Health of Romani children in Eastern Europe: A conceptual framework

Romani children (also referred in the literature as Gypsies) are an ethnic minority of northern Indian origin. Romani children in Eastern Europe have worse health outcomes compared to the general population. We propose a conceptual framework to explain the presence of negative health outcomes in Romani children. The conceptual framework is a modification of existing frameworks including the Upstream and downstream determinants of health, the Institute of Medicine model, the Theory of reasoned action, the Andersen behavioral model, the Conceptual framework for understanding social inequalities, and the Socio-cultural theory. It shows the influence of various factors at multiple levels. We discuss the importance of non-modifiable factors such as genetic determinants as well as modifiable factors such as socioeconomic status. Other important health determinants include cultural and structural issues. Within the cultural domain, attitudes and perceptions towards health and health care influence the receipt of health care, in turn affecting health outcomes. Structural factors, such as historical mistreatment, the political climate, and discrimination, greatly contribute to negative health outcomes. The model entails the existence of reciprocal influences affecting health. One area of limited research is the relative influence of cultural and structural factors on health outcomes. Conceptual frameworks, such as this one, may help develop culturally-sensitive interventions to improve the health of Romani children. These intervention are needed in early life to promote healthy development in adulthood. Romani individuals should design and lead such intervention to develop appropriate health messages.