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INTENSIVE COURSE IN BIOLOGICAL ANTHROPOLOGY 1st Summer School of the European Anthropological Association 16–30 June, 2007, Prague, Czech Republic EAA Summer School eBook 1: 209-215 ANTHROPOLOGICAL AND EPIDEMIOLOGICAL STUDY OF BAYASH ROMA POPULATION IN CROATIA Matea Zajc Institute for Anthropological Research, Zagreb, Croatia Introduction The Roma people (Romani) are widely dispersed ethnic group whose size is estimated at 8 to 10 million worldwide, of whom 7 to 9 million living in Europe (World Bank 2001). They are often called Gypsies or Gipsies, a term that is generally considered pejorative and is based on a mistaken belief of an origin in Egypt. It is possible to distinguish five main groups: 1. Kalderash - most numerous, traditionally coppersmiths, from the Balkans, many of whom migrated to central Europe and North America; 2. Gitanos (Calé) - occupying mostly the Iberian Peninsula, North Africa, and southern France; associated with entertainment; 3. Sinti - mostly in Alsace and other regions of France and Germany; travelling showmen and circus people (Some experts, and Sinti themselves, insist that Sinti are not a subgroup of Roma but rather a separate ethnic group which also had Indian origins and a history of nomadism); 4. Romnichal (Rom'nies) - in Britain and North America; and 5. Erlides (Yerlii or Arli), settled in south-eastern Europe and Turkey. The origin and early history period of the Romani was an enigma for long time because there are no written evidences. As early as 200 years ago, cultural anthropologists hypothesised an Indian origin of the Roma based on linguistic evidence (Fraser 1992), and since late 1990s, considering development of plenty of techniques in molecular biology, numerous genetic evidences confirm that theory (Malyarchuk et al. 2006, Wikipedia). The earliest references - evidence of the presence of the Roma in Croatia are found in trading documents from Dubrovnik (1362 AD) and Zagreb (1373 AD; Petrović 1975, Tkalčić 1898). In Međimurje region, for example, the Roma were mentioned for the first time in 1688 AD; the child of the “Gypsy” Duke was christened. The next document dates back to the 18th century when the feudal rulers of Međimurje allowed the immigration of the Bayash groups. The Bayash are one of many Romani branches/castes - they were held slaves in historical Romanian states Wallachia and Moldavia. In particular, the Boyash were forced to settle in the 14th century and work in mining (a regionalism for mine in Romanian: "baie"). Due to their close proximity with Romanian-speaking people, they lost the use of the Romani language. Such slavery was abolished in Romanian states in 1864, when larger Bayash groups immigrated to Croatia (Fraser 1992). The Bayash consist of numerous small groups speaking different dialects of the Romanian language and living dispersedly, mostly in Balkan peninsula. They are known under a variety of etnonyms; Bayash (Boyash) are used in Croatia and Hungary, Banyash, Karavlasi or Romanian Gypsy in Serbia and Băeşi in Romania (Sikimić 2005). Diverse Bayash groups are also often called by professionyms based on their traditional occupations (Lingurari – spoon makers, Koritari – trough makers, Rudari - miners). Today the Bayash pursue crafts like wickerwork or engage in trading with various consumer goods (traditional wooden objects are replaced by curtains, clothes, brooms etc.) or secondary processed materials (plastics and metals). Bayash in Croatia speak a distinct archaic dialect of the Romanian language, ljimba d’bjas. Despite some subdialectal or religious divisions among them it is important to note a strong cohesion of Bayash groups and their opposition to other Romani groups whom they refer to as Lăcătarii and to their language (Romani Chib) as lăcătăreaşce. Strict rules of endogamy apply and spouses are almost exclusively chosen within Bayash population. Because