This detailed introductory text presents a scoping review titled “Health Care and Access to Quality Social-Health Services of the Roma and Sinti: A Scoping Review” by Buonsenso et al.. Published in the International Journal of Environmental Research and Public Health in 2025, this open-access article provides a comprehensive analysis of the health status and healthcare access issues faced by Roma and Sinti populations across Europe.
The primary aim of this scoping review was to analyze the health status of Roma and Sinti in Europe, with a particular focus on issues affecting children and women. Furthermore, the authors sought to examine the access of these groups to healthcare services and identify potential interventions to increase their utilization. The study underscores the importance of addressing health inequalities in these marginalized communities, especially given their significant presence as the largest ethnic minority group in the European region, which encompasses various groups often broadly referred to as “Roma”.
The methodology involved a scoping review of existing literature, conducted in accordance with the PRISMA statement. The researchers performed their literature search on PubMed, Google Scholar, and the Trip Database, selecting articles published from January 2015 to June 2023. Inclusion criteria focused on studies investigating the health status of Roma and Sinti populations, their access to quality healthcare services, and evaluations of interventions aimed at encouraging healthcare access in Europe. The review considered all types of conclusive studies, including qualitative, quantitative, interventional studies, as well as reviews and editorials, provided they were written in English, Italian, or Spanish. Studies published before 2015, those that were inconclusive, not in the specified languages, focused on different groups (like nomads or gypsies, explicitly, as per the exclusion criteria), or were anthropological/historical articles were excluded.
The findings of the review consistently demonstrate that the health status of Roma and Sinti populations is generally worse than that of the general population, with a significantly lower life expectancy—7.5 years less for men and 6.6 years less for women, which can extend up to 15 years less in certain areas. This disparity is attributed to a complex interplay of factors, including their prevalent socio-economic exclusion, marginalization, vulnerability, and poverty, often leading to confinement in suburban camps and substandard living conditions.
Key health issues identified include:
- High prevalence of infectious diseases, such as measles, hepatitis (B and E), tuberculosis, diarrhea, typhoid, and scabies, often exacerbated by inadequate water and sanitation facilities, the presence of unregistered animals, and low vaccination coverage. The COVID-19 pandemic further highlighted the challenges of achieving high vaccination rates in these communities.
- Elevated rates of metabolic diseases, including diabetes, coronary heart disease, metabolic syndrome, obesity, overweight, and hypertension. While genetic predispositions remain inconclusive, socio-economic and behavioral factors, such as poor diet and high consumption of sweets and soft drinks among children, are considered primary drivers.
- Significant challenges in women’s and children’s health, marked by early onset of sexual activity and childbearing (with many women becoming mothers before age 18), low contraceptive use, and increased risks of abortion and premature birth. Children often suffer from acute malnutrition, stunting, underweight, poor oral hygiene, and higher rates of hereditary diseases due to intermarriage practices. Access to prenatal and maternal care is limited, and issues like vision problems are traditionally unaddressed.
- Cultural and mental health aspects that further complicate health outcomes. Cancer, for instance, is often seen as a taboo and diagnosed late due to poor screening access. Mental health issues, including stress disorders, somatization, depression, and anxiety, appear to be high, particularly among women, but are often underreported and inadequately addressed. Cultural beliefs and limited health literacy can lead to misunderstandings about health and wellness.
- While some studies explore genetic predispositions to conditions like kidney failure (Alport syndrome) or thyroid cancer, the evidence is often inconclusive, and ethical concerns regarding genetic data collection in marginalized populations are noted.
A consistent and overarching barrier to care identified in the literature is the deep mistrust Roma and Sinti populations have towards healthcare systems. This mistrust is fueled by perceived and actual direct and indirect discrimination from healthcare professionals, language barriers, illiteracy, misinformation, and prior negative experiences. Other practical obstacles include difficulties with mobility, the cost of medicines and treatments, and issues related to health insurance.
To improve healthcare access and outcomes, the review highlights several promising interventions:
- Adopting a welcoming and non-judgmental approach at the first point of contact.
- Utilizing facilitators and community mediators to bridge communication gaps and build trust.
- Training healthcare professionals in Roma and Sinti cultures, including gender dynamics, to enhance cultural competence.
- Establishing accessible contact points, such as mobile units or health orientation centers in marginalized areas.
- Implementing flexible booking systems and targeted invitations for preventive care.
- Engaging in participatory approaches that involve both healthcare workers and community members in identifying and addressing health needs.
- Addressing underlying socio-economic issues, which are often prioritized over health by the communities themselves.
In conclusion, the review underscores the critical need for multifaceted interventions that address not only the direct health disparities but also the systemic barriers and cultural dimensions shaping healthcare access for Roma and Sinti communities. Despite limitations such as small sample sizes and cross-country variations in studies, the evidence strongly suggests that targeted, comprehensive, and culturally sensitive approaches are essential for improving the health and well-being of these vulnerable populations and facilitating their integration into national health systems.
Reference Buonsenso, D., Pata, D., Raffaelli, F., Malorni, G., Colaiaco, F., & Malorni, W. (2025). Health Care and Access to Quality Social-Health Services of the Roma and Sinti: A Scoping Review. Int. J. Environ. Res. Public Health, 22(7), 1063. https://doi.org/10.3390/ijerph22071063
