Increasing employment opportunities for segregated Roma might prevent major economic losses and improve their health. Involvement of the private sector in Roma employment, on top of intensified governmental actions, is likely to be a key to sustainable improvement, but evidence on this is scarce. Our aim was to determine the potential outcomes of such a partnership regarding increased employability and the resulting improved well-being and health. We therefore investigated a Roma employment project called Equality of Opportunity, run since 2002 by a private company, U.S. Steel Kosice, in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain the perspectives of key stakeholders on the outcomes of this project. We found that they expected the employability of segregated Roma to increase in particular via improvements in their work ethic and working habits, education, skills acquisition, self-confidence, courage and social inclusion. They further expected as the main health effects of increased employability an improvement in Roma well-being and health via a stable income, better housing, crime reduction, improved hygienic standards, access to prevention and improved mental resilience. Social policies regarding segregated Roma could thus be best directed at increasing employment and at these topics in particular to increase their effects on Roma health.

Department of Community and Occupational Medicine University Medical Center Groningen University of Groningen Antonius Deusinglaan 1 9713 AV Groningen The Netherlands

Department of Health Psychology Medical Faculty P J Safarik University in Kosice Trieda SNP 1 040 11 Kosice Slovakia

Graduate School Kosice Institute for Society and Health P J Safarik University in Kosice Trieda SNP 1 040 11 Kosice Slovakia

Olomouc University Society and Health Institute Palacky University in Olomouc Univerzitni 22 771 11 Olomouc Czech Republic

See more in PubMed

Ivanov A., Kagin J. Roma Poverty from a Human Development Perspective. UNDP; Istanbul, Turkey: 2014. p. 96.

UNDP Employing the Roma: Insights from Business. [(accessed on 29 July 2019)];2005 Available online: https://www.undp.org/content/dam/rbec/docs/Employing-the-Roma-Insights-from-business.pdf.

Kolesarova J. Empowerment of Roma communities through municipal enterprises in the context of Slovak Republic. In: Penczes J., Radics Z., editors. Roma Popuation on the Peripheries of the Visegrad Countries. Integration Issues and Possible Solutions. DIDAKT Kft.; Debrecen, Hungary: 2012.

Korec P. Regionálny Rozvoj Slovenska v Rokoch 1989–2004. Identifikácia Menej Rozvinutých Regiónov Slovenska [Regional Development of Slovakia in 1989–2004. Identification of the Less Developed Regions of Slovakia] Geo-grafika; Bratislava, Slovakia: 2005.

Hyde A. Systemic Exclusion of Roma from Employment. Roma Rights Q. 2006;1:3–8.

Belak A., Madarasova Geckova A., van Dijk J.P., Reijneveld S.A. Health-endangering everyday settings and practices in a rural segregated Roma settlement in Slovakia: A descriptive summary from an exploratory longitudinal case study. BMC Public Health. 2017;17:128. doi: 10.1186/s12889-017-4029-x. PubMed DOI PMC

Pappa E., Chatzikonstantinidou S., Chalkiopoulos G., Papadopoulos A., Niakas D. Health-Related Quality of Life of the Roma in Greece: The Role of Socio-Economic Characteristics and Housing Conditions. IJERPH. 2015;12:6669–6681. doi: 10.3390/ijerph120606669. PubMed DOI PMC

Fundación Secretariado Gitano . Health and the Roma Community, Analysis of the Situation in Europe. Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain. Fundación Secretariado Gitano; Madrid, Spain: 2009.

Goodman N. The Impact of Employment on the Health Status and Health Care Costs of Working-Age People with Disabilities. Lead Center; Washington, DC, USA: 2015.

Stateva M., Stock L., Junge K., Serrano C.C. Good Practices in Social Inclusion through Employment: Learning from Roma Integration. The West London Alliance; London, UK: 2018.

Open Society Foundations . Open Society Roma Initiatives Policy Brief: Empowerment through Employment: Capitalizing on the Economic Opportunities of Roma Inclusion. Open Society Foundations; New York, NY, USA: 2012.

O’Higgins N., Ivanov A. Education and Employment Opportunities for the Roma. Comp. Econ. Stud. 2006;48:6–19. doi: 10.1057/palgrave.ces.8100147. DOI

Mušinka A. Podarilo sa. Príklady Úspešných Aktivít na Úrovni Samospráv Smerujúcich k Zlepšeniu Situácie Rómov [The Things that Worked. Examples of Successful Activities at Local Level Aimed at Improving the Situation of Roma] University of Prešov Publishing; Prešov, Slovakia: 2012.

Stănescu S.M., Alexandrescu A.M., Ernu S., Bojincă M., Rădulescu L. Model of social enterprises for Roma. Book review. Sociol. Asistenţă Soc. 2014;7:139–141.

Munteanu G. Ph.D. Thesis. Central European University; Budapest, Hungary: 2010. Roma Youth in Romania’s Changing Labor Market: Governmental and Nongovernmental Programs for Roma Employment in Rural Areas.

Pawson R., Tilley N. Realist Evaluation. SAGE; Newcastle upon Tyne, UK: 2004.

Linsley P., Howard D., Owen S. The construction of context-mechanisms-outcomes in realistic evaluation. Nurse Res. 2015;22:28–34. doi: 10.7748/nr.22.3.28.e1306. PubMed DOI

LeCompte M.D., Schensul J.J. Analysis and Interpretation of Ethnographic Data: A Mixed Methods Approach. AltaMira Press; Lanham, MD, USA: 2013.