of the lack of comprehensive and comparative studies dealing with health status and health-related bio-cultural and socio-economic characteristics of the Roma in Croatia, the scientists of the Institute for Anthropological Research, Zagreb initiated multidisciplinary anthropological, moleculargenetic and epidemiologic investigations (Škarić-Jurić et al. 2006, Government of the Republic of Croatia 2007) aimed at more detailed understanding of Romani biological and cultural heritage. Participants and methods The results presented in this paper are a part of extensive material collected in field studies carried out in 2005 and 2006 in Bayash settlements in Baranya and Međimurje (Fig. 1). A total of 266 adult Bayash individuals (95 men and 171 women, aged 18 to 84 years) from Baranya and 164 Bayash individuals (56 men and 108 women, aged 18 to 68 years) from Međimurje participated in field investigations. 209 INTENSIVE COURSE IN BIOLOGICAL ANTHROPOLOGY 1st Summer School of the European Anthropological Association 16–30 June, 2007, Prague, Czech Republic After informed consent was obtained, each examinee participated in an extensive interview with the help of the trained, linguistically and culturally competent Bayash activist to ensure the accurateness and objectivity of the obtained data about ethno-historical and demographic background, self-identity, living and hygiene conditions, education, employment, health insurance and health (dietary and smoking habits, reproductive characteristics, diagnosed and undiagnosed health problems, use of medications etc.). Anthropometric, spirometric, blood pressure and ultrasound bone densitometry measurements were also carried out. Statistical analyses Descriptive statistics were given as absolute numbers and frequencies for the qualitative variables, and means and standard deviations for the quantitative ones. Differences by region, sex and age were tested using Fisher’s exact test for qualitative, and t-test for quantitative variables. All analyses were performed by SPSS 10.0 statistical package for Windows (SPSS Inc., Chicago, IL, USA), with statistical significance set at p<0.05. Results Demographic, socio-economic and health-related characteristics Main demographic, socio-economic and health-related characteristics of the Bayash populations from two investigated Croatian regions are shown in Table 1 (Škarić-Jurić et al. 2007). Table 1. Demographic, socio-economic and health-related characteristics of the total Bayash population with regional, sex and inter-generational differences. Baranja vs. <35 y vs. 35+ Characteristics Total sample Men vs. women Međimurje y Demography: Gender (% male) 151 (35.1) ns ns Age, y (mean, SD) 41.3+15.1 45.5 vs. 34.4 ns 26.9 vs. 50.5 Age <35 y (%) 169 (39.3) 26.7 vs. 59.8 ns Number of examinees born 364 (88.8) 83.1 vs. 98.7 ns 94.4 vs. 85.1 within the region (n, %) Number of examinees whose both parents are born within 236 (69.4) 57.3 vs. 91.7 ns 80.2 vs. 62.3 the region (n, %) Social inclusion: 363 (85.0) ns ns ns Croatian citizenship (n, %) Social support (n, %) 341 (83.6) ns ns ns Child allowance* (n, %) 124 (47.0) 24.7 vs. 80.2 * 77.0 vs. 28.7 Health insurance (n, %) 216 (50.6) 40.4 vs. 67.3 43.0 vs. 54.7 ns Employment: 7 (1.7) 0.4 vs. 3.7 ns 3.8 vs. 0.4 Permanent (n, %) Occasional (n, %) 94 (23.0) 18.6 vs. 29.8 38.2 vs. 14.8 ns Other sources of income (n, 26 (6.4) 9.7 vs. 1.2 10.4 vs. 4.2 1.9 vs. 9.2 %) Education: ns 4.4. vs. 3.1 5.0 vs. 2.6 3.6+3.4 Education, y (mean, SD) Health related characteristics and life style conditions: Smokers (n, %) 301 (70.2) 65.3 vs. 78.1 ns ns Age at initiation smoking, y 16.9+7.3 18.1 vs. 14.3 ns 15.2 vs. 17.6 (mean, SD) 2 25.6+5.7 ns ns 24.0 vs. 26.7 BMI, kg/m (mean, SD) BMI < 18.5 (n, %) 29 (6.9) ns 3.4 vs. 8.8 ns 89 (21.0) ns ns 14.2 vs. 25.6 BMI > 30 (n, %) *reported for women only The traditional assumption of nomadic life is not evident in the sampled Bayash population