Social Exclusion as a Determining Health Factor of the Roma Population

Abstract

Introduction: Poverty, social inequality and marginalization of certain population groups cause the exclusion of these groups from the society and the benefits provided by the social relations of the community. Goal: The goal of this study was to evaluate the characteristics of social exclusion of the Roma population in the local community and to determine how this exclusion affects the health status of the population. Material and methods: Included-survey, medical examination and laboratory testing of full blood, blood glucose and markers of hepatitis B on 612 Roma. The data obtained are compared to those of the general population of the local community. Results and conclusion: The social exclusion of the Roma population in the local community causes its significantly worse health status. Infectious diseases caused by poor hygienic conditions in Roma settlements and chronic diseases caused by stress, inadequate nutrition and poor housing conditions occur 5-20 times more frequently than in the general population.

Social Exclusion as a Determining Health Factor of the Roma Population

DOI: 10.5455/medarh.2013.67.60-62 Med Arh. 2013 Feb; 67(1): 60-62

Received: November 18th 2012 | Accepted: January 20th 2013

CONFLICT OF INTEREST: NONE DECLARED

ORIGINAL PAPER

Social Exclusion as a Determining Health Factor of the Roma Population

Suad Sivic1, Adin Huremovic2, Haris Djerzic2

Institute of Public Health of Zenica-Doboj Canton, Zenica, Bosnia and Herzegovina1

Public Health Care Center Zavidovici, Bosnia and Herzegovina2

Introduction: Poverty, social inequality and marginalization of certain population groups cause the exclusion of these groups from the society and the benets provided by the social relations of the community. Goal: The goal of this study was to evaluate the characteristics

of social exclusion of the Roma population in the local community and to determine how this exclusion aects the health status of the population. Material and methods: Includedsurvey, medical examination and laboratory testing of full blood, blood glucose and markers of hepatitis

B on 612 Roma. The data obtained are compared to those of the general population of the local community. Results and conclusion: The social exclusion of the Roma population in the local community causes its signicantly worse health status. Infectious diseases caused by poor hygienic conditions in Roma settlements and chronic diseases caused by stress, inadequate nutrition and poor housing conditions occur 5-20 times more frequently than in the general population. Key words: Roma, social exclusion.

Corresponding author: Suad Sivic, MD, PhD. Institute of Public Health of Zenica-Doboj Canton. Fra Ivana Jukica 2. Zenica, Bosnia and Herzegovina. Mob: [phone]. E-mail: [email protected]

1. INTRODUCTION

Social inequality, poverty, marginalization and deprivation of all social norms in the part of the population, whether they are ethnic minorities, groups of the population with its specic determinations or otherwise formed groups of the population who are systematically deprived in their rights, opportunities and resources for a normal life in the last few decades is recognized as social exclusion (1). The term was introduced by the French sociologist during the seventies of 20th

century, in response to the expansion of the old and the emergence of new social problems conditioned by the economic restructuring of the capitalist countries. Economic crisis, social crisis and the reincarnation of neoliberalism in the 90 of the last century, particularly aecting socially marginalized population

groups, among them the most prominent Roma population, which becomes extremely poor (2).

Poor people often have low level of education, live in poor housing in poor neighborhoods, villages or regions. Besides, the poor generally do not have high-quality food and often have a problem to access basic health services. Because of their poverty, they are often exposed to multiple negative impacts.

There were numerous reports that socially excluded population groups have more health problems than the general population from their environment. Often these diseases are related to poor hygienic conditions (3), sometimes are caused by the unavailability of health services (4) and very often because of economic or traditional unfavorable conditions for the health care provision (5, 6).

Roma in Bosnia and Herzegovina are the minority group with clear signs of social exclusion. This exclusion is evident in all areas of social relations and the result of the historically acquired lifestyle. For centuries, they were subject to persecution, discrimination, segregation and exclusion. As a result, they organized themselves in closed exuded, even self-excluded groups with a specic way of life, economy, culture and the specic needs... Such an organization, lifestyle and social exclusion have caused a very poor population category, which further deepens the initial factors of poverty, putting them at the very bottom of the social scale (7).

