For
the Rome people, as well as for any other group of people, health
standards are a significant indicator of inequality, quality of
life and degree of active involvement in society as full-fledged
citizens. Unfavourable socio-economic conditions, educational
deficit, difficult access to the labour market, health-care deficiencies
and a low standard of living, are a few of the aspects responsible
for the Gypsy people being among the most disadvantaged and problem-ridden
ethnic groups in Europe.
The existing data is piecemeal, dispersed and difficult to find
and is no use in the implementation of interventions and the creation
of policies and programs that are tailored to the different realities
of the Roma communities.
Thus, the need for a creation of an information system on the
health status of Roma common to different countries and applicable
to their Communities stems from this difficulty in finding ongoing
and systematic data on the health status of the Roma and the incidence
of problems related to the phenomenon of drug dependency.
This system has been created in the framework of the SASTIPEN
Network “European Network for Drug Abuse and HIV/AIDS Prevention
in the Rom Community”, an informal network comprised of
national organisations from different countries that do social
intervention work with and have a deep understanding of the Gypsy
peoples:
- Fundación Secretariado General Gitano – Spain
-
Union Nationale des Institutions Sociales D’action pour
les Tsiganes-Etudes Tsiganes - France
- Red Europea Antipobreza– Portugal and Coordinamiento Nazionale
Communnità di Accoglienza – Italy
- Information and Support Center for Gypsies – Greece
- T3E Race Drug project - England
Even if its main goal is to obtain ongoing and updated information
in order to have a tool capable of evaluating the impact of drug
and health policies on the Roma communities, in short, it pretends
to be used for diagnostic purposes and design of interventions
tailored to meet their main health problems like drug dependencies.
In the case of Roma, the greatest difficulties are related with
the collection of information because in light of their nomadic
tendencies as travellers for example in England or their status
as refugees in Italy or the conditions of poverty and marginality
which characterise the lives of many groups, systematic and ongoing
data collection becomes very difficult.
Furthermore, the Roma as such do not identify with any of the
health systems operating in Europe today meaning that the normal
statistics do not shed any specific light on this issue.
Even if the research was focused on several areas, we will concentrate
on the Drug-dependency and associated diseases.
Aware
of the difficulties revealed in the gathering of information for
the development of indicators, there were established four strategies
that would be implemented sequentially in order to obtain the information
and implement different sources of data collection in order to feed
the system:
1. Search for already available statistical information.
2. Search for and use of secondary sources of data.
3. Implementation of a Delphi study with the collaboration of experts
from each country to fill in information that is not directly available.
4. Ad hoc, studies to gather information.
The system’s development phases are as follows:
Concerning the indicators, the selection has been done using the
following criteria:
1.- Importance and relevancy of the indicators for health issues
within the Roma community.
2.- The existence of the indicator in the non-Roma community.
3.- The ability to gather the information needed for the development
of the indicator by means of one of the methods proposed.
4.- Balanced coverage of the marked areas for the establishment
of a system of indicators.
The final objective is that of setting up a system of indicators
that is broad enough in number to cover the objective but not
so extensive so as to require undue effort.
Concerning drug dependencies, the following indicators and “possible”
sources of information have been finally selected:
1. Number and description of the people treated for drug dependency.
2. Deaths by overdose.
3. Arrests for trafficking and/or consumption.
4. Consumption of drugs (legal and illegal).
The data collected comes mostly from two types of sources: drug
centres and prisons. Neither of the cases is characterised by
a systematic collection of data but rather were ad hoc studies
carried out at a given time by the professionals working n these
services or centres.
1. Number and characteristics of individuals receiving treatment
for drug dependency.
Very little data was found due to the fact that none of the multi-centre
information systems register the ethnic group to which the patient
belongs.
Nevertheless, it can be highlighted some of the data withdrawn
from a study carried out in the Coruña Drug Dependency
Treatment Unit on Roma individuals on the period 1984-1995. In
this centre close to 200 requests for treatment were made by Roma
while the estimated Roma population residing in the city is around
2,000. They had the following characteristics:
• 86.8% were men.
• The average age of the men was around 25,5 and 21.7 in
the case of the women.
• Over 50% had been previously arrested.
• The principal addictive drug was heroine.
• 75% requested methadone treatment.
In this case it can be observed that the demand was mostly for
methadone treatment that, in principle, is the one less culturally
influenced from among traditional treatments.
This same study points to the importance of HIV/AIDS infection
within the Roma, drug-dependency population.
1. Deaths caused by overdose
It was not possible to find any information regarding this indicator
given the fact, that there were no ad-hoc studies or agreements
with health authorities to collect this information on a regular
basis in hospitals and forensic services. Nevertheless, it has
been not eliminated because it could be a useful and objective
indicator of evolution if it could be collected in a reliable
and systematic manner.
