The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA; Institute for Hygiene and Public Health, University Hospital Bonn, GeoHealth Centre, Bonn, Germany.
The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
Int J Hyg Environ Health. 2020 May;226:113506. doi: 10.1016/j.ijheh.2020.113506. Epub 2020 Apr 1.
The Roma are Europe's largest ethnic minority. Their history has been shaped by marginalization, stigmatization, discrimination, slavery, persecution and murder, and to date, they continue to face prejudice and social exclusion. The Roma population is generally poor, living in crowded and low quality housing in segregated communities on the outskirts of cities, often lacking basic physical infrastructure, including adequate water, sanitation and hygiene (WASH). To better understand the obstacles the Roma are facing, we aimed to review and synthesize available peer-reviewed literature, and identify obstacles to improvement.
We conducted the first systematic review of peer-reviewed literature on water, sanitation and hygiene among Roma communities in Europe, published between 2000 and 2020. A total of 30 publications met the inclusion criteria. We extracted data relating to WASH conditions and services, associated risk factors, exposures and outcomes, examined the role of cultural norms in shaping health behaviors, and obstacles to improvement.
Our review shows that across Europe, Roma communities face more challenges than the majority population with respect to access to WASH, waste management and environmental hygiene, appropriate housing and hygienic living environments. Prominent themes in the literature to describe WASH conditions about European Roma populations include limited access, affordability, and quality of WASH services; self-management of WASH as response and adaptive tactic; unsafe WASH as a reason for eviction; and health risks associated with substandard WASH services. The same factors determining the poor quality of WASH services and environmental health impede their improvement. Major barriers to WASH access and affordability among the Roma include discrimination, social exclusion, lack of formal education, poverty, geography, legal and social aspects, and cultural perceptions of health risks, political top-down approaches, lack of political will, and lack of involvement of the Roma community in planning. Besides, Roma are not well represented in national statistics, with data collection being complicated not only by difficulties of access and underfunding, but also by distrust and culturally distinctive health beliefs.
The situation and cultural context of WASH among Roma is challenging and complex. Our review demonstrates not only the urgent need for action for Roma communities in particular, but may have broader applicability to ethnic and social minorities in other parts of the world. Future research to overcome obstacles to improvement needs to be inclusive, and involve community members as key informants, with their participation enhancing the reliability of data, contributing to social justice and solidarity, disseminating information, contributing to feasible recommendations and implementation of interventions.
罗姆人是欧洲最大的少数民族。他们的历史深受边缘化、污名化、歧视、奴役、迫害和谋杀的影响，时至今日，他们仍然面临偏见和社会排斥。罗姆人普遍贫困，生活在城市郊区隔离社区中拥挤且质量低下的住房里，往往缺乏基本的有形基础设施，包括充足的水、卫生和个人卫生设施（WASH）。为了更好地了解罗姆人面临的障碍，我们旨在审查和综合现有的同行评议文献，并确定改善的障碍。
我们对 2000 年至 2020 年间发表的关于欧洲罗姆人社区水、环境卫生和个人卫生的同行评议文献进行了首次系统综述。共有 30 篇出版物符合纳入标准。我们提取了与 WASH 条件和服务、相关风险因素、暴露和结果有关的数据，研究了文化规范在塑造健康行为方面的作用，以及改善的障碍。
我们的综述表明，在整个欧洲，罗姆社区在获得 WASH、废物管理和环境卫生、适当住房和卫生生活环境方面面临的挑战比多数人口更大。描述欧洲罗姆人 WASH 条件的文献中的突出主题包括 WASH 服务的有限获取、负担能力和质量；WASH 自我管理作为应对和适应策略；不安全的 WASH 是驱逐的原因；以及与不合格的 WASH 服务相关的健康风险。决定 WASH 服务质量和环境卫生不佳的同样因素也阻碍了其改善。罗姆人获得和负担得起 WASH 的主要障碍包括歧视、社会排斥、缺乏正规教育、贫困、地理位置、法律和社会方面以及对健康风险的文化观念、自上而下的政治方法、缺乏政治意愿以及罗姆社区在规划中的参与度低。此外，罗姆人在国家统计数据中代表性不足，数据收集不仅因获取和资金不足的困难而变得复杂，而且还因不信任和文化独特的健康观念而变得复杂。
罗姆人 WASH 的情况和文化背景具有挑战性且复杂。我们的综述不仅表明罗姆人社区急需采取行动，而且可能对世界其他地区的族裔和社会少数群体具有更广泛的适用性。克服改善障碍的未来研究需要具有包容性，并让社区成员作为主要信息提供者参与其中，他们的参与提高了数据的可靠性，有助于社会正义和团结，传播信息，为可行的建议做出贡献，并实施干预措施。
