Working with the Roma to be more active and healthy: Challenges and action from Spain

Working with the Roma to be more active and healthy: Challenges and action from Spain

María Sanz and George Jennings

Unhealthy and inactive lifestyles have been increasing among global societies in recent decades, and it is unfortunately the disadvantaged populations who tend to have a particularly poor health status. This is in part due to several factors such as their lower socioeconomic status, but also to longstanding collectivist cultures that contrasts to the more individualist cultures from which the standardised exercise and diet recommendations come from. The World Health Organization (WHO, 2010; 2018) set both PA recommendations for adults such as at least 150 minutes of moderate-vigorous activity weekly or 75 minutes of vigorous-intensity per week, and a healthy diet recommendations include fruit, vegetables (400 grams per day) and legumes, no more than 25 grams per day intake from free sugars, no more than 30% of total energy intake from fats (it is recommended to reduce the maximum saturated and trans-fats) and less than 5 grams of salt. However, although these recommendations are well-known and there is a substantial body of knowledge on how exercise and healthy eating is good for people, little is known about the specific needs and challenges to meet these lifestyles among particular ethnic groups.

In an effort to consider this dilemma, this article identifies the case for examining the rich and complex culture of one ethnic group within an economically disadvantaged neighbourhood in Spain known as Perpetuo Socorro in the Huesca region of North-East Spain. It draws on a FEDER-funded project to develop a community-driven intervention involving the collaboration of parents and families as well as professionals in nutrition, exercise and social work. From this critical reflection about their customs, lifestyle, poorer health status and their needs, we would like to encourage health professionals to face current problems through measures from several areas at the same time, which is a topic little studied to date. Although focused on one small-scale social and collaborative intervention, we hope the article resonates with readers interested in working with longstanding communities integrated in neighbourhoods in other regions. We argue that scientific research needs to consider social scientific approaches to put policies and guidelines into effective action.

First, we must consider the demographics and history of the group in question. In English, the ‘Roma’ seems be the most accepted term to refer to this ethnic group. However, depending on their origin, different words are used (e.g., Spanish ‘gitanos’, ‘English Gypsies’, and ‘Irish Travellers’). The Roma have been in Spain for centuries since their migration from Northern India; in fact, it is the second largest European ethnic group. The ‘gitanos’ come from Western European Roma, whose migration finished in the second half of the 15th century. Their settlement is highlighted by constant persecutions and conflicts although they have come to settle in urban areas rather than continue as ‘travellers’. In general, when a generation of Spanish Roma population arrive at the city, they don’t move to another town over generations, and as a result, the place of birth and residence often is the same (Martin & Gamella, 2005). In Spain, there are around 750,000-900,000 Roma (around 2.1% of the total Spanish population) who tend to suffer marginalisation in social areas such as education, housing and employment. They have influenced in the Spanish culture, in particular in specific regions such as Andalusia (Martin & Gamella, 2005) and the ‘gitanos’ population usually feel proud of being.  However, nowadays going on existing many barriers between the Roma and the non-Roma population (‘payos’ in Spain), as explained in recent Spanish news.

Another consideration needs to be made to social structures such as class and gender. Current and detailed reports (Laparra Navarro et al., 2011) have shown the Spanish Roma population to live within a low socioeconomic level (high rates of unemployment), disadvantaged areas of residence and a low education level. In general, the Roma population has a high prevalence of young people alongside a low prevalence of people over 65 years old. Furthermore, the gender distribution has changed over the last decades, so the percentage of women is higher to men. Nonetheless, a typical characteristic among the Roma population is the familial hegemony and gender role-play. However, the above report showed a slow evolution of historical dominance of patriarchal community in the Spanish Roma women’s empowerment. The Roma family structure is characterised by men as the main source of authority and control, and women being responsible for households and family caregiving. Girls start to assume household tasks with their mothers from early ages (from 13 to 16 years), in contrast to boys, who follow the father’s path. As a consequence, both girls and boys usually drop out of school before finishing compulsory education.

Improving Spanish Roma women’s health
The Roma often have a poor health status due to their unhealthy behaviour patterns such as the consumption of high amount of soft drinks, sweets, and fatty foods. These behaviours, combined with low physical activity levels, result in negative consequences. Being overweight and obesity are the most common non-communicable diseases among Roma, in particular among women. Recent news has related obesity to power, resulting in an ‘obesity culture’. Diabetes, cardiovascular diseases, depression or migraines also prevail among this ethnic group. Overall, Roma women have a shorter lifespan than Roma men. According to the above report, 9 in 10 women claim to have a poor health status, even more from 55 years of age. The health status of Roma women is highlighted by the family hierarchy that make them focus on the family responsibilities instead of ‘their own life’. Depending on the ethnic group or socioeconomic status, among others, people perceived barriers to change their behaviours. For instance, the disadvantaged populations usually perceive specific barriers to do physical activity that are different to non-disadvantaged populations. For instance, African-American women perceive different barriers to Roma women. Therefore, does culture influence when people want to change behaviour? Before starting to change behaviour, it is recommended to know which barriers are perceived by the target population when they want to change behaviour like doing physical activity. Recently studies have found common barriers among disadvantaged populations such as family, low income, lack of time, motivation or energy, health problems, among others (Baruth et al, 2014; Hoebeke et al., 2008; Joseph et al., 2015 Van Stappen, 2018). However, although there are common barriers, each population or ethnic group could have particular barriers that should be researched.