2. Arrests for trafficking or consumption
With regard to this indicator, most of the available data is on
the prison population in Portugal and Spain. The following is
the most relevant:
In the Porto Penitentiary Centre (Custoias), the male Roma population
accounts for 3.4% of the total number of inmates with the following
age distribution:
• 50% 16-20 years of age
• 9.7% 21-25
• 15.9% 26-35
• 4.9% 36-40
• 17.1% Over 40
• 2.4% No information available
• 75% of the arrests were related to drug trafficking: 70.7%
for drug trafficking and 4.9% for suspicion of trafficking.
• 61% of the Roma inmates suffer drug dependency problems
although only 7.5% have participated in the Support Program for
Drug-dependent Inmates.
These figures show that today a high percentage of the Roma inmate
population is involved in the trafficking and consumption of drugs.
This information coincides with clinical data: 69% have had or
still have the hepatitis B or C virus and 12% are HIV/AIDS seropositive;
high-percentage pathologies in the drug-dependent population.
Another study on incarerated Roma throughout the whole of Portugal
showed that as an ethnic group the Roma account for 5.5% of the
total inmante population, relatively higher in comparison with
other groups.The majority are repeat offenders and/or members
of the same families which leads us to believe that they are not
representative of the entire Roma population but rather of a sub-group.
Of these 79% are men and 21% women.
In this case, 40% of the male inmates were drug-dependent, a figure
that indicates a close relationship between drug consumption and
prison sentences. This figure falls to 3.1% in the case of women.
The relationship that these Roma men and women have with drug
trafficking, however, is much stronger:
• 64% of the arrests are related to drug trafficking.
• 93.2% of the women inmates are serving sentences for drug
trafficking.
• 13.2% of the total number of inmates serving sentences
for drug trafficking are Roma.
This indicates a close relationship between women inmates and
drug trafficking (although the relationship with consumption is
much weaker) and a relatively higher relationship between drug
trafficking by the Roma when compared to non-Roma. These figures
may be relative, however, because there may be greater police
and court pressure on individuals from this ethnic minority.
In Spanish prisons, 25% of the women inmates are Roma (while it
is estimated that they account for 1,4% of the total Spanish population).
49% of the sample of 290 Roma women imprisoned in Spanish jails
was or had been a consumer of illicit drugs. This percentage rose
to between 60 and 65% in the case of those under 30 years of age.
This relationship between Roma women inmates and drug consumption
is significant because in many of the reports the consumption
of drugs by Roma women is not recognised, not even in the case
of legal drugs (alcohol and tobacco) as we will see below and
as was the case with the Portuguese prisons.
1. Drug consumption (legal and illegal)
We have data on the consumption of alcohol and tobacco in some
groups. We will now take a look at the most significant information.
Here we will analyse data on equipment, vaccination records, etc.
taken from an in-depth study done on four sites in Andalusia (somewhat
outdated being from 1985 but one of the most complete studies
done so far; figures are an average of the four sites).
MEN
• Alcohol 76.2%
• Tobacco 83.6%
It is hard to determine the reliability of these figures as is
generally the case particularly with alcohol, but they do show
a high or almost generalised use of alcohol and tobacco among
Roma men. In the case of women, no alcohol consumption was admitted
and only two sites recognised a very limited number of cases of
tobacco use. We feel that this clearly indicates a more moderate
consumption of alcohol and tobacco on the part of women (although
it is assumed that this is on the rise), as well as a tendency
to conceal this consumption in light of social stigmas.
In the case of illicit drugs, we have very little data except
that relating to the inmate population and is therefore not very
applicable to the population as a whole.
In the Porto prison analysed, 61% of the inmates had had drug
dependency problems although only 7.5% had actually turned to
the prison support program for help.
As is also the case with the non-Roma population, it appears that
there may be a relationship between the consumption and trafficking
of drugs and criminal activity and prison sentences. As was mentioned
above, women tend to be incarcerated more for drug trafficking
and this is probably due to the fact that if trafficking is a
family economic activity, women play an integral role while the
consumption of both legal and illegal drugs is culturally taboo
for women.
What does appear to be true is a high incidence of consumption
in some family environments. In a study done in Santiago de Compostela
on the incidence of drug-dependency problems within families (survey
of 84 people), the following was discovered:
• Spouse or partner 13.1%
• A sibling 36.9%
• A brother or sister-in-law 34.5%
• An aunt or uncle 41.2%
• A cousin 85.7%
These figures would seem to indicate family environments that
are quite affected but it should not be forgotten that families
are large and normally close-knit; a fact which could affect the
data.
Along these same lines, half of the men surveyed stated that they
had or had had some sort of drug problem while none of the women
admitted the same.
