1. IMPROVING THE HEALTH OF THE ROMA POPULATION Mr. Henry SCICLUNA The Council of Europe Model

2. POVERTY AND HEALTH  75% of Roma live in poverty  Cycle of misery : From shanty town through illiteracy and unemployment, and back to the shantytown One does not have to rely on statistics to see the poverty that prevails among Roma  “One does not have to rely on statistics to see the poverty that prevails among Roma” –Bozdan Djelic, Deputy Prime Minister of Serbia

3. POVERTY AND HEALTH  Data on health of Roma is lacking - fragmentary - subjective  WHO International Classification of Diseases – Extreme poverty is classified as one of the greatest causes of ill-health;  UNDP - Poor health is related to poverty, poor sanitation and lack of basic infrastructure.

4. The health situation of the Roma  lower life expectancy by circa 10 years  higher morbidity due to the environment  higher rate of pre-natal and infant mortality  higher rate of infectious diseases  higher rate of abortions

5. The health situation of the Roma  more premature babies  more miscarriages  more long-term illnesses  higher maternal mortality  poor dental health

6. Causes of ill-health Poor living conditions  no clean water  no sewage  poor housing  environmental exposure  malnutrition and unhealthy eating

7. Causes of ill-health Lack of access to health services  lack of vaccination  lack of transport  no contribution to health insurance  no identity documents  lack of information on prevention, contraception

8. Causes of ill-health Lower quality treatment  discriminatory behaviour and negative  attitude of health staff  insufficient training of health staff

9. Causes of ill-health Wrong perception of health  health is absence of disease  illness and hospitalisation related to death  immediate cure is sought  treatment is not followed  health care is a family affair  lack of health awareness  no preventive care  Early marriages and multiple births  No family planning

10. Health – one aspect of a complex problem Change is needed in:  the socio-economic infrastructure (housing, education, employment);  the health services and the health professionals;  the perception of health by the Roma.

11. Whose responsibility? Is it the responsibility of the national government?  The Roma are citizens of the country they live in and are entitled to the same rights as the other citizens; Is it a European responsibility?  The problem should not be shifted away but European institutions have a role to play What role for the NGOs?  They can help but it is not for them to do the government’s job

12. What solution? Council of Europe model  Rec. (2000)4 on the education of Roma children in Europe;  Rec. (2001)12 on the adaptation of health care services to people in marginal situations;  Rec. (2001)17 on improving the economic and employment situation of Roma and Travellers;  Rec. (2005)4 on improving the housing conditions of the Roma and Travellers;  Rec. (2006)10 on better access to health care for Roma and Travellers in Europe;  Rec.(2006)164 on health services in a multicultual society;  Rec (2008)5 on policies for Roma and Travellers.

13. OSCE Action Plan on improving the situation of Roma and Sinti within the OSCE area A national policy or implementation strategy should:  respond to real problems and priorities;  be comprehensive;  combine human rights goals with social policies;  maximise Roma ownership of the policies that affect them;  ensure implementation at the local level.

14. Common elements:  the development of coherent, comprehensive, integrated policies and strategies;  the acknowledgment that each issue (health, education, employment) is linked with a wide range of other factors and preconditions, namely the economic, the social and the cultural aspects.

15. A model policy  1. Adopt specific and comprehensive anti- discrimination legislation – include the express prohibition of direct and indirect discrimination in access to health care. Make the improvement of health a priority area for action with a broad range of health interests and needs: children, adolescents, women, elderly, sedentary, nomadic.

16. A model policy 2. Establish needs –identify socio-economic, political and cultural factors that have an impact on the health status of Roma and Sinti populations  housing  sexual and reproductive health  health education  effective access to health care, including for individuals without documentation and for refugees and asylum seekers. Absence of data should not halt development of the strategy

17. A model policy 3. Adopt a coherent, comprehensive and adequately resourced national and regional strategy with short- and long-term action plans, targets and indicators for implementing policies that address legal and/or social discrimination against Roma and/or Travellers and enforce the principle of equality. Ensure an inter-sectoral approach. 4. Involve the participation of the Roma communities, including NGOs, as well as of the regional and local authorities (local health authorities, health professionals).

18. A model policy 5. Ensure sufficient funding, including by local and regional authorities, and earmark specific funding for the improvement of the health situation of the Roma and/or Travellers. 6. Consider positive action 7. Appoint mediators or assistants, possibly Roma and/or Travellers

19. A model policy 8. Guidance and training of law enforcement officers and public officials (teachers, police officers, health-care practitioners, social welfare workers). 9. Incorporate the needs of Roma and/or Travellers in broader national strategies. 10. The implementation of the strategy should be monitored in various sectors and locally and/or regionally. 11. Information campaigns addressed to the Roma and Travellers and to the general public.

20. Conclusions:  The strategy must be national, accompanied by regional and local plans.  There must be a firm political commitment of the national authorities - local authorities must follow.  The strategy should list the actions to be undertaken, the authorities responsible for carrying them out, the time limit for completion and the funds allotted to each action.