The international comparative survey entitled “Roma and Health” provided a relatively wide range of in- formation about the health of the Roma population in the Czech Republic. When using this information, however, the specifi c features of this kind of research aff ecting the nature of its outputs should be kept in mind. One methodological problem, for example, is the selection of respondents and the representative- ness of the sample. The fact that the Czech Republic does not possess reliable statistics on which to base the selection of representatives of the Roma population should be taken into account. The fragmented nature and diff erent methodologies employed in producing records means that data on the number of Roma citizens and their structural characteristics are imprecise. Given that reliable offi cial data simply do not exist, qualifi ed estimates based on analysis of statistical data and demographic trends should be used in sample-based surveys of the Roma population. This is the most reliable foundation available but we must remember that they are merely estimates. An estimate of the number of Roma per region was used to select respondents in the said survey. Specifi cally, we used the middle estimate of the number of Roma in the Czech Republic at the start of the 21st century.
The willingness of the Roma population to take part in the survey and answer the questions also has an impact on the nature of the output. Willingness to respond to open questions is already a fi lter of sorts de- termining the type of person taking part in the survey but this is a general problem with all sample-based surveys and does not only aff ect the Roma population. Nevertheless, in the case of Roma citizens, char- acteristics linked to the willingness to take part in research are more complicated and may have a greater impact than in the case of sample-based surveys of the majority population.
Also, a typical feature of Roma respondents is to answer in the way they think they ought to or are expected to. Their eff ort to present themselves in a socially acceptable light is the result of a mix of socio-cultural norms and their notions about the majority society’s expectations. Experience with surveys of Roma citi- zens shows that this tendency is not displayed to the same degree for all topics and it is not easy to detect it in the survey results. It requires good knowledge both of Roma issues and of empirical research.
A certain lack of representativeness, a tendency to try to give expected replies and other specifi c features are in no way a reason to disregard the signifi cance of empirical surveys among the Roma population. We simply want to highlight the fact that a prudent approach should be taken when working with the fi ndings of these surveys. The results of surveys such as these are very useful and in a certain sense irreplaceable.
They should not be interpreted in isolation, however, their true value coming from comparison with other data. In the case of this particular survey, the other data in question is from medical documentation on Roma citizens, the experiences of doctors and health workers and information on the health of the majority population. This also applies to the subsequent list of principal fi ndings.
Viewed as a whole, the survey data on the health of Roma citizens appears relatively favourable as indicated by the subjective feelings of the Roma citizens themselves. The majority consider their state of health to be very good or at least good (two-thirds of adults and more than four-fi fths of minors). On the whole, data on diagnosed illnesses and health problems are not alarming either. Almost half of the adults (46%) are free of all of the illnesses scrutinised in the survey; just under a fi fth (15%) have been diagnosed with one of the ill- nesses or health problems addressed in the survey, fi gures being somewhat higher for Roma minors which comprise the vast majority of the population. Hearing and sight problems are also the exception among Roma citizens (according to the criteria used in the survey, slightly more than 10% of Roma adults have hear- ing and sight problems). Obesity may be something of a risk in the Roma community, but in this case as well the survey data do not suggest it to be widespread. According to the data on body weight and height, the vast majority of Roma citizens are either of normal weight (half of adults and roughly 70% of minors) or fall under the category of “overweight” posing only a small health threat (27% of adults and 10% of minors).
Despite these relatively favourable data, there is one group of Roma whose health is below mean values.
Depending on the criteria used, the size of this group ranges from one-tenth (individuals who perceive
their health as bad or very bad) to a quarter (persons diagnosed with three and more illnesses); in some age categories of the Roma population the relative size of the group is signifi cantly larger, however.
The relatively pronounced trend displayed among Roma in relation to the link between health status and age is one of the negative characteristics of the health situation in the Roma population. While deteriorat- ing health as age increases is natural, the fact that below-average health status is already apparent in the 45-59 age bracket and that this situation is very pronounced among the over-60 group is a warning sign.
This is evident both in the respondents’ subjective perception of their own health (perception of health as bad or very bad is twice as frequent in the 45-59 age group and four times as frequent among those over 60) and in the accumulation of multiple ailments (the proportion of those suff ering from three and more illnesses or health problems in older middle age is almost double the average, and two-and-a-half times higher among those age 60 and over). The same trend can be observed with hearing and sight problems.
