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Int J Public Health. 2018 Jun 16. doi: 10.1007/s00038-018-1134-2. [Epub ahead of print]

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

Author information

1
Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia. andrej.belak@upjs.sk.
2
Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia. andrej.belak@upjs.sk.
3
Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands. andrej.belak@upjs.sk.
4
Department of General Anthropology, Faculty of Humanities, Charles University, Prague, Czech Republic. andrej.belak@upjs.sk.
5
Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia.
6
Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia.
7
Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic.
8
Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands.

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.

KEYWORDS:

Adherence; Ethnographic study; Health inequality; Roma health; Slovakia

PMID:
29909522
DOI:
10.1007/s00038-018-1134-2

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