Unequal access: Roma and the health sector

Feb 15, 2013

A roma family from Hungary

Dotcho Mihailov

Various studies have shown that Roma suffer from poorer health than the general populations in the Central and Southeast European countries in which they are most numerous.

This brief analyzes health data from the 2011 UNDP/World Bank/EC regional Roma survey, which compared the living standards of Roma and non-Roma communities living in close proximity in 12 Central and East European countries. >> More on our Roma work

The survey findings demonstrate reduced access to health insurance, lower child vaccination rates, difficult physical access to medical services, and affordability concerns.

They also indicate that Roma are more likely to only recognize health problems as such once they reach acute forms later in life, resulting in a higher incidence of disabilities, long-standing illnesses, and greater numbers of in-patient visits. 

Combinations of socio-economic deprivation, resulting from Roma isolation from the social mainstream (particularly the educational system and formal labour markets) and unhealthy lifestyles, are usually blamed for these outcomes.

Access to health services. Compared to non-Roma living in close proximity, health care coverage and disparities in equity of access remain an issue for Roma and other ethnic minorities in these countries. Roma continue to have inferior access to health insurance, and to specialized health services, aggravated by low awareness of health issues.

the charts reporting varying levels of reported medical insurance coverage across the surveyed countries
Percentage of adults (age 16 and above) reporting medical insurance coverage in 2011.
Abbreviations:  AL (Albania), BA (Bosnia and Herzegovina), BG (Bulgaria), H (Hungary), HR (Republic of Croatia), CZ (Czech Republic), MD (Moldova), ME (Montenegro), MK (the former Yugoslav Republic of Macedonia), RO (Romania), RS (Republic of Serbia), SK (Slovakia). See EUROSTAT.)


the chart shows varying levels of households unable to afford prescription medications across countries in 2011
Percentage of households unable to afford prescription medication in 2011


Perceptions of health status. Although Roma generally have positive perceptions of their health, they report larger numbers of inpatient and emergency medical visits, and are more likely to suffer from disabilities and addictions. This can be explained by Roma households’ low access to health services.

the chart shows differing levels of inpatient stays during the last 12 months across the surveyed countries
Percentage of adults (age 16 and above) reporting inpatient stays in the last 12 months. “During the past 12 months, how many separate overnight stays have you made at a health facility?”

Maternal and child health. The frequency of unassisted births outside of hospitals — for both Roma and non-Roma living in close proximity — were particularly high in Serbia, fYR Macedonia, and Bosnia and Herzegovina.

The survey data also highlight significant differences in child vaccination rates,  a key indicator of health vulnerability, particularly for Roma respondents.

the chart shows child vaccination rates across the surveyed countries in 2011
Child (aged 0-6) vaccination rates in the countries of Central and Southeast Europe in 2011

Drivers of Roma health vulnerability. Socio-economic determinants, especially official employment and education status, have a large impact on Roma health conditions.

Affordability barriers to health services have declined in most of the countries surveyed, for both Roma and non-Roma respondents. Since 2008, household incomes and spending in many of these countries have stagnated, and jobless rates have risen. This raises questions about the future ability of favourable socio-economic trends to generate continued improvements in Roma health conditions.

Conclusions and recommendations

The 2011 survey results show that, despite some improvements since 2004, the principle of universal access to reproductive and child health – as articulated in the Millennium Development Goals –continues to be honoured in the breach. Differences between countries are larger than differences between Roma and non-Roma living in close proximity. Comparisons indicate that the shifts in health outcomes that have occurred are common for both Roma and non-Roma samples.

Support for Roma should focus on making official health, education and employment systems more inclusive. However, some issues, such as health education, child vaccinations and reproductive health need to be addressed urgently.

The introduction of “health mediators” and other community-based approaches would strengthen the interface between formal health institutions and Roma communities, rather than creating parallel health structures and services.

Albania, Bulgaria, Moldova and Romania face important challenges in improving access to health in general – not just for Roma.

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