For decades, efforts have been focused on the Roma population’s needs to remove their social and economic marginalisation. From Spain, different measures have been implemented since 2005. Recently, the Spanish Strategy for Social Inclusion of the Roma population 2012-2020 has been put into practise. This strategy follows the European Union’s guidelines (Ministerio de Sanidad Servicios Sociales e Igualdad, 2014) related to health status, genetic disorders, decrease in inequalities and childhood health. Numerous projects highlight the necessity to carry out intervention programs to improve people’s health status through an increase their physical activity levels and healthy eating. But there is a lack of intervention programs among the Roma population to help them to change their habits.

Action research
Nowadays, the European project CAPAS CIUDAD/CAPAS-CITÉ is leading three important research lines. One of them is focused on healthy habits-related intervention program in disadvantaged populations, mainly Roma women.  The participatory action research (PAR) project called ‘Pio keeps moving’ was conducted over two years in order to promote physical activity and healthy habits, and to achieve a healthy lifestyle adherence among a disadvantaged community. Being culturally sensitive, the intervention program was adapted to Roma women’s specific needs, demands, responsibilities and resources, just like their barriers to change unhealthy habits. In ‘Pio keeps moving’ the activities were rolled out depending on the community’s needs, with resulting multiple and participative activities for stimulating different behaviours (e.g., healthy eating, physical activity and parental education).

It is important to highlight the difficult sustainability of this type of program either for the ethnic group or health professionals. The maintenance of participants’ attendance is hard work. High drop out rates during the studies or intervention programs are common. Health professionals report that physical activity and advice given in the consultation are not carried out by the patients. Social workers claim access problems to societies with different cultural aspects both from the Roma ethnic group and the non-Roma ethnic group (i.e., ‘payos’). We wonder if the low attendance is produced by Roma culture and their lifestyle or because the intervention program is not adapted to the Roma’s characteristics. Perhaps changing their lifestyle is not prioritised over continuing their traditions? The improvement of the Roma population’s health means a challenge for specialists operating in different fields and working groups who address the problem in the same direction.

Baruth, M., Sharpe, P., Parra-Medina, D., & Wilcox, S. (2014). Perceived barriers to exercise and healthy eating among women from disadvantaged neighborhoods: Results from a focus groups assessment. Women & Health, 54(4), 336-353.
Hoebeke, R. (2008). Low-income women’s perceived barriers to physical activity: focus group results. Applied Nursing Research, 21(2), 60–65.
Joseph, R. P., Ainsworth, B. E., Keller, C., & Dodgson, J. E. (2015). Barriers to physical activity among African American women: an integrative review of the literature. Women and Health, 55(6), 679–699.
Laparra Navarro, M. (2011). Diagnóstico social de la comunidad gitana en España. Un análisis contrastado de la de la encuesta del CIS a hogares de población gitana 2007. Ministerio de Sanidad, Política Social e Igualdad. Madrid.
Martin, E., & Gamella, J. F. (2005). Marriage practices and ethnic differentiation: The case of Spanish Gypsies (1870–2000). The History of the Family10(1), 45-63.
Van Stappen, V., Latomme, J., Cardon, G., De Bourdeaudhuij, I., Lateva, M., Chakarova, N., … & Miguel-Etayo, D. (2018). Barriers from Multiple Perspectives Towards Physical Activity, Sedentary Behaviour, Physical Activity and Dietary Habits When Living in Low Socio-Economic Areas in Europe. The Feel4Diabetes Study. International Journal of Environmental Research and Public Health, 15 (12), 2840.


María Sanz is a PhD student in Education at the University of Zaragoza. She graduated in Physical Activity and Sport Sciences and, currently, she is conducting her dissertation about the physical activity promotion among disadavantaged population, in particular the Roma ethnic group. George Jennings is a lecturer in sport sociology / physical culture at Cardiff Metropolitan University, UK. He is interested in a range of physical cultures as studied through various qualitative research methods and social theories. George’s main research focus is on martial arts cultures, pedagogies and philosophies.