The relatively frequent deterioration of health and the considerable proportion of persons suff ering from health problems among generations of post-productive age is not the only negative phenomenon worthy of attention; dental health among the Roma population is another such phenomenon. Dental problems are very widespread among Roma; four or more defective teeth is by no means exceptional (found in almost two-fi fths of Roma individuals and almost half of those in the upper middle-age category). An incomplete set of teeth is symptomatic. Roma individuals tend to lose their teeth very early (20% of the 16-21 year olds and one third of those between 22 and 25 do not have all their natural teeth). By the time Roma move into the upper middle-age category a signifi cant majority do not have all their natural teeth (60% of those between 45 and 59 and 70% of the next higher age group). This problem is compounded by a relatively low interest in replacing lost teeth (between 40 and 50% of Roma who have lost teeth have not had them replaced.
Some negative trends are linked to lifestyle and health-related behaviour of Roma individuals. This is the case of smoking. Survey data clearly show that anti-smoking measures, awareness campaigns and debate of recent years have not had much of an impact on the lifestyle of the Roma population. Smoking is very widespread among Roma. According to comparable data for the Czech population as a whole, the proportion of full-time smokers among the Roma ethnic group is several times higher (60% of Roma age 16 and over smoke every day and 10% are occasional smokers). Moreover, Roma are also fairly heavy smokers and start very young, frequently during childhood (30% of today’s full-time smokers started at age thirteen or younger).
Alcohol consumption is less easy to accurately defi ne from survey data. The criterion for identifying a ten- dency to consume alcoholic beverages was defi ned in a way that makes it diffi cult to determine whether the 40% of Roma who admit to having consumed alcohol during the last six months, including on excep- tional occasions, represents a problem or not. The fact remains that if alcohol consumption is a problem, then it aff ects men twice as much as women and hard liquor is consumed as well.
Lack of exercise, characteristic of a large majority of Roma age 16 and over (70% have no leisure activities and spend almost all their free time engaged in sedentary or completely passive activities), appears to be a relatively clear-cut problem. Minors evidently do better in this regard but the problem of lack of exercise should not be underestimated in their case either (aff ecting 40% of minors).
Survey data point to a major socio-cultural component in the health of the Roma population. This is evident in the perception of the importance of health and attitudes towards illness. In general, two attitudes con- cerning health can be distinguished: an active, participatory attitude and an attitude that can be denoted as instrumental. Each of these is linked to a diff erent kind of health-related behaviour. According to the instrumental attitude where health is perceived as the absence of illness or health problems, interest in one’s own health focuses mainly on the use of healthcare and similar. The participatory attitude to health is not primarily linked to illness but rather to staying healthy and prevention as a prerequisite for a full life and integration into society.
Health-related surveys have shown that the relative weight of the participatory attitude to health is grow- ing in majority society. Healthy lifestyles and a priority on prevention is catching on as a kind of cultural
instrumental attitude towards health with all of the associated features (lack of appreciation for or failure to perceive the importance of prevention and healthy lifestyles). This specifi c characteristic distinguishing Roma from the majority society plays a very important role infl uencing both the health status of the Roma population and their upward social mobility and integration into society.
The survey identifi ed the factors shaping the health of the Roma population:
Socio-cultural characteristics
1. (myths, moral norms, value systems and their focus) and the result- ing attitude to one’s own health as something of value as well as the attitude to the health of those around them and its value);
Diff erent lifestyle vis-à-vis the majority population;
2.
Diff erent nutritional habits and diet;
3.
Diff erent attitudes to illness and disease prevention
4. – with the resulting diff erent behaviour
when illness strikes;
Infl uence of socio-professional status
5. – in most cases unskilled, physically demanding work per-
formed under high-risk conditions. Healthcare for ethnic minorities is not a problem confi ned to the Czech Republic, however. It is a pan-European problem mainly requiring political solutions with the active cooperation both of the state and its institutions and representatives of minority groups. It is one of the aspects aff ecting minority integration and the latter’s active participation in addressing their own problems is a crucial prerequisite.
The following factors aff ecting the quality of healthcare were identifi ed:
a cultural barrier hindering the doctor/patient relationship
1. (diff erent traditions, customs, habits,
lifestyle, attitude to the illness itself );
culturally conditioned way of displaying and presenting diffi culties and highly emotional 2.
accompaniment;
problems of diff erential diagnosis and therapy when there is no knowledge of the social back- 3.
ground of illness.
Healthcare measures should primarily be targeted at raising the Roma population’s awareness of healthy lifestyles, patients’ rights and how the healthcare system works in general. Awareness campaigns should also cover the issue of family planning. The root causes of poor health should likewise be tackled, includ- ing poor housing conditions, socio-pathological phenomena in excluded localities and illegal work in un- healthy working conditions.
In terms of direct work with clients, a programme involving social workers trained in health matters is used to improve health standards in Roma communities. The aim of these social workers is to actively seek out groups or individuals whose health is at risk either because of high-risk behaviour or for some other objec- tive reason. Implementation of the programme is supported by the Ministry of Health. Unfortunately, this eff ective measure is not available in all socially excluded localities.