Bosakova L. A Bottom-Up Approach to Employment. An Example of Good Practice. WHO Europe; Copenhagen, Denmark: 2018.

Marmot M. Fair Society, Healthy Lives: The Marmot Review: Strategic Review of Health Inequalities in England Post-2010. Institute of Health Equity; London, UK: 2010.

Dinca M., Luches D. Work Integration of the Roma: Between Family and Labor Market. Sustainability. 2018;10:1495. doi: 10.3390/su10051495. DOI

Riddell W.C., Song X. The Impact of Education on Unemployment Incidence and Re-employment Success: Evidence from the U.S. Labour Market. Labour Econ. 2011;18:453–463. doi: 10.1016/j.labeco.2011.01.003. DOI

Hronec M. The Education—Unemployment Relationship in the Slovak Republic: An Analysis with Special Regard to Economic Education. New Educ. Rev. 2007;11:115–126.

Bosakova L., Rosicova K., Filakovska Bobakova D., Rosic M., Dzurova D., Pikhart H., Lustigova M., Santana P. Mortality in the Visegrad countries from the perspective of socioeconomic inequalities. IJPH. 2019;64:365–376. doi: 10.1007/s00038-018-1183-6. PubMed DOI

Cutler D., Lleras-Muney A. Education and Health: Evaluating Theories and Evidence. National Bureau of Economic Research; Cambridge, MA, USA: 2006.

Kertesi G., Kézdi G. Roma employment in Hungary after the post-communist transition. Econ. Transit. 2011;19:563–610. doi: 10.1111/j.1468-0351.2011.00410.x. DOI

European Commission European Commission European Platform for Roma Inclusion 2017: “Transition from education to employment”; Proceedings of the 11th Meeting of the European Platform for Roma Inclusion; Brussels, Belgium. 27–28 November 2017.

Bandura A. Self-efficacy. In: Ramachaudran V.S., editor. Encyclopedia of Human Behavior. Volume 4. Academic Press; New York, NY, USA: 1994. pp. 71–81.

FRA—European Union Agency for Fundamental Rights . Transition from Education to Employment of Young Roma in Nine EU Member States. Publications Office of the European Union; Luxembourg: 2018.

Albert G., Dijksterhuis R., End M., Hrabanova G., Jařab J., Koller F., Mack J., Makaveeva L., Mille S., Mirga-Kruszelnicka A., et al. Antigypsyism—A Reference Paper; Alliance Against Antigypsyism: 2016. [(accessed on 1 August 2019)]; Available online: http://antigypsyism.eu/wp-content/uploads/2017/07/Antigypsyism-reference-paper-16.06.2017.pdf.

Jařab J. Eight Circles of Anti-Gypsyism. [(accessed on 1 August 2019)];2015 Available online: http://antigypsyism.eu/wp-content/uploads/2016/06/Jarab-2015.pdf.

Morrall P., Marshall P., Pattison S., Macdonald G. Crime and health: A preliminary study into the effects of crime on the mental health of UK university students. J. Psychiatr. Ment. Health Nurs. 2010;17:821–828. doi: 10.1111/j.1365-2850.2010.01594.x. PubMed DOI

World Health Organization (WHO) Housing and Health Guidelines. World Health Organization; Geneva, Switzerland: 2018.

Friedli L. Mental Health, Resilience and Inequalities. WHO Regional Office for Europe; Copenhagen, Denmark: 2009.

World Health Organization (WHO) Water, Sanitation and Hygiene Strategy 2018–2025. World Health Organization; Geneva, Switzerland: 2018.

Adler N.E., Newman K. Socioeconomic disparities in health: Pathways and policies. Inequality in education, income, and occupation exacerbates the gaps between the health “haves” and “have-nots”. Health Aff. 2002;21:60–76. doi: 10.1377/hlthaff.21.2.60. PubMed DOI

Wilson J.Q., Kelling G.L. Broken Windows: The police and neighborhood safety. Atl. Mon. 1982;3:29–38.

Keizer K., Lindenberg S., Steg L. The Spreading of Disorder. Science. 2008;322:1681. doi: 10.1126/science.1161405. PubMed DOI

McKee-Ryan F., Song Z., Wanberg C.R., Kinicki A.J. Psychological and Physical Well-Being during Unemployment: A Meta-Analytic Study. J. Appl. Psychol. 2005;90:53–76. doi: 10.1037/0021-9010.90.1.53. PubMed DOI

Blustein D.L. The Role of Work in Psychological Health and Well-Being. A Conceptual, Historical, and Public Policy Perspective. Am. Psychol. 2008;63:228–240. doi: 10.1037/0003-066X.63.4.228. PubMed DOI

Jahoda M. Employment and Unemployment: A Social-Psychological Analysis (The Psychology of Social Issues) Cambridge University Press; London, UK: 1982.

Creed P.A., Macintyre S.R. The relative effects of deprivation of the latent and manifest benefits of employment on the well-being of unemployed people. J. Occup. Health Psychol. 2001;6:324–331. doi: 10.1037/1076-8998.6.4.324. PubMed DOI

Bobakova D.F. Challenges for research, policy and practice in the field of Roma health. IJPH. 2019;64:645. PubMed

Appropriate Employment for Segregated Roma: Mechanisms in a Public-Private Partnership Project