which is autochtonous and sedentary. Reported migratory pattern reveals that almost 90% of the examinees were born within the region of residence and as much as 70% of examinee’s both parents were also born within the same region. Our data also indicate that high percentage of the Bayash in both investigated regions (85%) chose Croatian citizenship; most likely they did it to obtain social welfare support allowance (approximately 85% beneficiaries). In contrast, the overall low number of health insurance beneficiaries (40% in Baranya vs. 67% in Međimurje) reflects high unemployment rate in the Bayash. 210 INTENSIVE COURSE IN BIOLOGICAL ANTHROPOLOGY 1st Summer School of the European Anthropological Association 16–30 June, 2007, Prague, Czech Republic Almost one half of the studied population (47%) receives child allowance and there are almost three times more beneficiaries among younger parents. The extent of the Bayash exclusion from formal labor market is evident in their low unemployment rate (Table 1). For instance, only 7 examinees in total (one male person in Baranya and 3 male and 3 female persons in Međimurje) reported to have permanent jobs. A larger share of population is only occasionally employed (23%) in seasonal agricultural activities, trading with consumer good or collecting and trading with secondary processed materials. Much more Bayash men than women are occasionally employed (38% men vs. 15% women) probably due to traditional concept of the Bayash family in which a woman is responsible for household and children. The Bayash attend school 3.6 years on average (Table 1) and only 10% complete 8-year elementary education, 4.4% enroll in secondary education whereas none of the examinees report university level education (Fig. 2). If we compare it to the majority population in Croatia, there are two times more people with completed elementary education and ten times more with completed secondary education (Turek et al. 2001) than in the investigated Bayash population. Figure 1: Geographic location of the investigated Baranya and Međimurje regions (Škarić-Jurić et al. 2007). % 50 0 yrs 1-3 yrs 40 4-7 yrs 8 yrs 30 9-12 yrs >12 yrs 20 10 0 Baranya Bayash Međimurje Bayash Croatia Figure 2: Years of education in Bayash compared to the majority population of Croatia. Data from Central Beureau of Statistics of the Republic of Croatia (Kalaydjieva et al. 2005). The Bayash appear to have adequate nutritional status as revealed by body mass index (BMI) until the age of 35 yrs after which their average BMI exceeds the value of 25 kg/m2 and falls in the overweight category. However, 7% of Bayash individuals are underweight (BMI < 18.5 kg/m2). The underweight rate is especially high in women (8.8% women vs. 3.4% men). In parallel to considerable rate of underweight, the presence of obesity (BMI ≥ 30 kg/m2) is assessed in 21% of the total Bayash, with increasing trends in older population. Smoking, as a part of traditional life-style of the Roma, is recorded in 70% of the examinees regardless of sex (Table 1), as opposed to 38.7% in the majority population of Croatia (Central Beureau of Statistics of the Republic of Croatia 2007). 211 INTENSIVE COURSE IN BIOLOGICAL ANTHROPOLOGY 1st Summer School of the European Anthropological Association 16–30 June, 2007, Prague, Czech Republic Things considered to be essential housing facilities aren’t available to most of the Bayash; public water supply and sewage disposal are the main problem, but still more accessible to the Bayash in Baranya than in Međimurje. Interesting thing is that although almost the same percentage of the Bayash and Croatians possess TVs and video recorders, on average, ten times more Croatians have water toilets and one third more Croatians have refrigerators in their homes if we compare them to the Bayash (Fig. 3). % 100 indoor wc 80 tv video recorder 60 refrigerator 40 20 0 Baranya Bayash Međimurje Bayash Croatia Figure 3: