Roma represent one of the largest ethnic groups facing marginalization worldwide. However, significant knowledge gaps persist regarding: A) the social mechanisms supporting health-endangering practices among Roma; B) the social mechanisms adversely affecting their use of health services; and C) the social determinants underlying both above pathways. To fill these gaps, we conducted a series of four explorative ethnographic studies spanning over ten years. Beginning in 2004, the series involved 260 participants, including segregated Roma and health services staff in Slovakia. Of the four studies, two addressed gap A, two addressed gap B, and all addressed gap C. Regarding pathway A, we found that Roma in segregated Roma enclaves can be socialized into ethnically framed racialized ideologies that oppose the cultural standards of local non-Roma life, including certain healthy practices. This adherence to counter-cultural ideals of Roma identity increases specific health and care challenges. Regarding pathway B, we discovered that health service frontliners frequently lack any organizational support to better understand and accommodate the current living conditions and practices of segregated Roma, as well as their own and others' racism and professional expectations regarding equity. This lack of support leads many frontliners to become cynical about segregated Roma over their careers, resulting in health services being less effective and exacerbating health problems for both Roma and the frontliners themselves. Concerning pathway C, we found that the societal omnipresence of antigypsyism - racist and racialized anti-Roma ideas and sentiments - serves as a prominent driver of both the above pathways. We conclude that much of the unfavorable health status of Roma can be understood via a systems perspective that embraces structural racism.
- Keywords
- Discrimination, Ethnic health inequalities, Healthcare, Marginalized Roma, Racism, Slovakia, Social determinants of health,
- MeSH
- Adult MeSH
- Anthropology, Cultural * methods MeSH
- Humans MeSH
- Racism psychology MeSH
- Roma * psychology statistics & numerical data MeSH
- Social Determinants of Health ethnology MeSH
- Social Marginalization psychology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Slovakia MeSH
BACKGROUND: Real or perceived discrimination contributes to lower quality of care for Black compared to white patients. Some forms of discrimination come from non-physician and non-nursing (non-MD/RN) staff members (e.g., receptionists). METHODS: Utilizing the Burgess Model as a framework for racial bias intervention development, we developed an online intervention with five, 30-min modules: (1) history and effects of discrimination and racial disparities in healthcare, (2) implicit bias and how it may influence interactions with patients, (3) strategies to handle stress at work, (4) strategies to improve communication and interactions with patients, and (5) personal biases. Modules were designed to increase understanding of bias, enhance internal motivation to overcome bias, enhance emotional regulation skills, and increase empathy in patient interactions. Participants were non-MD/RN staff in nine primary care clinics. Effectiveness of the intervention was assessed using Implicit Association Test and Symbolic Racism Scale, to measure implicit and explicit racial bias, respectively, before and after the intervention. Acceptability was assessed through quantitative and qualitative feedback. RESULTS: Fifty-eight non-MD/RN staff enrolled. Out of these, 24 completed pre- and post-intervention assessments and were included. Among participants who reported characteristics, most were Black, with less than college education and average age of 43.2 years. The baseline implicit bias d-score was 0.22, indicating slight pro-white bias. After the intervention, the implicit bias score decreased to -0.06 (p=0.01), a neutral score indicating no pro-white or Black bias. Participant rating of the intervention, scored from 1 (strongly disagree) to 5 (strongly agree), for questions including whether "it was made clear how to apply the presented content in practice" and "this module was worth the time spent" was ≥4.1 for all modules. CONCLUSIONS: There was a decrease in implicit pro-white bias after, compared with before, the intervention. Intervention materials were highly rated.
The relationship between negative attitudes and psychopathology is not yet clear. The current shift to a dimensional approach to mental disorders, as reflected in both the DSM-5 and ICD-11 models of personality disorders, seems to enrich the traditional approach to study attitudes. This study investigates whether and how impairments in personality functioning are linked to attitudes toward minorities. A comparison of levels of impairment in global and Self and interpersonal personality functioning, negative attitudes, social distance, and racism was conducted in the sample of 127 adults from the general population group (n = 69) and a group of people with diagnosed personality disorders (n = 58). Differences between both groups were found. The personality disorders group showed higher impairment in personality functioning, scored higher on negative attitude measures, and was more prone to the blatant expression of attitudes than the general population. The association between attitudes and personality functioning did not fully reflect these trends. However, given the nature of differences, it is suspected that the proclivity to the blatant expression of negative attitudes could go beyond negative attitudes toward minorities themselves and reflect disorder-related characteristics, that is, more problematic and conflicted relationships with others in general.