2. GOAL

The goal of our study was to determine the social characteristics of the Roma population in the municipality Zavidovici, determine differences in social characteristics in comparison to the general population, that is, to determine the degree of social exclusion of the Roma population groups and to determine how these dierences impact on health status of this socially excluded community.

3. MATERIAL AND METHODS

The study was conducted on the territory of Municipality Zavidovici in the rst 6 months of 2012. Study included a survey of Roma population on their social status (housing conditions, economic activity, access to health services,

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Med Arh. 2013 Feb; 67(1): 60-62 ORIGINAL PAPER

Social Exclusion as a Determining Health Factor of the Roma Population

400

300

200

100

0

male female 0-6years 6-18

years 19-35

years 36-65

years above

65 years

educational structure). Also made was a basic health examination including their personal history and laboratory tests (whole blood, blood sugar, markers for hepatitis B). Th e data were compared with those in the same general population that are obtained from a regular health statistics of the Primary Health Care Center in Zavidovici. Th e results are presented in charts and tables and the dierence in the incidence of the disease has been tested by Chi-square test.

4. RESULTS

It is estimated that in the territory of Zavidovici there are about 830 inhabitants of the Roma minority in the 124 households, which amounts to 2.2% of the general population.

Residing in separate suburban Roma settlements Rupin Dol, Dragovac and Dolovi, while smaller number of Roma living in the streets named Sarajevo, Sutjeska and in the inner urban core.

Th e study comprised 612 Roma with equal representation of both sexes. Th e most common is the active age group of 19-65 years of age (Figure 1).

Social statusRoma on the territory of Zavidovici reside mainly in their own housing units (64.5% of them), a little less together in their parents apartments (30.2%) and very little in rented apartments. But it should be noted that of 612 respondents, 609 of them live in the house which has a sewage network and water supply, while 602 live in the house that has a bathroom. In case of 609 respondents living facility has electric power supply. However, by the subjective assessment of interviewers residential buildings in 62% of cases are uninhabitable.

More than half of the respondents were illiterate (56.7%), while slightly more of them have not completed any school (64.5%). Only 16 respondents had completed high school. One respondent was legally employed. Livelihoods are acquired mainly through various forms of government assistance (child benet, social security, disability) and most of them have other sources of income, mainly by collecting secondary raw materials (53.3% of them), re-

sell second hand goods (20.6% of them) and 22 of them earn money by begging.

Access to health careHealth insurance does not have 75% of respondents. A large percentage of respondents do not have always dened access with thehealth service (95% of themdid not chosen a general orfamily medicine doctor, 98%of them have not chosen adentist, 85% of children haveno dedicated pediatrician and93% of women do not have a gynecologist), but they contact the health system according to needs, where they canand usually it is emergencyservice. Although there is no organized approach to thehealth service and there are alarge number of those withouthealth insurance they still often nd the way to a doctor.

So slightly less than half ofthem said they were treatedin the hospital (40% of total sample) and by a specialist (49% of them). Only 30 respondents indicated that are regularly vaccinated (4.9% oftotal respondents), while onlyfor 17 of them (1.1%) there isa written proof that they are vaccinated. Average distanceof respondents from the nearest health facility is 2.45 km.

Morbidity ratesThe most common diseases caused by poor hygiene and epidemiological situation of the Roma population are urinary tract infections with a rate of 305.56 per 1000 respondents, the scabies with a

rate of 12.82 / 1000, hepatitis A at a rate of 13.07 / 1000 and hepatitis B with a rate of 4.90 / 1000 respondents.

