Undiagnosed: The Impact of Racial Discrimination on Roma Health
15 December 2004
The health status of a community is the simplest direct indicator of the access this community has to the goods and benefits a society provides for its members. When disparities in health status overlap with racial or ethnic boundaries, a myriad of other divisions along racial or ethnic lines are implicated.
Although scarce, existing research on Roma health status indicates serious inequalities between Roma and non-Roma. In addition to frightening data pertaining to differences in infant mortality, Roma are also generally more likely to die prematurely than non-Roma and to be affected by communicable diseases. While some evidence is already available, the basis of these disparities remains poorly studied and explained.
According to the dominant views among researchers and policy-makers, poverty is the central determinant of poor health among Roma. These views oversimplify the issue and tend to ignore or underestimate the particular, independent obstacles posed by racial discrimination. On the one hand, racial discrimination – past and present – has predetermined to a large extent the socioeconomic status of Roma. In general, Romani communities are disproportionately exposed to substandard living conditions and hazardous environments. Roma also have fewer educational opportunities than non-Roma. Racial discrimination in health care – direct and indirect – magnifies already existing inequities establishing separate and independent barriers for Roma to enjoy the right to the highest attainable standard of health. Thus, health disparity of Roma is the cumulative result of both past and current racism.
Racial barriers to health care are exhibited in the systemic disadvantages facing Roma in access to health. Certain general policies and administrative procedures have an adverse effect on Roma. Systemic disadvantages are visible in the disproportionate numbers of Roma excluded from health insurance; the large number of Roma living in neighbourhoods without health care facilities; the large number of Roma living in settlements not covered by general practitioners; the severe underrepresentation of Roma in the medical profession. Furthermore, barriers to quality health care manifest themselves in the disparate impact of the intersection of race and gender. Discriminatory treatment based on the compounded influence of race and gender magnifies the difficulties Romani women face in gaining equal access to quality health care. Coercive sterilisations of Romani women in Slovakia and in the Czech Republic documented by the European Roma Rights Center loom as an extreme example among a plethora of daily manifestations of this phenomenon. The unique experiences of Romani women have been largely ignored by the health care system. Finally, Roma are subjected to medical treatment of inferior quality based on their race and not related to their socioeconomic status. Again, what has pierced the curtain of indifference to this problem has been only the most egregious and therefore visible examples of negligent treatment or malpractice that has caused serious harm or death of the patients, while many other practices denying quality health services to Roma remain undisclosed. There can be no doubt that widespread discriminatory and segregatory practices in the provision of medical services – whether intentional or resulting from other processes, influence in no small degree the disparity in health status of Roma.
In their everyday work, human rights practitioners focusing on Roma rights witness and document these barriers with a frequency which invalidates attempts to deny their existence. Systematic research on the deleterious effects of racial discrimination on Roma health, however, is almost non-existent. Lack of data on the adverse impact of certain policies on Roma health as well as on the quality of health care services received by Roma perpetuates the problem. Moreover, the interference that racist stereotypes have on the quality of treatment Roma receive is vehemently opposed by medical practitioners and often covered up by public authorities. In some cases it appears that public officials are more concerned with preserving the honour of medical professionals than with eliminating the barriers for Roma access to quality medical services. In this issue of Roma Rights, the ERRC presents a summary of a survey on Roma access to health care commissioned by the Hungarian Ministry of Health but never published, presumably due to opposition to its conclusions. These included documentation of structural and individual influences diminishing the quality of health care provided to Roma and impairing Romani access to health.
The issue of discrimination of Roma in health care has come up in a number of previous editions of Roma Rights focusing on individual cases of malpractice and disparate treatment of Roma. This edition of Roma Rights takes the theme a step further, revealing several aspects of the problem of access of Roma to health care: (a) the pervasiveness of the stereotype of pregnant Romani women; (b) health care that is disproportionately inaccessible and undignified; and (c) the multifaceted impact of racial discrimination on health. These themes encompass social, political, and economic factors affecting the experiences of Roma in health care and mandate further investigation and intervention. Future ERRC activities will increasingly focus on health research and legal action to remedy discrimination of Roma in the health care system.