LEAPING FORWARD Adapting the post-2020 EU Roma Framework to the real needs of beneficiaries - European Public Health Alliance
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LEAPING
FORWARD
Adapting the post-2020 EU Roma
Framework to the real needs of beneficiaries
October 2019
The European Public Health Alliance (AISBL) has received funding from the European Union, in the framework of the Health Programme. Sole responsibility for the content displayed within this document lies with EPHA and the Executive Agency is not responsible for any use that may be made of the information contained therein. Transparency Register Number: 18941013532-08
ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
5
Table of content
Acronyms and abbreviations 4
Context 5
Making progress in core NRIS policy areas: health, housing, education, employment 6
Combating antigypsyism in all its forms 8
Recognising diversity and intersectionality 9
Integrating a health inequalities perspective into all policies 9
Protecting the rights and health of mobile Roma workers 9
Conclusion and recommendations 10
General recommendations: policy, funding, governance 12
Health 12
Education 13
Employment 13
Housing 13
Tackling discrimination / antigypsyism 14
Notes 15ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
4
Acronyms and abbreviations
EU- European Union
EC- European Commission
NRIS- National Roma Integration strategies
MS- Member States
ECD- Early childhood development
OSF- Open Society Foundation
EPHA- European Public Health AllianceROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
5
Context the lack of official desegregated data on ethnic,
gender and age criteria. In this context, desegre-
The EU Framework for National Roma Integration gated data collection, monitoring and reporting
Strategies (NRIS) was set up in 2011 to challenge becomes an essential factor for better design and
a number of social and economic issues faced implementation of policies within the next pro-
by Roma in EU countries. It resulted in European gramming period. Furthermore, it allows discrimi-
and national policy instruments and mechanisms, nation in social, economic and environmental fields
aiming to combat Roma exclusion in five key ar- (which not only affects Roma, but also represents a
eas: education, employment, housing, health and threat for EU fundamental rights and principles) to
antidiscrimination. The European Commission (EC) be challenged more effectively.
plays a crucial role in the entire process providing
tools, programmes and funds for Roma inclusion When it comes to social aspects, discrimination
as well as recommendations in response to reports and exclusion have significant consequences on
released by European bodies, Member States (MS) physical and mental health and wellbeing. Recent
and civil society in relations with Roma current sit- research shows a notable difference between life
uation. Since the EU framework has been adopt- expectancy of Roma and non-Roma. Roma live 10
ed, some positive results have been recorded in years less2 than the majority population, highlight-
certain countries in the field of education and em- ing the impact of health inequalities on vulnera-
ployment; however, they lack sustainable effects ble groups. A study focusing on national policies
and cannot help Roma to get out of their disadvan- conducted by the European Social Policy Net-
taged position. work found that Roma in European countries are
the most disadvantaged in accessing healthcare
Despite the efforts for achieving the objectives systems, and are particularly vulnerable when ac-
of the EU framework, Roma exclusion remains a cessing health and preventive services, including
persistent issue in European countries, regardless women’s health programmes.3 High child mortality
of the size of the Roma population. Roma live at rate among Roma, linked to socio-economic fac-
the margins of society - in deep poverty in their tors, is observed in Bulgaria, Hungary, Slovakia,
home countries but also, as mobile workers in host Czech Republic-countries with larger Roma pop-
countries in Western Europe. Access to housing ulations.4 This alarming evidence regarding the
and healthcare has not been improved and Roma current health status of Roma, which also affects
continue to face inequalities in key areas such as public health and economic competitiveness of the
health, employment and education. The EU frame- EU, reinforces the urgent need to tackle health in-
work has not proved to be efficient in combatting equalities in next EU Roma Framework.
poverty and social exclusion, leading to a signifi-
cant gap between Roma and the rest of the Eu- In its mid-term evaluation review5 the European
ropean population. The NRIS did not achieve any Commission (EC) not only acknowledged the need
improvements in the two closely connected areas for further action in regards to the NRIS, but also
of health and housing as most of the Roma contin- the need to take an inclusive approach, combin-
ue to live in the outskirts of cities, in isolated, un- ing mainstream policy and specific programmes,
der-developed and contaminated areas with poor targeting Roma in particular, enhancing the fight
infrastructure and substandard housing conditions, against discrimination. In the wake of the public
harming health and early childhood development. consultation that accompanied the EC’s mid-term
Such living conditions increase the health hazards review, EPHA issued “five key recommendations
for Roma and expose them to higher risk from ep- for better health”, prerequisites for achieving the
idemics, infectious diseases and accidents (fires, objectives in other fields of the EU framework.6
floods, electric shocks, road accidents) and illus- These recommendations, addressed to the Euro-
trate the gravity of social exclusion and discrimina- pean Commission, EU national governments and
tion against the community. civil society, remain valid and still await a reaction.