Among chronic noncommunicable diseases the most common are chronic bronchitis with a rate of 163.40 / 1000 respondents, diabetes mellitus with a rate of 29.41 / 1000 respondents, high blood pressure with a rate of 395.42 / 1000 respondents, lung cancer at a rate of 8.54 / 1000, heart disease with a rate of 184.64 / 1000 and anemia due to iron deciency with a rate of 400.32 / 1000 respondents. Test-

Disease X2test p Scabies 35.775 <0.05 Hepatitis A 92.416 <0.05 Hepatitis B 76.545 <0.05 Inammation of the urinary tract 1169.037 <0.05 Hypertension 645.567 <0.05 Anemia due to iron deciency 5562.321 <0.05 Heart disease 1538.336 <0.05 Psychosomatic disorders 150.758 <0.05 Bronchitis 813.165 <0.05 Diabetes 29.129 <0.05 Lung cancer 42.072 <0.05

Table 1. The results of differences testing between the two groups, X2 test for some diseases (in all cases, the rate is higher in the Roma population)

Disease

Figure 1. Gender and age structure of the examined Roma

Figure 1. Gender and age structure of the examined Roma population in Municipality Zavidovici

Disease X2test p

Scabies 35.775 <0.05

Hepatitis A 92.416 <0.05 Hepatitis B 76.545 <0.05 Inflammation of the urinary tract 1169.037 <0.05 Hypertension 645.567 <0.05 Anemia due to iron deficiency 5562.321 <0.05 Heart disease 1538.336 <0.05 Psychosomatic disorders 150.758 <0.05 Bronchitis 813.165 <0.05 Diabetes 29.129 <0.05 Lung cancer 42.072 <0.05

Table 1. The results of differences testing between the two groups, X2 test for some diseases (in all

cases, the rate is higher in the Roma population)

population in Municipality Zavidovici

Cases per 1000 inhabitants in Zavidovici general population

Cases per 1000 inhabitants in examined Roma population

Scabies 1.92 12.82 Hepatitis A 0.79 13.07 Hepatitis B 0.11 4.90 Inammation ofthe urinary tract 34.97 305.56

Table 2. Prevalence of the most common infectious diseases in the general and the Roma population in Zavidovici

Disease

Cases per 1000 inhabitants in Zavidovici general population

Cases per 1000 inhabitants in examined Roma population

Hypertension 90.87 395.42 Anemia due toiron deciency 10.54 400.32

Heart disease 9.40 184.64 Psychosomaticdisorders 18.06 86.60

Bronchitis 14.38 163.40 Diabetes 8.66 29.41 Lung cancer 0.68 8.54

Table 3. The prevalence of the most common chronic diseases in the Roma and the general population in Zavidovici

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Social Exclusion as a Determining Health Factor of the Roma Population

ing the dierence in frequency of certain diseases in the general population and examined Zavidovici Roma population by chi-square test showed statistically signicant dierences. Values

of

X2 test and statistical signicancep for certain diseases are given in Table 1.

5. DISCUSSION

In the area of Zavidovici Roma population is slightly more concentrated than in other parts of Bosnia and Herzegovina (7), so some of its more features are more prominent. This gives us an opportunity to more clearly dene their way of life and the consequences of social exclusion.

Although 99% of housing units in which Roma live has installed electricity and 98% of them are connected to the water supply and sewage system, the vast majority are living in housing units where the conditions of living in a large percentage (62%) are very poor, which diers from living conditions of the general population. Basically these are poorly built or crumbling buildings, wet or poorly heated rooms and spaces with inadequate cleaning. Such living conditions contribute to an increased prevalence of diseases caused by poor hygienic conditions such as scabies, a contagious jaundice or urinary tract infections (8). Comparing the prevalence of these diseases in the general population in Zavidovici and examined Roma populations we found that rates of morbidity are signicantly higher among Roma (Table 2).

