The role of Roma Health Mediation in addressing inequalities in health: bridging, filling, or reproducing the gap?

Battaglini, Mario (2024) The role of Roma Health Mediation in addressing inequalities in health: bridging, filling, or reproducing the gap? PhD thesis, London School of Economics and Political Science.

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Abstract

Health inequalities experienced by Roma in in the EU are a major policy concern. This thesis analyses the role of Roma Health Mediators (RHMs) in addressing these health inequalities. RHMs are community health and social workers who form part of the strategies for enhancing Roma health in many EU Member States. My primary focus is on Bulgaria, though I also examine the role of Roma health mediation in Spain and Belgium to understand what lessons the models of health mediation can learn from each other. Through extensive research with RHMs, their Roma clients and professional networks, I investigate: (1) the perceptions of the causes of health inequalities and the barriers to healthcare for the clients of RHMs; and (2) the extent to which RHMs address those health inequalities and barriers to healthcare. Interviews (n=44) are my main data collection method, though I also use a range of complementary and supplementary methods (e.g., a small survey of RHMs, n=48; observation; questionnaires). I show how poverty is perceived to be the main social determinant of health, shaping health outcomes and experiences of healthcare utilisation of RHMs’ clients. Poverty also frames the role of RHMs in addressing their clients’ barriers to health and healthcare. I analyse the different interpretations of poverty, as related to health inequalities, held by RHMs, their Roma clients, and their professional networks. On the basis of my findings, I argue that the structural or cultural dichotomy, which dominates understandings of poverty as a cause of poor health is a false one. Instead, I propose that the resource deprivation – material, informational, relational, symbolic, and emotional – of RHMs’ clients is attributable to both systemic factors at societal level and behavioural ones at community level. I apply this understanding of health inequalities faced by clients of RHMs to analyse what activities RHMs implement to overcome or mitigate them. In doing so, I develop a novel theoretical framework to clarify the extent to which activities are relevant, effective, and sustainable. I move beyond a binary split between what works and what does not, and suggest three potential impacts: bridging, concerned with the short-term fruition of healthcare services; filling, centred on transformative change at the health ecosystem level; and reproducing, which highlights the perils of RHMs reinforcing heteronomy and perpetuating inequalities. My findings emphasise the importance of context in shaping outcomes, including: the community, organisational features, the workplace, and the motivation and discretion of RHMs.

Item Type:	Thesis (PhD)
Additional Information:	© 2024 Mario Battaglini
Library of Congress subject classification:	H Social Sciences > HN Social history and conditions. Social problems. Social reform R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets:	Departments > Social Policy
Supervisor:	Platt, Lucinda and Shutes, Isabel
URI:	http://etheses.lse.ac.uk/id/eprint/4722

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