This paper builds on the previous recommenda-
In fact, severe forms of discrimination1 have been tions and reinforces the importance addressing
observed in countries with a high number of Roma social and economic factors to reduce health in-
population as well as amongst Roma mobile work- equalities. It looks beyond health and makes a
ers in Western Europe and Travellers, although case for the next EU Roma Framework to take ac-
such practices remain under-documented due to tion on the various determinants of health, includ-ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
6
ing ethnic discrimination (as manifest in the specif- EPHA’s recommendations called on the EC to
ic and particularly persistent form of antigypsyism) strengthen policy design and evaluation of the
and to adoption of intersectional lens. It presents impact of policies on Roma health and wellbe-
a number of additional recommendations for the ing, including mental health within the next Roma
post - 2020 framework, including proposals issued Framework. We called for the development of a
by EPHA partners, whose views we value and en- plan to eliminate health inequalities; comparable
dorse. data collection; the development of indicators to
measure progress on health and early childhood
development. Additionally, the participation of rel-
Making progress in core NRIS evant stakeholders, including Roma and pro-Roma
civil society organisations to be promoted, in all the
policy areas: health, housing, phases of the process.
education, employment
A 2019 paper released by the Open Society Foun-
EPHA’s 2017 recommendations, mentioned above, dations (OSF)7 maps the way forward, elaborating a
underline the fact that addressing Roma health vision for the four core policy areas and proposing
is not only a social but also an economic impera- to designate action against antigypsyism as a new
tive: a prerequisite for achieving the EU’s goals for stand-alone priority. On health, OSF notes the fol-
boosting economic competitiveness, innovation lowing priorities, which EPHA also supports:
and sustainability. Moreover, it allows the EU to
further its commitment to the achievement of the o Ensure “access to preventative health
UN Sustainable Development Goals and Agenda measures for all Roma” through an inte-
2030. At the same time, health is a crucial factor grated and intersectional approach
for achieving positive results in other strategic ar-
o Develop policies to “enable all Roma en-
eas of the EU framework for Roma Inclusion such
joy their right to safe drinking water and
as education, employment and housing. Improved
sanitation” in formal and informal settle-
Roma health requires measures for eliminating eth-
ments by recognising “the access to water
nic discrimination in social, economic and environ-
and sanitation as a human right”
mental areas.
o Promote “accessibility and affordability
Roma are being pushed to live in segregated
of water supply and services () for social-
zones without access to safe drinking water and
ly excluded and ethnically discriminated
sanitation, waste removal, and decent housing
groups” to challenge limited access to po-
conditions - an expression of the communities’ ex-
table water through data collection, legis-
clusion. Substandard housing conditions worsen
lation and funding
personal hygiene, nutrition; prevent employment
and access to healthcare; create favourable en- It is clear that there are close links between health
vironments for the spread of infectious diseases and poor housing conditions. From the isolated
and multi-drug resistant bacteria and increase vul- and under-developed Roma settlements in Central
nerability to non-communicable diseases such as and Eastern Europe to the slums in Italian, French
cancer or chronic obstructive pulmonary disease and Spanish suburbs to the post-industrial cities
(COPD). They require costly treatments, unafford- in the United Kingdom and Germany, many Roma
able for the large number of Roma on low incomes inhabit spaces often in direct proximity to environ-
or facing higher rates of unemployment. A “sub- mentally contaminated land, chemicals and haz-
stantial gender gap” compared to the rest of pop- ardous materials, and are subject to severe noise,
ulation also exists, as the Second European Union soil and air pollution or electro-magnetic radiation.
