Health 2020: policy framework and strategy nutritional status and vaccination rates reveal marked inequities between the Roma and the majority population, including (in some contexts) when Roma are compared with the poorest quintile of the general population (138,139).
Solutions that work Since the health problems of migrants and others who are vulnerable can result from or be worsened by their disadvantageous social position, measures that combat socially exclusionary processes are likely to have the most fundamental effect on their health. Furthermore, policies should address inequities in the state of health of migrants, Roma and others made vulnerable through exclusionary processes, and in the accessibility and quality of health and social services available to them. Many of the strategies for achieving this are not specific to such groups as the Roma, but are similar to those needed for ethnic minorities and others subject to multiple exclusionary processes in general. They include training health care workers in working with minority and marginalized populations, involving those populations in designing, implementing and evaluating health programmes, and improving health information systems so that data are collected and presented in an ethnically disaggregated format. Integrated policy approaches designed to tackle the multiple causes of social exclusion are the most successful (140). Many of the health and socioeconomic challenges associated with migration are the product of global inequity, and action that focuses solely on host countries will be less effective than integrated global programmes designed to mitigate the factors in the country and region both of origin and of destination. Migrants also frequently confront gender-specific challenges, particularly in the context of maternal, newborn and child health, sexual and reproductive health, and violence. Migrants should have early access to reproductive health services, preventive health services and health promotion, screening and diagnostic care, as well as prenatal and obstetric services. Special attention should be paid to women and girls who have been trafficked, as many have been exposed to gender-based violence. WHO resolutions adopted at global and regional levels relating to social inclusion and poverty and health are relevant to vulnerable people. These include the World Health Assembly resolution on reducing health inequities through action on the social determinants of health (47) and work following up Regional Committee resolution EUR/RC52/R7 on poverty and health (141), such as that addressing health inequities linked to migration and ethnicity (126). Specifically on the health of migrants, a World Health Assembly resolution in 2008 (142) was followed up by a WHO/International Organization for Migration global consultation on an operational framework during the Spanish EU Presidency in 2010 (143). The need for coordinated and sustained international action is being picked up through various policy processes and conferences, with outcome documents, such as the Bratislava Declaration on Health, Human Rights and Migration signed by Council of Europe Member countries in 2007 (144) and recommendations on mobility, migration and access to health care adopted by the Council of Europe Committee of Ministers in 2011 (145). The International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families (146) provides a broader framework for the universal human right to health without discrimination. The Decade of Roma Inclusion 2005–2015 is a political commitment by European governments to improve the socioeconomic status and social inclusion of Roma, and health is a priority area of focus together with education,
82