A mixed-methods evaluation of Roma health mediation: Bulgaria case study

(Source: Zdravé Komunity. Accessed online at: http://zdravekomunity.sk/en/about-healthy-communities)

Mario Battaglini is a pentalingual Sicilian with a passion for mixed-methods research. He has 5 years’ experience working in think tanks across Europe as EU public policy consultant. Winner of the 2016 Titmuss Prize for the MSc Social Policy (research) at LSE, he also holds an MA summa cum laude in International Relations from the University of Trieste. Currently, he is the graduate research intern at the Centre for Analysis of Social Exclusion, and he is set to start a PhD in Social Policy at LSE in September. A fervent European Federalist politically, in his spare time he enjoys chess, football and cooking –  as well as the occasional pint.

Mario’s paper, A mixed-methods evaluation of Roma health mediation: Bulgaria case study, is published in the 2017 edition of The Public Sphere, available to read online here. This piece is part of a series of articles contributed by authors featured in this year’s issue.


“Born into this”, writes Bukoswki. Born into a world where hospitals are so expensive that it’s cheaper to die, and one where our sensitivity dies too. Born into a world that lacks love, humanity, fraternity. A world that will soon make Dante’s Inferno look like a children’s playground, in his desperate outcry. It is too heavy the burden of living in a world Bukowski does not recognise himself in, a world that leaves him “castrated, debauched, disinherited”, with the “fingers reaching out for the bottle, the pill, the powder”. The poet casts his eyes on the poor and the excluded, desperately advocating a moral regeneration of mankind. Despite British Marxist historian E.P. Thompson’s claim that poets cannot be committed to any political view, Bukoswki’s writings show that a poet’s lived experience is in fact political, and social – not unlike a researcher’s. But while the author voices his utter disillusionment through beautiful poetry, a social policy researcher individuates areas of criticality and points to solutions. It is the job’s categorical imperative. The predicaments of Roma people are what struck me as worth investigating –  they are the largest and most excluded ethnic minority in Europe.

My chapter in the 2017 Public Sphere Journal – A Mixed-Methods Evaluation of Roma Health Mediation, Bulgaria Case Study – is a shorter version of my MSc Social Policy (research) dissertation, in which I administered a survey and conducted interviews with Roma health mediators and institutional stakeholders. My aim was to get an understanding of the nuances of Roma clients’ predicaments and to synthesise this evidence in my conclusion and policy implications. My initial research took place between January and August 2016, and it laid the foundations for a much larger project on the subject. This larger project explores the relative importance of barriers to healthcare for Roma across the EU, always by surveying and interviewing Roma Health Mediators, but also including Roma and doctors – in the 12 EU countries where the Roma Health Mediator Programme is in place . Roma Health Mediators are social workers, usually of Roma origin, who provide a range of social and health-related services to increase and improve access to healthcare. The extended research will be developed into a parsimonious, novel, and useful framework of the barriers Roma experience, thus moving beyond the limitations of the current literature, and measuring whether they are predominantly at the micro, meso or macro level, and on the demand or supply side. Exploratory and confirmatory factorial analysis could be useful tools to achieve this.

(Source: FXB Center for Health and Human Rights. Accessed online at: https://fxb.harvard.edu/call-for-papers-discrimination-against-roma-effects-on-health/)

Certainly, social scientists often face methodological challenges in their research… and these are not inconsequential. No one could reasonably say that Roma (and Gypsy and Travellers) are not vulnerable, facing multiple disadvantages, especially women and children. But research may point to contradictory evidence, leaving questions unanswered – and this makes the difference when switching from poetry to social research, especially when there is public money involved. Social scientists, therefore, should confess what their limitations are in their study – it is, again, a job’s categorical imperative. In the case under consideration, the main strength of getting expert insights into what they think barriers are, is also the main weakness. Mediators cannot conclusively explain what the barriers are. To an extent, this could be remedied by including doctors and Roma, but then it must be recognised that such a Roma sample would likely be skewed to those who benefit from health mediation.

In the face of methodological adversity, a social researcher should be resourceful and aim to be a classical hero – a Ulysses who kisses “his rocky native Ithaca”, who succeeds in bringing clarity and a sense of direction. Indeed, this research would offer ample opportunity to find out about what health mediators regard as the issues, how they attempt to address them, what obstacles they feel they face, and how they are regarded by doctors and by Roma clients. The findings, therefore, may point to ways in which health mediators can be effective or restricted, providing valuable insights to build into policies intending to improve health outcomes, and fortifying hope that Dante’s Inferno be confined to Gustave Doré’s illustrations.

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