Minorities and Discrimination Survey released by Access to housing is an issue also faced by Roma
the Fundamental Rights Agency reveals. Mental mobile workers which deprives them from enjoy-
health and wellbeing are also affected by substan- ing their right to intra-EU mobility (see below). In
dard housing conditions and ethnic segregation, some host countries in Western Europe Roma fam-
unaddressed in the previous framework for Roma ilies with children live in makeshift housing with no
inclusion, need particular attention in national and access to water and electricity, because of lack of
EU policy in the next programming period. administrative documents, stable employment or
biased perception of Roma by society. The forcedROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
7
evictions which Roma experience in several EU school by directors (Bulgaria) and mayors (France)¹⁰
countries (France, Italy, Bulgaria) are another bar- prevent Roma from secure an education and fu-
rier preventing them from enjoying fundamental ture employment. Thus, securing employment and
rights such as access to housing, healthcare, edu- financial resources under such circumstances be-
cation and employment-pillars of Roma inclusion.8 comes a major challenge for Roma in Europe. Un-
employment rates remain sky-high despite the – at
Furthermore, substandard living conditions and time of writing - very low unemployment rates (un-
access to water and sanitation are also obstacles der 5%) in a number of Central/South Eastern Euro-
to proper physical development, education and pean countries including the Czech Republic, Hun-
training, which impact on later earning potential in gary, Romania and Bulgaria. EPHA supports OSF’s
adulthood. The importance of early childhood de- recommendations in this area including the intro-
velopment (ECD) is particularly relevant for Roma duction of targeted vocational training schemes in
children as often they live in deep poverty in the return for tax benefits for employers; the improve-
Roma settlements, exposed to risks of epidemics, ment of youth employment at national and EU lev-
infections and accidents, due to poor living condi- el (including reforming the European Youth Guar-
tions and infrastructure. Lack of financial resourc- antee and the Youth Employment Initiative) and to
es makes it impossible for parents to offer healthy the earmarking of funds under the new European
nutrition, stimulating physical activity, prevent dis- Social Fund Plus (ESF+) for Roma integration.
eases and afford medicines and vaccination. Pov-
erty then becomes a factor for the placement of The valorisation of technical, communication, digi-
Romani children in childcare institutions in several tal, trade and other professional skills of Roma can
Eastern European countries. Hence the provision be a solution for challenging unemployment. From
of integrated, quality ECD programmes must be an economic perspective it can be an added value
significantly scaled up in the new EU Roma Frame- for the evolution of the EU labour market and its
work, to provide wide-ranging support to families economic competitiveness. In its current version,
and children, ensure positive impact on health sta- it puts Roma in a disadvantaged position as often
tus for future generations of Roma. There is new- they lack formal qualifications and diplomas. Re-
found momentum at the EU level on this issue, quirements to prove professional competencies
following incoming Commission President Ursula practically exclude Roma from job application pro-
von der Leyen’s commitment to maternal and chil- cedures, freelance professional activities and push
dren’s health, while the continuing discussions in them toward unregulated activities and the infor-
the European Parliament on establishing a Child mal economy.
Guarantee would tackle economic and social is-
sues faced by children, such as the access to free EPHA also strongly supports OSF’s recommenda-
healthcare, adequate nutrition and decent hous- tions to improve the availability of targeted fund-
ing.9 EPHA member Eurochild is leading a Euro- ing, and the establishment of participatory policies
pean (EU and national level) campaign on ECD in to achieve better quality housing and living condi-
partnership with other organisations covering key tions for Roma across Europe, taking into account
sectors in child development, aiming to advocate the diversity of settings, social contexts and the
for children’s rights in EU policy. countries where they are living. Improving living
conditions is a necessary step for facilitating ac-
ECD is a necessary step to successful education. cess to education for Roma and to combat unem-
Again, Roma children are at a severe disadvan- ployment. EPHA also supports OSF’s recommen-
tage, because of their spatial and school segrega- dations11 regarding education which call, inter alia,
tion, discriminatory practices such as placement for the EU to stimulate the collection of data per-
of Roma children in institutions for children with taining to segregation; the elaboration and imple-
mental disabilities; affordability of transportation, mentation of desegregation strategies at regional
school clothing and equipment resulting in lower and local level, and the introduction of national
quality education and school attendance as well reforms to shape policies which consider the edu-
as frequent school dropout. Stereotypes and prej- cational needs of Roma children from an early age
udices coming from educational authorities lead to and throughout the period of formal education pe-
experience of antigypsyism – of bullying and ethnic riod.
