Skip to main content
Top
Published in: International Journal of Public Health 9/2018

Open Access 01-12-2018 | Original Article

Why don’t segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia

Authors: Andrej Belak, Andrea Madarasova Geckova, Jitse P. van Dijk, Sijmen A. Reijneveld

Published in: International Journal of Public Health | Issue 9/2018

Login to get access

Abstract

Objectives

The health status of segregated Roma is poor. To understand why segregated Roma engage in health-endangering practices, we explored their nonadherence to clinical and public health recommendations.

Methods

We examined one segregated Roma settlement of 260 inhabitants in Slovakia. To obtain qualitative data on local-level mechanisms supporting Roma nonadherence, we combined ethnography and systematic interviewing over 10 years. We then performed a qualitative content analysis based on sociological and public health theories.

Results

Our explanatory framework summarizes how the nonadherence of local Roma was supported by an interlocked system of seven mechanisms, controlled by and operating through both local Roma and non-Roma. These regard the Roma situation of poverty, segregation and substandard infrastructure; the Roma socialization into their situation; the Roma-perceived value of Roma alternative practices; the exclusionary non-Roma and self-exclusionary Roma ideologies; the discrimination, racism and dysfunctional support towards Roma by non-Roma; and drawbacks in adherence.

Conclusions

Non-Roma ideologies, internalized by Roma into a racialized ethnic identity through socialization, and drawbacks in adherence might present powerful, yet neglected, mechanisms supporting segregated Roma nonadherence.
Appendix
Available only for authorised users
Literature
go back to reference Andreassen T, Weiderpass E, Nicula F, Suteu O, Itu A, Bumbu M, Tincu A, Ursin G, Moen K (2017) Controversies about cervical cancer screening: a qualitative study of Roma women’s (non) participation in cervical cancer screening in Romania. Soc Sci Med 183:48–55CrossRef Andreassen T, Weiderpass E, Nicula F, Suteu O, Itu A, Bumbu M, Tincu A, Ursin G, Moen K (2017) Controversies about cervical cancer screening: a qualitative study of Roma women’s (non) participation in cervical cancer screening in Romania. Soc Sci Med 183:48–55CrossRef
go back to reference Archer MS (2000) Being human: the problem of agency. Cambridge University Press, CambridgeCrossRef Archer MS (2000) Being human: the problem of agency. Cambridge University Press, CambridgeCrossRef
go back to reference Babinska I, Geckova AM, Jarcuska P, Pella D, Marekova M, Stefkova G, Veselska ZD (2014) Does the population living in Roma settlements differ in physical activity, smoking and alcohol consumption from the majority population in Slovakia? Cent Eur J Public Health 22:S22–S27CrossRef Babinska I, Geckova AM, Jarcuska P, Pella D, Marekova M, Stefkova G, Veselska ZD (2014) Does the population living in Roma settlements differ in physical activity, smoking and alcohol consumption from the majority population in Slovakia? Cent Eur J Public Health 22:S22–S27CrossRef
go back to reference Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT (2017) Structural racism and health inequities in the USA: evidence and interventions. Lancet 389:1453–1463CrossRef Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT (2017) Structural racism and health inequities in the USA: evidence and interventions. Lancet 389:1453–1463CrossRef
go back to reference Belak A (2013) Health-system limitations of Roma health in Slovakia: a qualitative study. WHO Country Office in Slovakia, Bratislava Belak A (2013) Health-system limitations of Roma health in Slovakia: a qualitative study. WHO Country Office in Slovakia, Bratislava
