Emese Ibolya:
Improving medical school curricula and Roma access to health care in Hungary
Initial Issue Paper

Background
The health status of the Roma population is the worst of all minorities in Central-Eastern Europe. In Hungary, as well, the morbidity and mortality indicators of the Roma are generally worse than the majority population’s; as a result their life expectancy is 15 years lower than he average. The underlying reasons behind these indicators are of an extremely complex origin, which need to be explored from multiple angles. The problems affecting the health situation of the Roma population are of both social and cultural roots with a borderline between the two categories often difficult to recognize.
Hungary has already gone through a significant change since the transition from the communist political system to market economy; however, economic regression following this era had a significant effect on social and health conditions. The Government currently implements a health-centered governmental strategy, which mobilizes all economic means and entire mental capacity of society in the interest of each individual
As a significant step in 2002 the Government 2002 launched a wide-ranging program in order to improve the life and living conditions of the Roma. The program also aimed at developing their physical and mental health with special focus on providing equal education chances and marketable job opportunities to promote their social integration; nevertheless, there are still unsolved areas. A large proportion of Roma people in Hungary still do not have access to quality public health services, due to negative mechanisms present in the health care system unable to tackle with biases and negative attitude of health service providers towards members of this minority.

The aims of the research
This research aims at giving an overview and analysis of medical school curricula in Hungary for revision and possible improvements in the interest of preparing health care personnel for more effective communication and cooperation with Roma patients in their work. Therefore, better access would be guaranteed for the Roma for quality health care services to increase their life expectancy. On the other hand, I intend to explore underlying reasons for Roma patients general attitude towards health service providers in order to gain insight into the problem in question from both sides.

Geographical and social exclusion
There is a severe lack of access to public health care from the side of the Roma population, not only because of the negative, often discriminatory attitude of medical personnel of health care institutions towards them, but due to regional inequalities as well. Roma communities are usually situated in segregated settlements at the most deprived areas of the socially disadvantaged regions of Hungary. As a consequence, Roma people often lack proper medical treatment due to geographical reasons based in segregated settlements with significant distance not only from local hospitals, but often the office of the closest GP in their area.

The ‘culture’ of medical education and the attitude of health care providers towards social issues
Geographical inequalities, the Roma need to face, are often supplemented with negative, biased attitude of medical personnel of public health institutions. These notions originate from different stereotypes on Roma people, due to insufficient information and lack of objective data on poverty and related issues, including ethnicity. Therefore, it is of utmost importance to clearly emphasize the complexity of social disadvantages in medical education. Moreover, future health service providers need to be faced with the realities of poverty and social problems through direct, first-hand experiences as part of their education in order to be sensitive enough towards, and understand problems with social origin in their work. As a consequence, the curricula of medical schools need to be filled with both theoretical-factual and practical features of social contents.

Proposed outcomes of the project
After analyzing the underlying reasons behind factors causing improper access to public health care for the Roma, moreover the insufficient cooperation and cooperation of health service providers with them I wish to come up with the following results:
Having understood the ‘culture’ of medical education, moreover its insufficient functioning in sensitize future medical personnel for socially disadvantaged groups, I will make specific recommendations for leaders of medical schools for possible improvements in their curricula with special focus on social issues and their complexity. Designing an ethnically, and socially sensitive model curriculum to such schools based on well-functioning foreign resources also accounts for the final outcomes of this research. After revealing the underlying notions of Roma patients towards health service providers, I will be able to recommend content material for education programs aiming at improving the health-consciousness and self-advocacy skills in human, and patient rights of the Roma. I will also produce practical policy recommendations for future decisions in public health care. The findings of this research study will be circulated amongst relevant government ministries in Hungary, the Hungarian Office of the World Health Organization (WHO), International Non-Government Organizations and a range of civil society organizations across Hungary and abroad.  

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