discrimination at school, whether by classmates or
their teachers; refusal to enrol Romani children at Additionally, EPHA is convinced that enriching the
Roma Framework with a complementary strategyROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
8
promoting Roma culture (arts, language and histo- antees against discrimination. The Charter of Fun-
ry) as proposed by OSF and supported by many damental Rights of the EU prohibits discrimination
civil society partners, would validate the belonging based on a number of grounds including ethnic,
of Roma communities to the European continent racial and social origin. Antigypsyism as a specif-
and acknowledge their contribution to Europe’s ic expression of racism was addressed in 2013 by
cultural heritage. Valorisation of Romanes, spoken the acknowledgment of the Council of the need to
by Roma communities in its communication and combat antigypsyism to achieve effective Roma in-
linguistic aspects, would help build knowledge on tegration; in 2017 the European Parliament adopt-
Roma culture and history, ensure society’s accep- ed a resolution highlighting the fundamental rights
tance of Roma, and combat stereotypical repre- aspects of Roma integration and antigypsyism by
sentation of the community -thus eliminating anti- calling for the establishment of a truth commission.
gypsyism. Nevertheless, the EU’s legal framework does have
its limits as Roma continue to experience different
Combating antigypsyism in all its forms forms of discrimination. In its recent paper, OSF
highlights the limitation of the current legal provi-
Historical persecution and genocide have proven sions against discrimination:
Roma are targeted as an entire population based
on a common ethnic origin, regardless of an in- “Combating antigypsyism through the existing an-
dividual’s social status. Ethnic segregation in set- ti-discrimination legislation is not enough. The four
tlements, maternity wards, hospitals, schools etc. key areas of NRIS – education, employment, hous-
pushed by authorities for decades highlights the ing and healthcare, accompanied by other relevant
presence of structural discrimination which rein- areas (…) – should include a clear reference to anti-
forces the exclusion of Roma communities-an is- gypsyism. Concrete measures to combat all the di-
sue that has been raised by civil society on many mensions and manifestations of antigypsyism must
occasions. Recent attacks and incidents such as be developed, including measures to prevent and
physical violence and racist insults against mem- combat hate crime and hate speech, especially on-
bers of the community recorded in many Europe- line”.
an countries, prove that Roma are subjected to
antigypsyism. Biased representation of Roma in In May 2019, the Alliance against Antigypsyism re-
national media, racist statements made by leading leased a paper12 containing twelve recommenda-
politicians create narratives that further worsen the tions, almost all directed at EU institutions and na-
Roma situation and feed the negative perception tional governments alike. They not only press them
of this population group. As a result, Roma have to improve institutional and policy frameworks,
limited access to rights and services, including data collection and state response to antigypsyist
healthcare and social welfare and are more vulner- incidents, but also call on them to: enable access
able to social and economic disruption. to justice and legal protection for victims of hate
crimes and to eliminate structural discrimination,
EU institutions need to look closer at antigypsy- such as restricting the right to free movement with-
ism in all its forms. It is one of the main reasons in the EU, which present an obstacle to developing
for the particular vulnerability of this population Roma agency and self-realisation.
and it should be tackled in parallel with the social
and economic aspects of the next Roma inclusion EPHA strongly supports these views given that,
framework. ultimately, antigypsyism can be a determining fac-
tor of poor early childhood development, prevent-
Racist incidents and discriminatory practices con- ing acces to the education, healthcare and social
tinue to take place, despite a body of legislation, services which are essential as supporting instru-
adopted by the EU and Member States, guarantee- ments for disadvantaged communities in particular
ing the human rights of EU citizens. The Treaty of to make progress. Similarly, in the context of the
the European Union (TFEU), Racial Equality Direc- NRIS, a 2017 EPHA-CRIS paper on the Romanian
tive 2000/43/EC aiming to counter discrimination situation noted that “different forms of manifesta-
in a number of areas including housing, education tion of antigypsyism, including institutional racism,
and employment and the Framework decision on must be tackled across the four key areas (…) of the
combating certain forms of racism and xenophobia strategy by introducing specific reactive and pre-
by the means of criminal law provide further guar- ventive measures.”13ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
9
Recognising diversity and of the post-2020 Roma framework. This requires
intersectionality the collection of much more comprehensive data
about individuals’ lived experience and the protec-
Intersectionality has been described as “where tion of their rights through legislation that explicitly
different grounds interact in a manner that makes references multiple discrimination and intersec-
them inseparable”14, e.g. ethnicity and gender dis- tionality.