Also other social conditions are very unfavorable. Only one respondent is legally employed, while everyone else is to contrive a variety of ways to earn for a living. Basically it is legally unregulated collection and sale of secondary raw materials, then the sale of second hand goods and social assistance. Illit-

eracy, unemployment, lack of means of subsistence, hard work and ongoing uncertainty caused statistically signicantly higher incidence of many chronic diseases than they occurs in the general population. Most common are diseases associated with stress and inadequate nutrition such as high blood pressure, iron-deciency anemia or diabetes (9, 10). Our study showed a statistically signicantly higher incidence of these chronic diseases in a group of Roma population (Table 3).

A large number of respondents are not insured and does not have dened access to the health services (dened responsible health professionals), but they contact the health system as needed, where they can and usually it is the emergency service. Inaccessibility of health care causing the poor or inadequate treatment of the patients, the diseases are detected in the late stages when the treatment is difficult and this is one of the reasons for the increased rates of chronic diseases among the Roma population (11, 12).

6. CONCLUSIONS

In conclusion we can say that social exclusion, closed communities and consequently poor economic situation, customs, lack of education, lack of health services and many other factors had signicant negative impact on the health status of the Roma population in Zavidovici. All this creates a further precondition for even deeper isolation and social exclusion and a very hard life for the Roma population.

REFERENCES

1. uur Z. Socijalna iskljuenost: pojam, pristupi i operacionalizacija. Revija za sociologiju. 2004; 35(1-2): 45-60.

2. Ivanov A, Collins M, Grosu C, Kling J, Milcher S, OHiggins N, Slay B, Zhelyazkova A. Ugroenost: Romi i raseljene

osobe u JI Evropi. UNDP, 2006. 3. Freitas DA, Moreira G, Jones KM, Caldeira AP. Social exclusion and myiasis of the upper lip in a Brazilian rural resident. Rural Remote Health. 2012 Jul; 12(3): 2188.

4. Zere E, Oluwole D, Kirigia JM, Mwikisa CN, Mbeeli T. Inequities in skilled attendance at birth in Namibia: a decomposition analysis. BMC Pregnancy Childbirth. 2011 May14; 11:34.

5. Sharma Bhattarai LP. Older peoples exclusion from healthcare services in Nepal: An analysis of the political economy of development aid, domestic policy and research. Geriatr Gerontol Int. 2012 Sep19. doi: 10.1111/j.1447-0594.2012.00947.x.

6. Mumtaz Z, OBrien B, Bhatti A, Jhangri G. Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion. BMC Health Serv Res. 2012 Sep19; 12(1): 326.7. Ivanov A. et all. Ugroenost: Romi i raseljene osobe u JI Europi. UNDP Region-alni Ured za Europu i Zajednicu nezavisnih drava, Bratislava, 2006.

8. Mello CS, Tahan S, Melli LC, Rodrigues MS, de Mello RM, Scaletsky IC, de Morais MB. Methane production and small intestinal bacterial overgrowth in children living in a slum. World J Gastroenterol. 2012 Nov7; 18(41): 5932-9. doi: 10.3748/wjg.v18.i41.5932.9. Saydah SH, Imperatore G, Beckles GL. Socioeconomic Status and Mortality: The Contribution of Health Care Access and Psychological Distress Among United States Adults With Diagnosed Diabetes. Diabetes Care. 2012 Aug 28.

10. Pan L, Sherry B, Njai R, Blanck HM. Food insecurity is associated with obesity among US adults in 12 states. J Acad Nutr Diet. 2012 Sep; 112(9): 1403-1409. doi: 10.1016/j.jand.2012.06.011.

11. Zarate-Abbott P, Etnyre A, Gilliland I, Mahon M, Allwein D, Cook J, Mikan V, Rauschhuber M, Sethness R, Muoz L, Lowry J, Jones ME. Workplace health promotionstrategies for low-income Hispanic immigrant women. AAOHN J. 2008 May; 56(5): 217-222.12. Colombo C, Galli A, Pero M, Giani R, Jucker S, Oreste P, Giommarini C, Aiol E, Judica E. Sociodemographic and health conditions of the Rom population in Milan. Epidemiol Prev. 2011 Sep-Dec; 35(5-6): 282-291.

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