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

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  • Andrej Belak

    (P.J. Safarik University
    P.J. Safarik University
    University Medical Center Groningen
    Charles University)

  • Andrea Madarasova Geckova

    (P.J. Safarik University
    P.J. Safarik University
    Palacky University Olomouc)

  • Jitse P. van Dijk

    (P.J. Safarik University
    University Medical Center Groningen
    Palacky University Olomouc)

  • Sijmen A. Reijneveld

    (University Medical Center Groningen)

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.

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  • Andrej Belak & Andrea Madarasova Geckova & Jitse P. van Dijk & Sijmen A. Reijneveld, 2018. "Why don’t segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(9), pages 1123-1131, December.
    • Handle: RePEc:spr:ijphth:v:63:y:2018:i:9:d:10.1007_s00038-018-1134-2
    DOI: 10.1007/s00038-018-1134-2
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    1. Pavol Jarcuska & Daniela Bobakova & Jan Uhrin & Ladislav Bobak & Ingrid Babinska & Peter Kolarcik & Zuzana Veselska & Andrea Madarasova Geckova, 2013. "Are barriers in accessing health services in the Roma population associated with worse health status among Roma?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(3), pages 427-434, June.
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    2. Belak, Andrej & Filakovska Bobakova, Daniela & Madarasova Geckova, Andrea & van Dijk, Jitse P. & Reijneveld, Sijmen A., 2020. "Why don't health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices," Social Science & Medicine, Elsevier, vol. 246(C).
    3. Barbara Pavlikova & Lenka Freel & Jitse P. van Dijk, 2020. "To Comply or Not to Comply: Roma Approach to Health Laws," IJERPH, MDPI, vol. 17(9), pages 1-13, April.
    4. Michal Kozubik & Jitse P. van Dijk & Daniela Filakovska Bobakova, 2019. "Aspects of Illness and Death among Roma—Have They Changed after More than Two Hundred Years?," IJERPH, MDPI, vol. 16(23), pages 1-11, November.
    5. Andrej Belak & Andrea Madarasova Geckova & Jitse P. van Dijk & Sijmen A. Reijneveld, 2019. "What Roma nonadherence is likely and what drives it? Reply to Broz and Nunes," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(5), pages 805-807, June.
    6. Richard Filčák & Daniel Škobla, 2021. "Sanitation Infrastructure at the Systemic Edge: Segregated Roma Settlements and Multiple Health Risks in Slovakia," IJERPH, MDPI, vol. 18(11), pages 1-11, June.
    7. Lucia Bosakova & Andrea Madarasova Geckova & Jitse P. van Dijk & Sijmen A. Reijneveld, 2020. "Appropriate Employment for Segregated Roma: Mechanisms in a Public–Private Partnership Project," IJERPH, MDPI, vol. 17(10), pages 1-18, May.
    8. Jan Brož & Marisa Nunes, 2019. "Why don’t segregated Roma do more for their health? A complex question," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(5), pages 803-804, June.
    9. Daniela Filakovska Bobakova, 2019. "Challenges for research, policy and practice in the field of Roma health," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(5), pages 645-646, June.

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