crimination working together in a way which creates
even stronger stereotypes, and concomitant disad- Integrating a health inequalities
vantages, for specific (sub-) groups. This is particu- perspective into all policies
larly relevant for Roma as they are often subjected
to multiple forms of discrimination combining fac- EPHA believes that more horizontal discussions
tors such as religion, social status, gender, sexual must take place to ensure that the needs of Roma
orientation, age etc. making access to justice much and other disadvantaged groups are better anal-
more difficult for them. Biased perception of Roma ysed and commonly addressed by policymakers
as a homogeneous and compact community by working in different “policy silos”. This would re-
society, public authorities, policymakers and pub- quire setting up effective mechanisms to include
lic servants make it impossible to pay attention to a specific health inequalities perspective on other
an individual’s needs. Taking an intersectional lens policies rather than focusing on the consequences
thus places emphasis on mechanisms of power and once the impact is apparent. Infusing the EU Roma
exclusion in modern-day society, especially in the framework with a health inequalities perspective
absence of legislation to protect individuals from would also allow more in-depth knowledge about
such forms of overlapping discrimination. This ap- how intersectionality works in practice to be gath-
proach highlights the particular needs of such peo- ered and to enable solutions which meet both the
ple within anti-discrimination and equality policies needs of wider communities and individuals.
and legislation. While the EC and a number of MS
are increasingly paying attention to intersection- EPHA therefore strongly supports the OSF conclu-
ality and multiple discrimination, whether through sion that only a mix of mainstream and targeted
studies or policy work, it is still an emerging field policy measures – both at EU and national level
when it comes to Roma. However, in the context - will be effective and comprehensive enough to
of the Roma Inclusion Framework and its failure to gradually improve the situation.
achieve progress in key policy areas, it is very like-
ly that discrimination occurs simultaneously on the At EU level, the European Semester and its Coun-
basis of different grounds, thereby posing a par- try-Specific Recommendations (CSRs) have al-
ticularly challenging obstacle to Roma integration. ready included Roma issues as a formal reminder
and stimulus for MS to take action in the key areas
Multiple forms of discrimination can be observed discussed above. In the future, a stronger focus
when accessing healthcare and prevention ser- should be placed on Roma inclusion, with more
vices. This is more challenging for disadvantaged concrete objectives, targets and measurable indi-
groups within Roma communities: for instance, cators which can effectively resolve the challenges
Roma mothers are more likely to be subjected to experienced by different sub-groups of Roma, e.g.
segregation in maternity wards; elderly and dis- women, LGBT, children, mobile workers (see also
abled Roma face more barriers in receiving basic below). Moreover, improving Roma health and so-
healthcare, especially for those who live in isolated cial inclusion should be discussed as part of the
areas with poor infrastructure, making them inac- EU’s commitment to the implementation the UN
cessible by emergency services. Addressing health Sustainable Development Goals, to which the Eu-
issues faced by such groups is a path to health eq- ropean Pillar of Social Rights is now linked.
uity that can positively influence the future of Eu-
rope and provide a response to the demographic Protecting the rights and health of mo-
change which require new thinking about inclusion bile Roma workers
and diversity in the context of increasingly multicul-
tural societies. In the current socio-economic context, intra-EU
mobility is a response to demographic change and
EPHA therefore recommends that diversity and economic growth. However, mobile workers from
intersectionality must become integral features Roma communities are often negatively perceived,The post-2020 EU Roma
Framework needs to become
more binding and better
enforced, and evidence-based
policies need to be shaped that
are bold enough to tackle the
problem head-on.ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
11
ignoring the potential and capacity of Roma peo- of antigypsyism, Roma are believed to be overrep-
ple, especially youth. The NRIS were designed to resented in prisons in a number of EU countries,
integrate Roma in their country of origin without not least because they lack proper legal represen-
taking into account the context of economic mo- tation, and may not be able to read or understand
bility, which practically prevent Roma mobile work- legal language and procedures.
ers from benefiting from support within the NRIS.