go back to reference Belak A, Geckova AM, van Dijk JP, Reijneveld SA (2017) Health-endangering everyday settings and practices in a rural segregated Roma settlement in Slovakia: a descriptive summary from an exploratory longitudinal case study. BMC Public Health 17:128CrossRef Belak A, Geckova AM, van Dijk JP, Reijneveld SA (2017) Health-endangering everyday settings and practices in a rural segregated Roma settlement in Slovakia: a descriptive summary from an exploratory longitudinal case study. BMC Public Health 17:128CrossRef
go back to reference Bobakova D, Dankulincova Veselska Z, Babinska I, Klein D, Madarasova Geckova A, Cislakova L (2015) Differences between Roma and non-Roma in how social support from family and friends helps to overcome health care accessibility problems. Int J Equity Health 14:37CrossRef Bobakova D, Dankulincova Veselska Z, Babinska I, Klein D, Madarasova Geckova A, Cislakova L (2015) Differences between Roma and non-Roma in how social support from family and friends helps to overcome health care accessibility problems. Int J Equity Health 14:37CrossRef
go back to reference Bourdieu P (1998) Practical reason: on the theory of action. Polity Press, Cambridge Bourdieu P (1998) Practical reason: on the theory of action. Polity Press, Cambridge
go back to reference Bourdieu P (2000) Pascalian meditations. Stanford University Press, Stanford Bourdieu P (2000) Pascalian meditations. Stanford University Press, Stanford
go back to reference Cockerham WC (2005) Health lifestyle theory and the convergence of agency and structure. J Health Soc Behav 46:51–67CrossRef Cockerham WC (2005) Health lifestyle theory and the convergence of agency and structure. J Health Soc Behav 46:51–67CrossRef
go back to reference Cook B, Wayne GF, Valentine A, Lessios A, Yeh E (2013) Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003–2012. Int J Public Health 58:885–911CrossRef Cook B, Wayne GF, Valentine A, Lessios A, Yeh E (2013) Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003–2012. Int J Public Health 58:885–911CrossRef
go back to reference Crowe D (2007) A history of the gypsies of Eastern Europe and Russia, 2nd edn. Palgrave/Macmillan, New YorkCrossRef Crowe D (2007) A history of the gypsies of Eastern Europe and Russia, 2nd edn. Palgrave/Macmillan, New YorkCrossRef
go back to reference Dressler WW (2005) What’s cultural about biocultural research? Ethos 33:20–45CrossRef Dressler WW (2005) What’s cultural about biocultural research? Ethos 33:20–45CrossRef
go back to reference Dressler WW, Oths KS, Gravlee CC (2005) Race and ethnicity in public health research: models to explain health disparities. Annu Rev Anthropol 34:231–252CrossRef Dressler WW, Oths KS, Gravlee CC (2005) Race and ethnicity in public health research: models to explain health disparities. Annu Rev Anthropol 34:231–252CrossRef
go back to reference EUC (2014) Roma Health Report. Health status of the Roma population. Data collection in the Member States of the European Union, p 153 EUC (2014) Roma Health Report. Health status of the Roma population. Data collection in the Member States of the European Union, p 153
go back to reference Fanon F (2008) Black skin, white masks. Grove Press, New York Fanon F (2008) Black skin, white masks. Grove Press, New York
go back to reference Fassin D (2011) Racialization. How to do races with bodies. In: Mascia-Lees FE (ed) A companion to the anthropology of the body and embodiment. Wiley-Blackwell, Oxford, pp 419–434CrossRef Fassin D (2011) Racialization. How to do races with bodies. In: Mascia-Lees FE (ed) A companion to the anthropology of the body and embodiment. Wiley-Blackwell, Oxford, pp 419–434CrossRef
go back to reference Filadelfiova J, Gerbery D (2012) Report on the living conditions of Roma households in Slovakia 2010. UNDP, Bratislava, p 234 Filadelfiova J, Gerbery D (2012) Report on the living conditions of Roma households in Slovakia 2010. UNDP, Bratislava, p 234
