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WORKSHOP: 2.1. Primary care policy European 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

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Page 1: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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

Page 2: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Health of Roma in EUROPE

• Phenomenon which undesirably influences health of population as whole alike health of individuals in so called „majority“ population.

Page 3: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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.

Page 4: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Social Determinants of Health

Page 5: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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)

Page 6: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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

Page 7: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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.

Page 8: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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.

Page 9: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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

Page 10: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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

Page 11: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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.

Page 12: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

welfare system´s problem

• Imaginary solutions of which we are witnesses directly favor discrimination according to breed

Page 13: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Do you recognize the concept „long-term unemplyment“?

long term unemployment

Yes

No

Page 14: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Do you recognize the concept „poverty of daily-breaders“?

poverty of daily-breaders

Yes

No

Page 15: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Do you percieve welfare system in Slovakia as to be equitable?

equity of welfare system

Yes

No

Page 16: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Is it profitable to be unemployed for a long time in Slovakia?

it worth it

Yes

No

Page 17: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Is the problem of Romas in Slovakia an insufficiently financed

welfare system? lack of money?

Yes

No

Page 18: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

Is quality of your life in Slovakia growing up?

quality of life

Yes

No

Page 19: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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!!!

Page 20: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

THANK YOU FOR YOUR ATTENTION

Page 21: WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

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