At the same time, mobile Roma workers continue EPHA therefore recommends that special consid-
to face social exclusion in their host country due eration should be given to Roma when it comes
to limited capacity to fulfil the reigning settlement to the right to freely move and reside in another
criteria in other EU MS, namely to secure employ- EU MS. The vast majority of Roma do migrate to
ment after three months of residence. While some access legal employment offers and support their
EU migrants have successfully defended their families living in the country of origin. Easier ac-
rights as mobile EU citizens despite being deemed cess to long-term residence permits and forms of
“economically inactive”, Roma continue to be tar- employment that match with their skills, including
gets of expulsions and collective evictions in many non-formal competences would allow more mobile
MS, including France, Italy and the UK. Even as EU workers to come out of the shadows and enter the
citizens, they are subjected to removal procedures job market, pay taxes and take advantage of ed-
by state authorities to deny them re-entry in the ucation, health and social welfare services. Exist-
longer term. Potential expulsions due to exceed- ing apprenticeship programmes and other youth
ing the legal residence period push many Roma to employment initiatives, but also re-training and
avoid undertaking administrative procedures re- conversion programmes, could specifically target
quiring contact with public authorities. As a result, Roma in host countries.
they are plunged into unregulated activities which
often represent severe forms of labour exploitation
linked to a black market, performing the most pre- Conclusion and
carious and physically demanding task; while many
women, often victims of trafficking, are forced to
recommendations
become sex workers. Children are particularly Roma communities face a number of issues in
vulnerable to such practices; often targeted and different areas of political, social and economic
exploited by criminal networks to perform illegal life making the entire process of social inclusion
activities endangering their health, physical and long and complex, requiring special attention from
mental development. Many mobile Roma workers policymakers in all political levels. On one hand,
– especially those lacking formal education and this means that key policies within the EU frame-
experience - are in dangerous, poorly paid forms of work for Roma inclusion should be developed in
employment which in turn condemn them to living such a way that they meet the needs of increas-
in sub-standard conditions (rent exploitation also ingly diverse communities across Europe. On the
being common). Crucially, these forms of informal other, policymakers and professionals need to be
employment limit their access to rights, important aware that, under certain circumstances and for
benefits and services, including child benefit or various reasons including the lingering effects of
healthcare insurance, in many MS. From a health antigypsyism, extra efforts are required to ensure
perspective, living irregularly in their host coun- that Roma can benefit from mainstream policies in
tries may have physical, mental health and social the same way as other citizens. The post-2020 EU
effects on them and their families, in turn leading Roma Framework needs to become more binding
to increased domestic violence, drug addiction or and better enforced, and evidence-based policies
severe diseases. need to be shaped that are bold enough to tackle
the problem head-on.
Without stable employment and decent housing,
many Roma effectively become undocumented In summary, EPHA advances the following key rec-
migrants, especially should the validity of their ID ommendations for the next EU Roma Framework–
cards or passports also expire. As a last resort, they although by no means exhaustive and sufficient on
are forced into begging, prostitution, petty crime their own – to embed the next Roma Framework
and other ad hoc survival mechanisms, for which with a stronger public health focus:
they may pay dearly if criminal and immigration of-
fences combine. Given the institutionalised nature General recommendations: policy, funding,ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
12
governance and environmental policies.
o The EU should fight against corruption
o The EU and Member States should en- and misuse of EU funds allocated to Roma
sure that Roma health inequalities are inclusion by establishing monitoring and
addressed both as part of mainstream reporting mechanisms at European and
policies (health, education, employment, national levels.
housing, anti-discrimination) and, where o The next Roma Framework should support
necessary/appropriate and based on ev- the role of local and regional authorities
idence, through targeted actions from and their capacity to develop strategies
which Roma could benefit. geared towards supporting the local Roma
o The EU should encourage Member States communities.
to collect desegregated data on ethnicity,
gender and age criteria, whilst guarantee- Health
ing confidentiality and data protection, to
assess the needs of the targeted groups In addition to EPHA’s 2017 recommendations15
and improve policy design and implemen-
tation. o The Roma inclusion framework should en-
o The EU and Member States should set courage Member States to ensure access
binding and realistic objectives and tar- to safe drinking water and sanitation for
gets, combined with measurable indica- all.16
tors and thorough monitoring and evalua- o Roma health should be enhanced by ac-
tion mechanisms. cess to healthcare, affordable medicines,
o The role of civil society and Roma commu- free vaccination and medical prevention.
