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16.04.2014Roma are significantly disadvantaged in health care – Granada - 5th European Conference on Migrant and Ethnic Minority Health. Health in EU integration and cohesion policies?

European countries have responded to economic crisis with reducing health and social expenditures. Health budget cuts affect in particular the Roma minority and increase even further the vulnerability of this population group already affected by social marginalization and exclusion. The effect of growing restrictions on access to health services is aggravated by increasing violations of Roma people’s health rights. This was only one of the parallel topics during a satellite Session workshop by Open Society Foundations with a theme “Promoting Roma inclusion in health in the context of the current systemic crisis in Europe: challenges and opportunities”. The workshop was part of the 5th European Conference on Migrant and Ethnic Minority Health, organized by EUPHA in Granada, Spain.
 
Three representatives of Center Amalipe were part of the OSF delegation to the conference – the keynote speaker Deyan Kolev, Teodora Krumova and Momchil Baev. The session was chaired by Alina Covaci, Program Officer, Open Society Foundations, Roma Health Project and Maria Eva Foldes, Assistant Professor, University of Vienna, Institute for European Integration Research.

The workshop explored the impact of reductions of health and social expenditures by European countries on the health of the Roma population. Focusing specifically on the situation of Roma people living in Central and Eastern Europe, the workshop featured approaches by NGOs to increase the protection of health rights of Roma and strengthen efforts that pursue Roma inclusion in health in the context of the economic crisis. In line with this topic Center Amalipe presented a good example in its work within the program Community monitoring of the healthcare services. The given example showed how the health monitoring changes the access to health for the local people. For three years of implementation the program made the so called community moderators more of partners to the institutions rather than subjects of intervention. The community mobilization as part of that work made the local people more proactive in dialogue and interaction with the health institutions and other local stakeholders. Nowadays, the local institutions even reach out for the community representatives to have a dialogue with them on issues that concern the communities.
 
As a panel speaker Mr. Kolev – Chairman of Center Amalipe argued that Roma are significantly disadvantaged in health care: both in access to quality health care services and in health status; The medical workers share deep anti-Roma stereotypes that worsen additionally the disadvantaged situation of Roma; Another main point in his presentation was that the economic crises leads to forming European Roma policy and that this policy at present does not pay enough attention to health care; Last, but not least in his point was that it is crucial to include health care in the EU Roma policy.  

It is well-recognized that there is deep gap in health care between Roma and non-Roma throughout Europe: both in terms of health status and healthcare service delivery. “Life expectancy at birth in the EU is 76 years for men and 82 for women. For Roma, it is estimated to be 10 years less” – EU Framework for NRIS. According to recent estimations due to the economic crisis this difference is up to 15 years now in some countries.
 
Community inquiry done by Center Amalipe in June 2012 in two municipalities in Bulgaria shows that the percentage of health uninsured Roma is 52,21 %; around 17 % are without primary care physician; the illegal payments are more than 42 %.

For 2 years of implementation of community monitoring project, Amalipe managed to decrease the illegal payments to 32,21 % and the percentage of people without general practitioner to 9,05 %. The number of health uninsured remained the same;

Amlipe’s Chairman presented the EU Roma policy based on 3 main pillars:

—Policy pillar: EU Framework for NRIS, mechanism for annual reporting, country specific recommendations on Roma within European semester, etc,

Legal pillar: Council’s Recommendations from December 9, 2013 – for first time we have EU legislation (although soft one) on Roma integration;

—Financial pillar: through the usage of EU funds for Roma integration. F.e. the ESF regulations require at least 20 % for social inclusion, investment priority “Socio-economic integration of vulnerable communities such as the Roma”, etc.

Where is the healthcare in the EU policy? At present healthcare is part of the EU Framework for NRIS although in a modest way; healthcare is included in the Council’s recommendation on effective Roma integration measures in the member states, again in a modest way. Unfortunately, healthcare is almost absent from the financial pillar: ESF pays little attention to healthcare and even less attention to the health integration.

Here I would like to draw a parallel between this topic and another initiative in late November 2013 when number of organizations from the European region of WHO signed a call to the European Commission (EC) and President Barrozo to step up its political response to the escalating TB and HIV epidemics in the European region as those are infectious diseases that hit heavily minority groups, migrants and people of color. Fernando Frutuoso de Melo issued a response to the letter on behalf of President Barroso. Frutuoso de Melo is a Director-general for development co-operation department of the EC.

After giving an overview of the amounts that the EU invests in the fight of the above mentioned diseases through generous contribution to the Global Fund since 2002, Frutuoso de Melo states that the problem “remains great concern to the European Commission”. The bottom line of the position of the EC and President Barosso is undisputable: “it must be clear that the organisation of health services, including the fight against TB and HIV, must remain first and foremost the responsibility of the government of each country”. Such position is rather a cold shower for the millions of European citizens, migrants, minorities, advocacy organizations and patients who suffer from exclusion or limited access to quality healthcare and long for more Healthcare in EU policies. This status quo will be certainly challenged by the next EU parliament that is to be elected on May 25th, 2014 as fractions in the current Parliament already advocate for more involvement of the EC in the overall healthcare policy in the EU.

In his closing speech to the panel Deyan Kolev on behalf of Center Amalipe introduced concrete propositions to address the effect of the economic crisis on access to healthcare for migrants and ethnic minorities inEurope:

1. Preparing Roma health related Country-specific recommendations within the European semester;

2. Paying special attention to the implementation of health care chapter of the NRISs: within the annual reporting mechanism

3. Incorporating Roma health integration in the national ESF funded operational programs: within the investment priority “Socio-economic integration of vulnerable communities such as the Roma”

4. Brusselsoperated program for Roma health integration 

The 5th European Conference on Migrant and Ethnic Minority Health held at the AndalusianSchool of Public Health,Spain concluded with a written document called The Granada Declaration. “We call on all European governments to take concrete steps to protect the health of migrants and ethnic minorities in Europe and, specifically to demonstrate that they will live up to their obligations under the International Covenant on Social, Economic and Cultural Rights”, the Declaration calls.

To endorse the Declaration press here.

 

(http://www.eupha-migranthealthconference.com/?page_id=1766




 

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