WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of Roma Good practice and policy to optimise interprofessional primary care for Roma patients

Health of Roma in EUROPE Phenomenon which undesirably influences health of population as whole alike health of individuals in so called „majority“ population.

Report on social determinants of health and the health divide in the WHO European Region 2012 solutions are known and are result of scientific investigation with their concrete outputs formulated in WHO documents as a recommendations for European Union and for European Commission are not accepted accordingly to their importance.

Social Determinants of Health

education employment / unemployment hygiene of work hygiene of living hygiene of nature environment quality of interpersonal relationship (peace in families, degree of divorce rate, functionality of social system, state mode and extend of criminality)

proportionate universalism exclusion as a process, not as a state improvement of starting point to reach as healthy lives as possible for all members of society but not at the expense of others welfare system on concept which eliminates (not creates) risk factors for health proportionally to degree of social status of every individuals and community

equity in health Health becomes progressively better as the socioeconomic position of people and communities becomes higher. It is important to design policies that act across the whole gradient and to address the people at the bottom of the social gradient and the people who are most vulnerable. It is crucial that no one part of population can be damaged by system´s errors leading to worsening of previously reached start points for healthier life.

Social Determinants of Health we must address the conditions in which people are born, grow, live, work and age – key deter- minants of health equity. These conditions of daily life are, in turn, influenced by structural drivers: economic arrangements, distribution of power, gender equity, policy frameworks and the values of society.

Social Determinants of Health illness human society health human work creativity stakeholders (public, private, voluntary) levels (transnational, national, regional, local) local communities matter (whole society, whole government) GDP (gross domestic product) life style hygiene of work, relax living condition housing, nature environment

Social Determinants of Health failure of current social-economical relations (failure of market mechanism alike as labour market failure) illness society unemployment, poverty of working, illegal work, criminality, war psychical problems, abuses (alcohol, smoking), somatization, addictions, obesity human POVERT Y

SOLUTION ? to stop funding of long term unemployment to stop funding harmful birthrate Slovak Republic is on th first place among OECD countries and at the second place what about taxation and social insurance rates of human work which make it unacceptably expensive and at the same time extremely low net incom of working people is the result.

welfare system´s problem Imaginary solutions of which we are witnesses directly favor discrimination according to breed

Do you recognize the concept „long-term unemplyment“?

Do you recognize the concept „poverty of daily-breaders“?

Do you percieve welfare system in Slovakia as to be equitable?

Is it profitable to be unemployed for a long time in Slovakia?

Is the problem of Romas in Slovakia an insufficiently financed welfare system?

Is quality of your life in Slovakia growing up?

CONCLUSION: Problem undeniably arise from welfare system failure. Slovakia is the best example in Europe that we haven´t any further scope to improve health care delivery when welfare system collaps. health care delivery is a part of health-welfare system as a unseparable complex system accordingly to its fundig. Romas have to receive a social service as a whole but none money because they are threaten by usurers among them – it is another aspect of their health which depends on community. IT IS NOT IN ANY CASE PROBLEM OF RACE – IT WOULD BE EMPHASIZED TOO!!!

THANK YOU FOR YOUR ATTENTION