nities in design, implementation, monitor- Member States should explore the feasi-
ing and evaluation of the NRIS should be bility of universal health coverage avail-
enhanced in the next EU Roma Inclusion able to all disadvantaged groups, includ-
Framework. Roma communities should be ing mobile Roma workers.
empowered to prevent a culture of depen- o Mental health and well-being of Roma and
dence and enhance self-reliance. disadvantaged groups should become a
o The post-2020 Roma Framework needs specific priority for EU and Member States
to include policies and resources to end addressing the psychological dimension
to institutionalised forms of discrimination of socio-economic exclusion and antigyp-
and antigypsyism, promoting the social syism.
inclusion of Roma. All NRIS policy areas o Encourage Member States to adopt poli-
should include a clear reference to anti- cy, legal framework and programmes to
gypsyism. Concrete measures must be address substandard living conditions,
developed, including the prevention and poor infrastructure and health hazards in
elimination of hate crime and hate speech current Roma settlements; combat spatial
on-and offline. segregation by promoting access to de-
o Antigypsyism should be a stand-alone, cent housing in desegregated neighbour-
overarching priority in the new Roma hoods.
Framework and Member States should be o The next EU Framework should provide
encouraged to recognise it in national law. better protection of Roma women and
o The European Semester should be used girls’ health by promoting their access
to encourage action at national level, us- to health services, sexual and reproduc-
ing the CSRs and EPSR as levers to ensure tive rights and affordable contraception.
meaningful pursuit of NRIS goals. Women and girls’ mental health must be
addressed through preventive strategies
o The next Roma Framework should pay
against domestic violence, including edu-
particular attention to intersectionality and
cation of men and boys.
all forms of multiple discrimination in paral-
lel with the current pillars of NRIS. Diversity o EU should promote access to affordable
within Roma populations should be taken dental healthcare for people without per-
into account in political, social, economic manent residence and medical insurance,
including Roma mobile workers, by en-ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
13
couraging Member States to eliminate Employment
administrative barriers and provide pre-
ventive services free of charge for such o The EU and Member States should act to
groups. make vocational training and apprentice-
o EU funds should be directed to scaling up ship schemes available to young Roma to
the deployment of Roma health media- allow them to apply their existing skills and
tors and Roma health professionals in and gain formal qualifications. Such schemes
from local communities, who should them- should also take into account the gender
selves benefit from secure employment dimension of employment.
and career development. o Encourage Member States to create mech-
o A specific focus should be young Roma anisms to promote the employment of
girls and boys given the need to stimulate Roma in public administration and institu-
healthy behaviours at an early age (nutri- tions by providing subsidies for employing
tion, physical activity, good mental health, disadvantaged groups, including Roma.
etc.). Mechanisms to prevent drug addic- o Member States must establish reporting
tion and human trafficking should be easi- and awareness-raising mechanisms for
ly accessible for Roma youth. Roma and other disadvantaged groups to
prevent labour exploitation, discrimination
Education in access to employment and career de-
velopment, whilst guaranteeing data pro-
o The EU and Member States should sig- tection and confidentiality.
nificantly boost their investment in Early o The EU and Member States should estab-
Childhood Development (ECD) and de- lish special employment services for in-
velop policies to ensure the best possi- tra-EU mobile Roma who may not be able
ble, healthy start in life for Roma children to secure employment by themselves due
and provide appropriate support to Roma to language, qualification and administra-
mothers (pre-and postnatal care) and fam- tive barriers.
ilies.
o Desegregation must be prioritised and EU Housing
funds allocated for the development and
implementation of such strategies in all o The EU and Member States should ensure
education settings. National governments that the next Roma Framework brings con-
should be encouraged to implement crete improvements to Roma living condi-
mechanisms providing financial support tions, including adequate shelter and sani-
to disadvantaged families to send their tation, infrastructure, access to clean water,
children to desegregated schools (trans- safe environments, public transportation
port, clothes, school materials) and raise easily connecting Roma settlements to hos-
awareness among non-Roma parents to pitals and other public services.
