Why Roma communities lower life expectancy must be addressed

Historically, there has been poor uptake of preventative services amongst Roma people, with many reporting stigmatisation from providers, fear of discrimination and, significantly, language and communication barriers when engaging with frontline services. Wider societal behaviours have had a detrimental impact on mental health for this group. The report ‘Hate: As Regular as Rain’ by Greenfields and Rogers reported on the ‘ripple effect’ of hate crime on mental wellbeing and  heightened risk of suicide.

We know that facing these disadvantages over a lifetime has a cumulative impact in old age, with inequities in social and economic supports compounding negative health outcomes for Roma communities. This results from what has been termed the social gradient of ill health, or put simply, the lower one’s social and economic position, the poorer the health outcomes. To address these inequalities, ‘interventions are required of a scale and intensity proportionate to the disadvantage’.  

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Unfortunately, whilst policy has identified Roma people as a key priority, there has been a lack of effective action to bring about change. Roma communities are often grouped under the umbrella term ‘Gypsy, Traveller and Roma’ which fails to consider their diverse languages, cultural traditions and migration pathways.

The Roma voice has rarely been captured in designing health and wellbeing services and supports. As a community, they feel largely misunderstood and not enough work has been done to proactively bridge links with the Roma community. It is therefore unsurprising that efforts have failed to deliver the interventions in the places and communities where the Roma population need them.

Roma communities have strong familial and multigenerational ties, report higher levels of social cohesion within their group, and have deep cultural and religious values. These are traits that should be valued and are known to have health protecting benefits. However, these positives have led to a perception that the Roma community are insular or ‘unwilling to engage’ and wish to operate separately from others. This results in them being ‘othered’, a form of social distancing, which perpetuates negative labelling and stigma and pushes them further away. 

Roma community mental heath advocacy project (Image: Heriot-Watt University)

In terms of wider institutional support, community groups are undertaking excellent work across neighbourhoods in Scotland such as Govanhill in Glasgow through Community Renewal: Rom Romeha (meaning For Roma, By Roma) and Romano Lav but the charitable sector is overstretched and under-resourced. More systemically, there exists a mistrust of formal care providers, much of which is stemming from previously negative experiences Roma people have when accessing preventative care. Stronger relationships based on norms of trust and reciprocity urgently need building.

Integrated health interventions are therefore  needed to address the place-based disadvantage that Roma communities face. These need to be shaped around an understanding of how Roma communities experience healthy ageing across the lifecourse, challenge the oppression that Roma communities encounter, and they must integrate the voices of the Roma community within healthcare delivery.

Professor Ryan Woolrych (Image: Heriot-Watt University)

For too long, healthcare interventions for minoritised groups have been ‘deficit’ driven in that they     focus on problems and deficiencies that only serve to promote high levels of dependence on welfare services. Asset based responses aim to redress ‘the balance between meeting needs and nurturing the strengths and resources of people and communities’.  An asset is any resource which can protect against negative health and wellbeing outcomes such as practical skills, networks and connections, and provision through public, private and third sector organisations.

Adopting the principles of an asset-based model, we are embarking on a three year project funded by the Arts and Humanities Research Council, which is exploring how a community assets approach can support healthy ageing for Roma communities and to co-produce Integrated Place-based Hubs aimed at reducing health inequities. These hubs will creatively integrate community assets within focus communities across the UK, one of which will be Govanhill in Glasgow. Using this approach will better target health and wellbeing interventions where they are needed the most.

The research will be co-led with voluntary and community sector groups, develop collaborations with education, employment and wellbeing providers, and importantly Roma communities to codesign service interventions. We will employ a co-researcher model, which involves members of the Roma community collecting research evidence and shaping the research, building capacity from the ground up. In delivering impact, we will explore how we can best scale up those place-based models to have wider applicability across other areas in Scotland and the UK.

The existing health and wellbeing information we have on Roma communities is currently limited in scope, which is undermining our ability to develop effective interventions. We need more in-depth evidence-based research exploring the everyday lives of the Roma community. This requires creative approaches to capturing the stories of individuals and groups, including photography, storytelling, arts, that engage in more participatory and culturally appropriate ways.

Finally, from a social justice and rights-based perspective, it behoves us as a society to do more to address health inequities for Roma. From a healthcare angle, we need a ‘systems change’ in how we deliver services which focus on a ‘people, place and community’ approach. This requires developing the tools and resources that empower Roma communities and support their rights to age well across the life course and to be afforded the opportunities to live a long and healthy life. As a society, we can do better, we must do better.

Professor Ryan Woolrych is the Director of the Urban Institute at Heriot-Watt University