Background There is growing evidence that Roma populations in Europe experience significantly poorer health–including higher rates of communicable and non-communicable diseases, poorer self-rated, child and maternal health–and shorter life expectancy than majority populations. Health outcomes are often worse than for others in similar social positions, suggesting the differences are not simply the effect of poverty. Roma women are thought to be worst affected. However, data pertaining to the multiple social inequalities affecting Roma populations, their interaction and cumulative effect on health over time, have yet to be explored. The aim of this paper is to critically review the state and shape of the research evidence on the multiple intersecting determinants of health for Roma populations in Europe.

Methods Studies were identified by searching four bibliographic databases (MEDLINE, Science Citation Index, Social Sciences Citation Index and Scopus), screening reference lists, consulting key informants and searching organisational websites. Any empirical studies (quantitative and qualitative) that explored more than one influencing factor in the pathway to poor relative health for Roma populations residing in the 53 countries of the WHO European region were included. Two reviewers carried out screening, data extraction and quality appraisal; disagreements were discussed by the wider team. This was followed by a narrative synthesis to explore the interactive effects of multiple axes of inequality.

Results From 2043 bibliographic records, 37 studies met our inclusion criteria. The median number of influencing factors explored through qualitative and quantitative methodologies was 2 (range 1–5) and 3 (range 1–11) respectively. Quantitative studies focus most strongly on factors that are well-defined and relatively easily turned into health indicators using available datasets, namely: poverty (10 studies) and other indicators of socio-economic status including education (13 studies), housing (9 studies) and employment (9 studies). Very few studies unpick interactive effects; instead testing each factor’s contribution to poor health independently. On the other hand, qualitative studies tended to explore “Roma culture” (11 studies) and the impact of discrimination/racism on health behaviour (10 studies). There is a lack of gender-disaggregated data and little analysis of the impact of social policy on the health of Roma populations.

Conclusion Evidence for associations between determinants and health outcomes among European Roma populations is patchy.Research needs to pay more attention to the health impact of social policies that have the potential to reinforce (as well as mitigate) the exclusion of Roma populations and the disadvantages experienced by women.