead to additional innovative ideas and solutions.

1 http://ec.europa.eu/health/social_determinants/docs/healthinequalitiesineu_2013_en.pdf
2http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52012DC0226&from=en
3http://ec.europa.eu/justice/discrimination/files/com_209_2014_en.pdf

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