ensure the inclusion of Roma children in o Member States should be encouraged to un-
such schools. dertake policies to tackle spatial segregation
o National education policies and reforms by providing sustainable solutions for Roma,
must ensure that the diverse needs of such as access to proper housing in deseg-
Roma children and students can be met regated areas.
and institutions and teachers are well pre- o Member States should be encouraged
pared and trained to provide quality edu- to adopt national plans and mechanisms
cation for all. against poverty to address substandard
o Encourage Member States to create mech- housing conditions faced by Roma in formal
anisms to prevent discrimination in school and informal settlements such as slums and
and provide pedagogical and psychologi- squats, by making accessible social housing
cal support to Roma children placed in de- and shelter regardless of employment status,
segregated schools. especially in cases of slum clearance and
forced evictions.
o Member States should consider the conse-ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
14
quences of forced evictions for Roma fami-
lies and for social cohesion, public health and
exposure to health risks; relocation should
always result in improved housing and living
standards.
Tackling discrimination / antigypsyism
o Relevant EU legislation and policy tools
should be used in the fight against dis-
crimination, racism and xenophobia.
o Member States must recognise their his-
torical responsibility towards the Roma
population and ensure that Roma history,
language, art and culture are fostered so
their place in the development of Europe-
an heritage is recognised.
o Roma mobile workers should not be
subjected to repeated evictions and ex-
pulsions from another Member State on
grounds of economic inactivity; Roma mi-
grants from non-EU countries should en-
joy their right to apply for asylum and their
cases should be assessed on a case-by-
case basis.
o The EU should foster gender equality as
a key objective by including the gender
dimension and applying an intersectional
lens in antidiscrimination policy and anti-
gypsyism.
o Civil servants, police officers, educators,
health care professionals and social work-
ers in contact with the Roma community
should receive appropriate training and
support.
o Specific training must be provided to jour-
nalists to address biased representation of
Roma and change prejudiced narratives in
national and local media.ROMA HEALTH AND EARLY CHILDHOOD DEVELOPMENT
15
Notes
1. https://fra.europa.eu/sites/default/files/fra_uploads/fra-2016-eu-minorities-survey-roma-selected-findings_en.pdf
2. Roma Health and Early Childhood Development study, December 2018: https://epha.org/wp-content/
uploads/2019/02/closing-the-life-expectancy-gap-of-roma-in-europe-study.pdf
3. European Social Policy Network, Inequalities in access to healthcare, A study of national policies, 2018
4. EC, Health status of the Roma population- Data collection in the Member States of the European Union, 2014 (page
5)
5. EC, COM (2018) 785 final
6. https://epha.org/wp-content/uploads/2017/11/Roma-campaign-recommendations.pdf
7. Naydenova, V.and Matarazzo, M. (2019), Post-2020 EU Roma Strategy: The way forward,
8. https://www.coe.int/en/web/roma-and-travellers/-/stop-evictions-of-roma-and-travellers
9. https://ec.europa.eu/social/main.jsp?catId=1428&langId=en
10. CDERE study on access to education for children living in slums, 2016: https://www.romeurope.org/wp-content/
uploads/2016/09/etude_cdere_ados_bidonville_ecole_impossible.pdf
11. https://www.opensocietyfoundations.org/uploads/7004b0da-956d-4df9-a1f7-d889a00ae9d5/post-2020-eu-roma-
strategy-the-way-forward-20190627.pdf
12. Alliance against Antigypsyism (2019), Combating antigypsyism in the post-2020 EU Roma Framework
–Recommendations”, http://ergonetwork.org/wp-content/uploads/2019/06/2019_05_31-Antigypsyism-
Recommendations.pdf
13. EPHA-CRIS recommendations (2017), Antigypsyism – combating negative attitudes about Roma in Romania,
14. Equinet (2016), Innovating at the Intersections. Equality bodies tackling intersectional discrimination.
15. https://epha.org/wp-content/uploads/2017/11/Roma-campaign-recommendations.pdf
16. https://www.un.org/sustainabledevelopment/water-and-sanitation/European Public Health Alliance (EPHA) AISBL
Rue de Trèves 49-51, 1040 Brussels (B) • +32 02 230 30 56 •
www.epha.org • epha@epha.org @EPHA_EU • Transparency
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