- MeSH
- Diagnostic and Statistical Manual of Mental Disorders MeSH
- Adult MeSH
- Ethnic and Racial Minorities * MeSH
- Humans MeSH
- Personality * MeSH
- Personality Disorders diagnosis MeSH
- Attitude MeSH
- Psychopathology MeSH
- Racism MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVES: The health status of segregated Roma is poor. To understand why segregated Roma engage in health-endangering practices, we explored their nonadherence to clinical and public health recommendations. METHODS: We examined one segregated Roma settlement of 260 inhabitants in Slovakia. To obtain qualitative data on local-level mechanisms supporting Roma nonadherence, we combined ethnography and systematic interviewing over 10 years. We then performed a qualitative content analysis based on sociological and public health theories. RESULTS: Our explanatory framework summarizes how the nonadherence of local Roma was supported by an interlocked system of seven mechanisms, controlled by and operating through both local Roma and non-Roma. These regard the Roma situation of poverty, segregation and substandard infrastructure; the Roma socialization into their situation; the Roma-perceived value of Roma alternative practices; the exclusionary non-Roma and self-exclusionary Roma ideologies; the discrimination, racism and dysfunctional support towards Roma by non-Roma; and drawbacks in adherence. CONCLUSIONS: Non-Roma ideologies, internalized by Roma into a racialized ethnic identity through socialization, and drawbacks in adherence might present powerful, yet neglected, mechanisms supporting segregated Roma nonadherence.
- Keywords
- Adherence, Ethnographic study, Health inequality, Roma health, Slovakia,
- MeSH
- Poverty MeSH
- Anthropology, Cultural MeSH
- Humans MeSH
- Cross-Sectional Studies MeSH
- Racism MeSH
- Roma psychology MeSH
- Interviews as Topic MeSH
- Social Stigma MeSH
- Health Status * MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Slovakia MeSH
BACKGROUND: Racial bias is associated with suboptimal healthcare treatment for minorities. Research focuses on bias among physicians rather than non-physician healthcare staff (e.g., receptionists). Patients spend considerable amounts of time with non-physician staff. Therefore, we investigate differences in implicit and explicit racial bias by healthcare staff race and occupation using the Implicit Association Test and Modern Racism Scale, respectively. METHODS: Staff (n = 107) were recruited using the Alabama based Primary Care Research Coalition. Occupation was categorized into "medical doctors/registered nurses" (MD/RN) and "non-MD/RN" (e.g., receptionists). RESULTS: Implicit bias scores were higher among whites compared with blacks (0.62, -0.04, respectively; p < 0.01). Among whites, non-MD/RNs demonstrated more pro-white implicit bias compared with MD/RNs (0.67, 0.44, respectively; p < 0.01). Whites had higher explicit bias scores than blacks (17.7, 12.3, respectively; p < 0.01). CONCLUSION: Non-MD/RNs should not be overlooked for cultural competency training, and efforts are needed to reduce racial bias among healthcare workers identified as having higher levels of bias.
- Keywords
- Disparities, Explicit bias, Healthcare staff, Implicit bias, Perceived discrimination,
- MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Multivariate Analysis MeSH
- Attitude of Health Personnel ethnology MeSH
- Racism ethnology MeSH
- Racial Groups psychology MeSH
- Socioeconomic Factors MeSH
- Health Personnel psychology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
This paper reviews domestic and international activism seeking justice for Romani and other women harmed by coercive, forced, and involuntary sterilization in the former Czechoslovakia and Czech Republic. Framed by Michel Foucault's theory of biopower, it summarizes the history of these abuses and describes human rights campaigns involving domestic and international litigation, advocacy, and grassroots activism, as well as the responses of the Czech governments. The paper describes how legal and policy work during the past decade has led to recognition of coercive, forced, and involuntary sterilization as a present-day human rights issue worldwide, to the adoption of new guidelines on female sterilization, and to a joint statement on the issue by seven UN agencies. Relying on academic literature, reports by domestic and international human rights groups, state investigations, judgments from Czech courts and the European Court of Human Rights (ECHR), media reports, and the experience of the authors, who have been allies of the Romani women harmed in the Czech Republic since 2005 and 2012, respectively, the paper describes the current state of play with respect to achieving redress for them, including current conceptual, legal, political, and social obstacles and their antecedents in 20th century notions of population control.