go back to reference FRAEU, UNDP (2012) The situation of Roma in 11 EU Member States. Survey results at a glance. European Union Agency for Fundamental Rights & UNDP, Luxembourg, p 31 FRAEU, UNDP (2012) The situation of Roma in 11 EU Member States. Survey results at a glance. European Union Agency for Fundamental Rights & UNDP, Luxembourg, p 31
go back to reference Frohlich KL, Corin E, Potvin L (2001) A theoretical proposal for the relationship between context and disease. Sociol Health Illn 23:776–797CrossRef Frohlich KL, Corin E, Potvin L (2001) A theoretical proposal for the relationship between context and disease. Sociol Health Illn 23:776–797CrossRef
go back to reference Geckova AM, Babinska I, Bobakova D, Veselska ZD, Bosakova L, Kolarcik P, Jarcuska P, Pella D, Halanova M (2014) Socioeconomic characteristics of the population living in Roma settlements and their association with health and health-related behaviour. Cent Eur J Public Health 22:S57–S64CrossRef Geckova AM, Babinska I, Bobakova D, Veselska ZD, Bosakova L, Kolarcik P, Jarcuska P, Pella D, Halanova M (2014) Socioeconomic characteristics of the population living in Roma settlements and their association with health and health-related behaviour. Cent Eur J Public Health 22:S57–S64CrossRef
go back to reference Grill J (2017) ‘In England, they don’t call you black!’Migrating racialisations and the production of Roma difference across Europe. J Ethnic Migr Stud 44:1136–1155CrossRef Grill J (2017) ‘In England, they don’t call you black!’Migrating racialisations and the production of Roma difference across Europe. J Ethnic Migr Stud 44:1136–1155CrossRef
go back to reference Halanova M, Jarcuska P, Kalinova Z, Carikova K, Oravcova J, Jarcuska P, Pella D, Marekova M, Geckova AM, Cislaková L (2014) The prevalence of Chlamydia trachomatis in the population living in Roma settlements: a comparison with the majority population. Cent Eur J Public Health 22:S32–S36CrossRef Halanova M, Jarcuska P, Kalinova Z, Carikova K, Oravcova J, Jarcuska P, Pella D, Marekova M, Geckova AM, Cislaková L (2014) The prevalence of Chlamydia trachomatis in the population living in Roma settlements: a comparison with the majority population. Cent Eur J Public Health 22:S32–S36CrossRef
go back to reference Hausmann-Muela S, Muela Ribera J, Nyamongo I (2003) Health-seeking behaviour and the health system response. DCPP working paper no. 14. Disease Control Priorities Project, pp 1–37 Hausmann-Muela S, Muela Ribera J, Nyamongo I (2003) Health-seeking behaviour and the health system response. DCPP working paper no. 14. Disease Control Priorities Project, pp 1–37
go back to reference Hedström P, Ylikoski P (2010) Causal mechanisms in the social sciences. Annu Rev Sociol 36:49–67CrossRef Hedström P, Ylikoski P (2010) Causal mechanisms in the social sciences. Annu Rev Sociol 36:49–67CrossRef
go back to reference Hijova E, Geckova AM, Babinska I (2014) Do eating habits of the population living in Roma settlements differ from those of the majority population in Slovakia? Cent Eur J Public Health 22:S65–S68CrossRef Hijova E, Geckova AM, Babinska I (2014) Do eating habits of the population living in Roma settlements differ from those of the majority population in Slovakia? Cent Eur J Public Health 22:S65–S68CrossRef
go back to reference Janevic T, Sripad P, Bradley E, Dimitrievska V (2011) “There’s no kind of respect here” A qualitative study of racism and access to maternal health care among Romani women in the Balkans. Int J Equity health 10:53CrossRef Janevic T, Sripad P, Bradley E, Dimitrievska V (2011) “There’s no kind of respect here” A qualitative study of racism and access to maternal health care among Romani women in the Balkans. Int J Equity health 10:53CrossRef
go back to reference Janevic T, Jankovic J, Bradley E (2012) Socioeconomic position, gender, and inequalities in self-rated health between Roma and non-Roma in Serbia. Int J Public Health 57:49–55CrossRef Janevic T, Jankovic J, Bradley E (2012) Socioeconomic position, gender, and inequalities in self-rated health between Roma and non-Roma in Serbia. Int J Public Health 57:49–55CrossRef
