The problem with 'vulnerability'
It’s taken as a self-evident truth: the Roma are vulnerable. Read any academic paper on the position of Roma in Europe; attend any meeting Roma-focused meeting with policy makers; read any Roma NGO’s mission statement and you’ll see the same assertions of ‘marginalisation’, ‘discrimination’ and ‘vulnerability’: the triumvirate of disadvantage. But what does any of this mean? And what utility does it have to the actual situation of Roma people?
I’ve now nearly completed a PhD on Roma health and worked in policy and mental health advocacy for a Roma grassroots organisation, and I’ll admit that I took these terms at face value when I began this work. Many Roma do, after all, live in poverty, and many have experienced extremes of discrimination. If you take vulnerability to mean that people are less able to advocate for themselves within public services and achieve their desired outcomes then, yes, it seemed logical that the Roma would be defined as vulnerable. Yet as I delved deeper into the practical consequences of the designation, it seemed that the widespread application of the term could only serve to heighten the inequalities it was intended to address. Assuming that the Roma are vulnerable equates poverty and discrimination with helplessness; and defining policy objectives around assertions of vulnerability only deprives a group of their influencing power in setting public priorities.
First, though, let’s consider the potential usefulness of the ‘vulnerable’ designation in the context of health. Within national UK policy, the Roma receive attention within the semi-defunct Inclusion Health agenda, under the category of ‘vulnerable migrants.’ If you want to attract the attention of a certain class of equalities-minded policy makers, an emphasis on disadvantage can help bring the need for reform into focus. Yet when I’ve described the Roma as ‘vulnerable’ in public settings, it’s carried the connotation that Roma people simply don’t understand the way that ‘mainstream’ services work. The idea that services aren’t fit for purpose in meeting the needs of a whole range of so-called vulnerable groups rarely enters into the discussion.
Much of the work with Roma that draws accolades from policy audiences deploys awareness-raising and advocacy initiatives to teach the Roma how to access services. While acknowledging that there will be members of the Roma community who will need this specialised advocacy support (just like there will be members of any community who will need specialised advocacy support), behaviour change programmes assume that disadvantaged people simply don’t understand services, don’t know how to access them. Decision makers put forth agendas aimed a fixing these vulnerable people – showing them how our world works – and presenting this as a path to model citizenship. All the while, any suggestions of substantive service-level change are swept neatly under the rug. After all, it’s cheaper to change the people than to change the system.
Or is it?
The question remains: how would health services look if Roma – and other purportedly vulnerable groups – were more widely recognised as people with agency? What if Roma fed directly back on their experiences of accessing services, and service developers actually listened? Instead of hearing time and time again that health interpreting services simply don’t have the funds to train interpreters in the Roma languages, what if we demanded that the government dip into its deep pockets and find that money for the most underserved communities? What if we stopped accepting that old fallacy that there’s no money for public programmes? There’s more than enough money in the world; it’s just a matter of how we’re using it.