WORKSHOP: 2.1. Primary care policyEuropean Forum for Primary Care
Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic
Primary care and health of Roma
Good practice and policy to optimise interprofessional primary care for
Roma patients
Health of Roma in EUROPE
• Phenomenon which undesirably influences health of population as whole alike health of individuals in so called „majority“ population.
Report on social determinants ofhealth and the health divide in the
WHO European Region 2012
• solutions are known and are result of scientific investigation with their concrete outputs formulated in WHO documents as a recommendations for European Union and for European Commission
• are not accepted accordingly to their importance.
Social Determinants of Health
Social Determinants of Health
• education
• employment / unemployment
• hygiene of work
• hygiene of living
• hygiene of nature environment
• quality of interpersonal relationship
(peace in families, degree of divorce rate, functionality of
social system, state mode and extend of criminality)
proportionate universalism
• exclusion as a process, not as a state • improvement of starting point to reach as healthy
lives as possible for all members of society but not at the expense of others
• welfare system on concept which eliminates (not creates) risk factors for health proportionally to degree of social status of every individuals and community
equity in health
• Health becomes progressively better as the socioeconomic position of people and communities becomes higher.
• It is important to design policies that act across the whole gradient and to address the people at the bottom of the social gradient and the people who are most vulnerable.
• It is crucial that no one part of population can be damaged by system´s errors leading to worsening of previously reached start points for healthier life.
Social Determinants of Health
• we must address the conditions in which people are born, grow, live, work and age – key deter-minants of health equity.
• These conditions of daily life are, in turn, influenced by structural drivers: economic arrangements, distribution of power, gender equity, policy frameworks and the values of society.
Social Determinants of Health
illness
human
society
health
human workcreativity
stakeholders(public, private, voluntary)
levels (transnational, national, regional, local)
local communities
matter (whole society, whole government)
GDP(gross domestic product)
life stylehygiene of work, relax
living conditionhousing,
nature environment
Social Determinants of Health
failure of current social-economical relations (failure of market mechanism
alike as labour market failure)
illness
society
unemployment,poverty of working,
illegal work, criminality, war
psychical problems,abuses
(alcohol, smoking), somatization, addictions,
obesity
human
POVERTY
SOLUTION ?
• to stop funding of long term unemployment • to stop funding harmful birthrate• Slovak Republic is on th first place among
OECD countries and at the second place what about taxation and social insurance rates of human work which make it unacceptably expensive and at the same time extremely low net incom of working people is the result.
welfare system´s problem
• Imaginary solutions of which we are witnesses directly favor discrimination according to breed
Do you recognize the concept „long-term unemplyment“?
long term unemployment
Yes
No
Do you recognize the concept „poverty of daily-breaders“?
poverty of daily-breaders
Yes
No
Do you percieve welfare system in Slovakia as to be equitable?
equity of welfare system
Yes
No
Is it profitable to be unemployed for a long time in Slovakia?
it worth it
Yes
No
Is the problem of Romas in Slovakia an insufficiently financed
welfare system? lack of money?
Yes
No
Is quality of your life in Slovakia growing up?
quality of life
Yes
No
CONCLUSION: Problem undeniably arise from welfare system failure.• Slovakia is the best example in Europe that we
haven´t any further scope to improve health care delivery when welfare system collaps.
• health care delivery is a part of health-welfare system as a unseparable complex system accordingly to its fundig.
• Romas have to receive a social service as a whole but none money because they are threaten by usurers among them – it is another aspect of their health which depends on community.
IT IS NOT IN ANY CASE PROBLEM OF RACE – IT WOULD BE EMPHASIZED TOO!!!
THANK YOU FOR YOUR ATTENTION