go back to reference Jarcuska P, Bobakova D, Uhrin J, Bobak L, Babinska I, Kolarcik P, Veselska Z, Madarasova Geckova A (2013) Are barriers in accessing health services in the Roma population associated with worse health status among Roma? Int J Public Health 58:427–434CrossRef Jarcuska P, Bobakova D, Uhrin J, Bobak L, Babinska I, Kolarcik P, Veselska Z, Madarasova Geckova A (2013) Are barriers in accessing health services in the Roma population associated with worse health status among Roma? Int J Public Health 58:427–434CrossRef
go back to reference Kelly JA, Amirkhanian YA, Kabakchieva E, Csepe P, Seal DW, Antonova R, Mihaylov A, Gyukits G (2004) Gender roles and HIV sexual risk vulnerability of Roma (Gypsies) men and women in Bulgaria and Hungary: an ethnographic study. AIDS Care 16:231–245CrossRef Kelly JA, Amirkhanian YA, Kabakchieva E, Csepe P, Seal DW, Antonova R, Mihaylov A, Gyukits G (2004) Gender roles and HIV sexual risk vulnerability of Roma (Gypsies) men and women in Bulgaria and Hungary: an ethnographic study. AIDS Care 16:231–245CrossRef
go back to reference Kolarcik P, Geckova AM, Orosova O, van Dijk JP, Reijneveld SA (2009) To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia? Soc Sci Med 68:1279–1284CrossRef Kolarcik P, Geckova AM, Orosova O, van Dijk JP, Reijneveld SA (2009) To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia? Soc Sci Med 68:1279–1284CrossRef
go back to reference Kolarcik P, Geckova AM, Orosova O, van Dijk JP, Reijneveld SA (2010) Predictors of health-endangering behaviour among Roma and non-Roma adolescents in Slovakia by gender. J Epidemiol Community Health 64:1043–1048CrossRef Kolarcik P, Geckova AM, Orosova O, van Dijk JP, Reijneveld SA (2010) Predictors of health-endangering behaviour among Roma and non-Roma adolescents in Slovakia by gender. J Epidemiol Community Health 64:1043–1048CrossRef
go back to reference Kolarcik P, Geckova AM, Reijneveld S, van Dijk J (2012) Social support, hopelessness and life satisfaction among Roma and non-Roma adolescents in Slovakia. Int J Public Health 57:905–913CrossRef Kolarcik P, Geckova AM, Reijneveld S, van Dijk J (2012) Social support, hopelessness and life satisfaction among Roma and non-Roma adolescents in Slovakia. Int J Public Health 57:905–913CrossRef
go back to reference Krajcovicova-Kudlackova M, Blazicek P, Spustova V, Valachovicova M, Ginter E (2004) Cardiovascular risk factors in young Gypsy population. Bratisl Lek Listy 7–8:7 Krajcovicova-Kudlackova M, Blazicek P, Spustova V, Valachovicova M, Ginter E (2004) Cardiovascular risk factors in young Gypsy population. Bratisl Lek Listy 7–8:7
go back to reference LeCompte MD, Schensul JJ (2013) Analysis and interpretation of ethnographic data: a mixed methods approach, 2nd edn. AltaMira Press, Lanham LeCompte MD, Schensul JJ (2013) Analysis and interpretation of ethnographic data: a mixed methods approach, 2nd edn. AltaMira Press, Lanham
go back to reference Majdan M, Coman A, Gallová E, Ďuricová J, Kállayová D, Kvaková M, Bošák Ľ (2012) Assessment of the indoor environment and implications for health in Roma villages in Slovakia and Romania. Cent Eur J Public Health 20:199CrossRef Majdan M, Coman A, Gallová E, Ďuricová J, Kállayová D, Kvaková M, Bošák Ľ (2012) Assessment of the indoor environment and implications for health in Roma villages in Slovakia and Romania. Cent Eur J Public Health 20:199CrossRef
go back to reference Merrild CH, Andersen RS, Risør MB, Vedsted P (2017) Resisting “reason”: a comparative anthropological study of social differences and resistance toward health promotion and illness prevention in Denmark. Med Anthropol Q 31:218–236CrossRef Merrild CH, Andersen RS, Risør MB, Vedsted P (2017) Resisting “reason”: a comparative anthropological study of social differences and resistance toward health promotion and illness prevention in Denmark. Med Anthropol Q 31:218–236CrossRef