- MeSH
- Humans MeSH
- Coercion * MeSH
- Racism MeSH
- Roma ethnology MeSH
- Social Discrimination ethnology MeSH
- Social Justice * economics ethics MeSH
- Sterilization, Involuntary * MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
- Czechoslovakia MeSH
OBJECTIVE: Perceived discrimination is an important risk factor for minority health. Drawing from the scholarship on multidimensionality of race, this study examines the relationships between perceived discrimination in health care and two dimensions of racial identity: self-identified race/ethnicity and perceived attributed race/ethnicity (respondents' perceptions of how they are racially classified by others). METHODS: We used Behavioral Risk Factor Surveillance System data collected in 2004-2013 and we specifically examined the data on perceived racial discrimination in health care during the past 12 months, perceived attributed race/ethnicity, and self-identified race/ethnicity. RESULTS: In models adjusting for sociodemographic and other factors, both dimensions of racial/ethnic identity contributed independently to perceived discrimination in health care. After controlling for self-identified race/ethnicity, respondents who reported being classified as Black, Asian, Hispanic, and Native American had higher likelihood of perceived discrimination than respondents who reported being classified as White. Similarly, after taking perceived attributed race/ethnicity into account, self-identified Blacks, Native Americans, and multiracial respondents were more likely to report perceived discrimination than counterparts who self-identified as White. The model using only perceived attributed race/ethnicity to predict perceived discrimination showed a superior fit with the data than the model using only self-identified race/ethnicity. CONCLUSION: Perceived attributed race/ethnicity captures an aspect of racial/ethnic identity that is correlated, but not interchangeable, with self-identified race/ethnicity and contributes uniquely to perceived discrimination in health care. Applying the concept of multidimensionality of race/ethnicity to health disparities research may reveal understudied mechanisms linking race/ethnicity to health risks.
- Keywords
- Health Care, Measures of Race, Perceived Discrimination, Racial Identity,
- MeSH
- Behavioral Risk Factor Surveillance System MeSH
- Healthcare Disparities MeSH
- Health Status Disparities MeSH
- Adult MeSH
- Ethnicity * MeSH
- Hispanic or Latino statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Minority Groups * MeSH
- Perception * MeSH
- Delivery of Health Care * MeSH
- Racism * MeSH
- Racial Groups MeSH
- Risk Factors MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- United States MeSH
BACKGROUND: The over-representation of Roma children in segregated schools is well documented as a prevalent form of institutional racism in the Czech Republic. In the paper, we examine the inclination of parents to support school segregation. OBJECTIVE: The paper looks at parents' preference for school segregation and explores its association to social dominance orientation, intergroup contacts, belief in traditional schooling and the absence of Roma children in school as proof of the school's good quality. The first hypothesis examines an association between parents' preference to withdraw their children from ethnically diverse schools and social dominance orientation (one's degree of preference for inequality among social groups). The second one tests the belief in traditional schooling as a factor contributing to a preference for ethnically motivated withdrawal. The third one studies the extent to which parents' preference to withdraw their children from ethnically diverse schools is affected by contact with Roma in their everyday life. The final hypothesis tests if parents who view Roma students as an indicator of poor education in a given school are more likely to oppose the presence of Roma students among their children's peers. METHODS: Quantitative data collection was carried out on a sample of 1,803 respondents. The target group were families with at least one child of primary school age (6-14 years). A binary logistic regression analysis was implemented to assess these relationships. RESULTS: The study confirmed that ethnically motivated school withdrawal is associated with social dominance orientation, belief in traditional school culture and education. On the other hand, the role of inter-group contact in a school environment was not proved. However, the final statistical model was rather weak explaining approximately 9% of variance in segregation endorsement. The model fit improved significantly when an additional variable - absence of Roma as a sign of a good school - was added. Approximately 15% of the variance in segregation endorsement was explained by the modified set of predictors. CONCLUSION: The study argues that ethnically motivated school withdrawal is a result of individual attitudes and situational factors. This means that researchers interested in informal school segregation will need to consider both groups of factors.
