A Sense of Injustice: Experiences of the Central and Eastern European Roma in Accessing UK Health and Public Services

Abstract

This study explores how Central and Eastern European Roma communities perceive and experience UK health and public services. The Roma arguably experience poorer health than any other minority ethnic group in the UK, according to a range of indicators, measures and outcomes. Health issues in UK Roma communities are reported to stem from language barriers, difficulties in registering with a GP and mistrust of health professionals. To date, there has been little comprehensive exploration of the influence of social, cultural and political factors on health in Central and Eastern European Roma communities in the UK. Much of the literature provides an overview of barriers to access, yet gives limited attention to the complex social dynamics underlying interactions between the Roma and health service providers. This study investigates the interplay of Roma migration experiences, personal histories of discrimination, barriers to accessing health and benefits systems, and the influence of public policy decisions in shaping UK Roma people’s experiences of health services.

This study incorporates data collection through participant observation and interviews, as well as an analysis of national and local policy attention to the health situations of Gypsy, Roma and Traveller (GRT) communities. The policy analysis occurred concurrently with fieldwork, and findings helped to contextualise Roma interviewees’ impressions of health system functioning. Field data was collected over the course of volunteer work carried out at Roma community organisations in London and Luton. Field notes were recorded throughout the course the this fieldwork, and interviews with 27 Roma community members and 10 health professionals began after approximately 5 months of active participant observation. Analysis of field data proceeded according to a strategy that hybridised grounded theory and narrative methodologies. This entailed an initial round of grounded theory analysis, which involved the constant comparison methods of analysing concepts arising from the data, and provided an overarching framework for understanding the social phenomena under observation. Fieldnotes and selected interviews were then subjected to a second round of scrutiny, with particular emphasis on their narrative character. Analysing these individual stories added nuance and depth to the results of grounded theory analysis, and provided insight into the ways in which Roma migrants experience discrimination, unconscious bias and unequal treatment within UK public service environments.

The time period in which this study occurred – 2014 to 2018 – was a time of substantial political change in the UK, and the results are best understood in the context of growing public hostility to migrant groups. Within a policy landscape of limited official attention to the needs of the Roma, intra-community development of health-related knowledge, direct contact with health services and engagement in a broader environment of public service provision contribute to the development of power differentials between Roma individuals and service providers. Many participants in this study suffered from long-term ill health, yet intra-community networks of health information-sharing aided participants in better understanding their health conditions and empowering themselves to seek out support. Their contact with health and benefits systems, however, revealed barriers related to limited language support, lack of transparency in administrative procedures, difficulties in navigating complex and unfamiliar systems and cultural disparities between patients and providers. Analysis of these factors in light of participants’ distinct narrative revealed further dimensions of service providers’ unconscious bias, participants’ efforts to assert their right to equitable access to services and the long-term emotional impacts of unequal treatment.