go back to reference Sasinka M, Nyulassy S, Badalik L (2003) Vademecum medici, 6th edn. Osveta, Martin Sasinka M, Nyulassy S, Badalik L (2003) Vademecum medici, 6th edn. Osveta, Martin
go back to reference Singer MK, Dressler W, George S, NIH Expert Panel (2016) Culture: the missing link in health research. Soc Sci Med 170:237–246CrossRef Singer MK, Dressler W, George S, NIH Expert Panel (2016) Culture: the missing link in health research. Soc Sci Med 170:237–246CrossRef
go back to reference Singh-Manoux A, Marmot M (2005) Role of socialization in explaining social inequalities in health. Soc Sci Med 60:2129–2133CrossRef Singh-Manoux A, Marmot M (2005) Role of socialization in explaining social inequalities in health. Soc Sci Med 60:2129–2133CrossRef
go back to reference Smith GD (2000) Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the United States. Am J Public Health 90:1694–1698CrossRef Smith GD (2000) Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the United States. Am J Public Health 90:1694–1698CrossRef
go back to reference Stewart M (1997) The time of the gypsies. Westview Press, Boulder Stewart M (1997) The time of the gypsies. Westview Press, Boulder
go back to reference Stewart M (2012) The gypsy menace: populism and the new anti-gypsy politics. Hurst & Company, London Stewart M (2012) The gypsy menace: populism and the new anti-gypsy politics. Hurst & Company, London
go back to reference Tauber E (2006) Du wirst keinen Ehemann nehmen!: Respekt, die Bedeutung der Toten und Fluchtheirat bei den Sinti Estraixaria [You will not take a husband! Respect, the significance of the dead and flight marriage among Sinti Estraixaria]. LIT Verlag, Münster Tauber E (2006) Du wirst keinen Ehemann nehmen!: Respekt, die Bedeutung der Toten und Fluchtheirat bei den Sinti Estraixaria [You will not take a husband! Respect, the significance of the dead and flight marriage among Sinti Estraixaria]. LIT Verlag, Münster
go back to reference Trostle JA (2004) Epidemiology and culture. Cambridge University Press, Cambridge Trostle JA (2004) Epidemiology and culture. Cambridge University Press, Cambridge
go back to reference Voko Z, Csepe P, Nemeth R, Kosa K, Kosa Z, Szeles G, Adany R (2009) Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary? J Epidemiol Community Health 63:455–460CrossRef Voko Z, Csepe P, Nemeth R, Kosa K, Kosa Z, Szeles G, Adany R (2009) Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary? J Epidemiol Community Health 63:455–460CrossRef
go back to reference WHO (2010) A conceptual framework for action on the social determinants of health. Discussion paper series on social determinants of health, no. 2. World Health Organization, Geneva WHO (2010) A conceptual framework for action on the social determinants of health. Discussion paper series on social determinants of health, no. 2. World Health Organization, Geneva
go back to reference Williams SJ (1995) Theorizing class, health and life-styles—can Bourdieu help us? Sociol Health Illn 17:577–604CrossRef Williams SJ (1995) Theorizing class, health and life-styles—can Bourdieu help us? Sociol Health Illn 17:577–604CrossRef
go back to reference Williams P (2003) Gypsy world: the silence of the living and the voices of the dead. University of Chicago Press, Chicago Williams P (2003) Gypsy world: the silence of the living and the voices of the dead. University of Chicago Press, Chicago
Metadata
Title
Why don’t segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia
Authors
Andrej Belak
Andrea Madarasova Geckova
Jitse P. van Dijk
Sijmen A. Reijneveld
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
International Journal of Public Health / Issue 9/2018
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI
https://doi.org/10.1007/s00038-018-1134-2

Other articles of this Issue 9/2018

International Journal of Public Health 9/2018 Go to the issue