Implicit bias against the Romas in Hungarian healthcare: taboos or unrevealed areas for health promotion?

The Roma or Gipsy population is the largest ethnic minority both in Europe and Hungary with a 10-15 years lower life expectancy and significantly worse health indicators than majority populations. The purpose of this exploratory study was to investigate a sensitive and controversial topic: the perspectives of healthcare staff about the presence and impacts of implicit bias in the Hungarian healthcare system towards Roma patients. Therefore, between June 2017 and May 2018 semi-structured interviews were conducted involving 13 healthcare professionals. Interview transcripts were coded and thematically analysed. The presence and occasional manifestation of prejudices against the Romas were noted by the interviewees, most commonly in the form of longer waiting time, comments or other meta-communicative tools. Study participants appeared to exclude a direct relationship between health providers' implicit bias and the lower quality of health services or the worse health status of Roma patients. However, as reported, indirect negative effects may occur in cases where a patient refrains from seeking care due to previous perceived or experienced discrimination. As barriers to effective patient-provider communication and cooperation, differences in culture, health-seeking behaviour and gaps between health literacy levels were emphasized. In terms of prevention, enhancing anti-discriminatory attitudes from early childhood within the families, the role of media in conveying unbiased information, increasing health awareness of the Roma people as well as educating healthcare providers on culture-related issues may be beneficial. Stress and burnout of healthcare professionals also need to be addressed as these may impact on the enactment of unconscious biases.