Jun 11 2009

Bringing it together: the Roma, health care and theories of how things are.

by at 3:11 pm under Uncategorized


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As a cat lover, I have always cringed at the phrase “there’s more than one way to skin a cat.” In considering the problem of Romani access to health care, however, I can think of no better way to put it other than that dreaded saying.   There are a number of ways to approach this project, depending largely on the exact location and resources.  My research question can be narrowed to asking: under what circumstances can the majority population and the marginalized Roma of Eastern Europe work together to enhance Romani access to health care?  Put differently, I will draw from the readings for our class to explore the factors leading to poor Romani health care and suggest possible solutions to overcoming those barriers. I suggest that, in drawing from many of the readings, three main themes can be identified throughout and appropriately applied to this quandary.  The three overarching themes related to helping the Roma are:  effectively developing the means by which the programs are communicated, considering the role and structure of networks, and adapting each program as necessary when necessary. 

            I think that this problem is largely an issue of communication between the Roma and non-Roma – not only regarding this specific question of health care, but also a broader disconnect that perpetuates a history of discrimination.  Therefore, Everett Rogers’ discussion of diffusion applies beautifully to programs designed to introduce the “innovation” of health care into the Romani communities.  His diffusion model would suggest that a sequential process ranging from introducing the system through actual successful adoption of the new system would be critical for success.[1]  In this way, an important factor in a Romani health care program would be not to simply devote monetary resources to building a clinic, but would instead begin with working to introduce the concept of why health care is important and how to go about building a health care system.  Efforts such as the Tanzania project discussed by Rogers could be very useful in reaching a wide-range of audiences with messages specifically tailored to the local needs.[2] The ideal communications would be aimed at both the Romani population as well as the general public, for a critical piece of building this program would be to enhance communication between the general and the marginalized to make each internalize the need for Romani health. 



            In introducing health care initiatives to Romani communities and encouraging an understanding in surrounding majority areas, development programs would be working toward the development of a network.  Mark Buchanan discusses the various structures of networks, a concept that surfaces in various other readings as well.  The role of networks in Romani health programs is seen in the creation of ties within the Roma community and expanding the network to the outside.  In this way, Buchanan’s discussion of the importance of having both strong and weak ties is greatly applicable to my research. Recalling that “bridges are almost always formed by weak links,”[3] the focus discussed above regarding Rogers’ communication model to connect the Roma and the general public is directly tied to Buchanan’s ideas.  Further, the importance of strengthening internal network ties among the Roma regarding the issue reflects Jane Jacobs’ focus on building locally before extending outward.  In this way, programs enhancing Roma health need to be incorporate internal networks led by Romani leaders on the ground as well as bridges to others outside their own community.  Creating these networks can also help identify anomalies in the relationship between the majority and the minority – or, alternatively, between the state and the Roma communities.  The connection between the local and the distant is discussed by both Jeffrey Henderson (in his discussion of how policies made abroad can impact domestic production[4]) and Jane Jacobs.  Finally, as discussed by Anver Greif, the creation and maintenance of networks must take into consideration the role of trust and the need to be weary of ill-intentioned nodes.[5]




            Perhaps the most important overarching theme in effectively diffusing the idea of enhanced access to health care is that of the need to adapt each program according to the time and space in which it is implemented.  Drawing upon Douglas North’s focus on creating “adaptively efficient”[6] institutions, it is critical to create programs that are adaptable to a given community.  In this way, catch-all development policies such as those criticized by Joseph Stiglitz should not be deployed into the communities.  Instead, efforts should consider individual Romani communities across the continent.  For example, a Romani settlement in Slovakia may require programs focused on different health issues or diffused through different channels than required in a Hungarian community.   Because of this, it is important to re-adapt even programs deemed successful in one area to suit the needs of the societal framework of another area. 


            Exploring the issues of enhancing Roma access to health care includes a multitude of issues, players and potential paths.  Throughout the readings for this class, I have gained exposure to the complex nature of development – from the impact of actions taken far away to the negative externalities possible despite the best of intentions.  While the goal of increasing a populations’ access to health care may seem daunting, breaking down the steps to addressing individual communities makes success perhaps more attainable.  Learning lessons and adapting programs as necessary will show that there is, indeed, more than one way to skin a cat.  Yet, the “best” way will very well vary from location to location. 




[1] Rogers, Everett. Diffusion of Innovations.  5th Ed. Free Press: New York (2003).  p 169.

[2] Rogers, Everett. p 200.

[3] Buchanan, Mark.  Nexus.  W.W. Norton and Co: New York (2002). p 43.

[4] Henderson, Jeffrey. Global Production Networks, Competition, Regulation and Poverty Reduction: Policy    Implications.  Centre on Regulation and Competition.  Paper No. 115. June 2005.  p 5

[5] Greif, Avner.  “Commitment, Coercion and Markets.”  in Handbook of New Institutional   Economics, C. Menard and M. Shirley (eds.).  Springer: 2005.   P 733. 

[6] North, Douglass. Institutions, Institutional Change and Economic Performance.  Cambridge University         Press: New York (2008).  p 82.  

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