- Keywords
- Roma, intergroup contact, parents’ attitudes, racism, school culture, school segregation, social dominance orientation,
- Publication type
- Journal Article MeSH
RATIONALE: Unequal provision of health care contributes to the poor health status of segregated Roma in Central and Eastern Europe. Studies on the drivers and mechanisms behind this are lacking. OBJECTIVE: We explored what kinds of substandard practices health care frontline professionals engage in regarding segregated Roma and what mechanisms support such practices during the professionals' careers in care services. METHODS: Over a three-month period at five different locations in Slovakia we interviewed and observed 43 frontline professionals serving segregated Roma. Next, through qualitative content analysis we identified in the data three themes regarding kinds of substandard practices and 22 themes regarding supporting mechanisms. We organized these themes into an explanatory framework, drawing on psychological models of discrimination and intergroup contact. RESULTS: The frontline staff's substandard practices mostly involved substandard communication and commitment to care, but also some overt ethnic discrimination. These practices were supported by five mechanisms: the staff's negative experiences with people labelled "problematic Roma patients"; the staff's negative attitudes regarding segregated Roma; adverse organizational aspects; adverse residential-segregation aspects; and poor state governance regarding racism. In the course of their careers, many professionals first felt obliged and diligent regarding segregated Roma patients, then failing, unequipped and abandoned, and ultimately frustrated and resigned regarding the equal standard of care towards the group. CONCLUSIONS: Health care frontline staff's practices towards segregated Roma are frequently substandard. The psychological processes underlying this substandard care are supported by specific personal, organizational and governance features. These mechanisms cause many frontline professionals gradually to become cynical regarding segregated Roma over the course of their careers. Health care staff should be supported with skills and tools for effectively handling their own and others' racism, the culturebound and structural vulnerabilities of patients as well as related professional expectations regarding equity.
- Keywords
- Discrimination, Ethnography, Health inequalities, Health services, Qualitative research, Racism, Roma health, Slovakia,
- MeSH
- Humans MeSH
- Delivery of Health Care MeSH
- Roma * MeSH
- Social Segregation * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Slovakia MeSH
- Europe, Eastern MeSH
INTRODUCTION: This study examined how perceived racial privilege and perceived racial discrimination in health care varied with race and socioeconomic status (SES). METHODS: The sample consisted of white, black, and Native American respondents to the Behavioral Risk Factor Surveillance System (2005-2013) who had sought health care in the past 12 months. Multiple logistic regression models of perceived racial privilege and perceived discrimination were estimated. Analyses were performed in 2016. RESULTS: Perceptions of racial privilege were less common among blacks and Native Americans compared with whites, while perceptions of racial discrimination were more common among these minorities. In whites, higher income and education contributed to increased perceptions of privileged treatment and decreased perceptions of discrimination. The pattern was reversed in blacks, who reported more discrimination and less privilege at higher income and education levels. Across racial groups, respondents who reported foregone medical care due to cost had higher risk of perceived racial discrimination. Health insurance contributed to less perceived racial discrimination and more perceived privilege only among whites. CONCLUSIONS: SES is an important social determinant of perceived privilege and perceived discrimination in health care, but its role varies by indicator and racial group. Whites with low education or no health insurance, well-educated blacks, and individuals who face cost-related barriers to care are at increased risk of perceived discrimination. Policies and interventions to reduce these perceptions should target structural and systemic factors, including society-wide inequalities in income, education, and healthcare access, and should be tailored to account for racially specific healthcare experiences.
- MeSH
- Behavioral Risk Factor Surveillance System MeSH
- White People psychology statistics & numerical data MeSH
- Black or African American psychology statistics & numerical data MeSH
- Discrimination, Psychological * MeSH
- Healthcare Disparities statistics & numerical data MeSH
- Adult MeSH
- Health Services Accessibility ethics statistics & numerical data MeSH
- Indians, North American psychology statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Minority Groups psychology statistics & numerical data MeSH
- Young Adult MeSH
- Perception * MeSH
- Cross-Sectional Studies MeSH
- Racism psychology statistics & numerical data MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Social Class * MeSH
- Health Status MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
- Geographicals
- United States ethnology MeSH