Selected indicators of living conditions in Bayash compared to the majority population of Croatia (20). Data from The Governament of the Republic of Croatia and European Commission (Turek et al. 2001) and Central Beureau of Statistics of the Republic of Croatia (Kalaydjieva et al. 2005). Reproductive status The results of the reproductive status reported by the Bayash women (Table 2) show their traditional life-style and multi-child family model (Škarić-Jurić et al. 2007). All the women marry very young, at the age of 16.8 years on average and the age at marriage among men is on average 2.4 years higher. The mean menarcheal age also shifts towards earlier age. It is found to be lower in Baranya women who have as much as four years longer reproductive period compared to the women in Međimurje. The average birth rate is 3.9 children per woman. This rate is markedly lower in Baranya (3.1 in Baranya vs. 5.3 in Međimurje) where is the number of born infants equal to the number of induced abortions per woman. Women from Međimurje reported more than three times lower rate of induced abortions. The lower level of reproductive status is associated with higher number of schooling years and health insurance. The role of age and region, also considered as independent variables, is significant. It indicates that older people have more children and that more children are born in families in Međimurje (data not shown). Table 2. Female reproductive characteristics of the total Bayash population with regional, sex and inter-generational differences. Characteristics Total sample Baranja vs. Međimurje <35 y vs. 35+ y Women in menopause (n, %) 99 (35.5) 48.0 vs. 15.7 0.0 vs. 56.9 Menarcheal age, y (mean, SD) 13.2+1.7 12.8 vs. 13.7 12.9 vs. 13.3 Menopauseal age, y (mean, SD) 47.5+6.1 ns 34.8 vs. 30.8 Length of reproductive period, y (mean, SD) 34.1+5.9 Number of spontaneous abortions (mean, SD) 0.5+1.1 ns ns 3.2 vs. 0.9 0.8 vs. 3.2 Number of induced abortions (mean, SD) 2.3+4.2 3.0 vs. 5.1 ns Number of alive children (mean, SD) 3.8+2.4 Number of deceased children (mean, SD) 0.1+0.4 ns 0.1 vs. 0.2 3.1 vs. 5.3 ns Total number of born children (mean, SD) 3.9+2.5 Percentage of deceased children (mean, SD) 96.4+14.1 ns ns 20.0 vs. 18.0 ns Age at first marriage – men, y (mean, SD) 19.2+4.3 Age at first marriage – women, y (mean, SD) 16.8+3.2 ns 16.2 vs. 17.2 Bone mineral density – Baranya According to the WHO criteria, osteoporosis (T score less than or equal to 2.5) is observed in 9.1% males and 34.4% females from Baranya (Fig. 4). The prevalence of T-values ranging from -1 to -2.5 indicating osteopenia is found in 63.6% males and 45.3% females, while normal T-values range is found only in 27.3% males and 20.3% females. Using T score –1.8 as a threshold, which is recently recommended criteria, the osteoporosis prevalence increases to 50% in males and to 56.3% in females aged 50 and over (Fig. 5). 212 INTENSIVE COURSE IN BIOLOGICAL ANTHROPOLOGY 1st Summer School of the European Anthropological Association 16–30 June, 2007, Prague, Czech Republic Figure 6 presents BMD values for Bayash males and females of different ages (7 age groups). The size of male-female difference in the age group 55-64 provides an explanation for the huge difference among two sexes in the estimated prevalence of osteoporosis (for aged 50+) as well as for the size of differences between the two criteria (< -2.5 and < -1.8) in estimated prevalence of osteoporosis in men. 9% 20% 27% 34% 64% 45% MALES FEMALES T score > -1.0 (normal BMD) T score -1.0 - -2.49 (osteopenia) T score < -2.5 (osteoporosis) Figure 4: Prevalence of osteopenia (T score < -1.0) and osteoporosis (T score < -2.5) in Bayash – Baranya population aged 50 and over (Government of the Republic of Croatia 2007). 44% 50% 50% 56% MALES FEMALES T score > -1.8 (normal BMD) T score < -1.8 (osteoporosis) Figure 5: Prevalence of osteoporosis (T score < -1.8) in Bayash – Baranya population aged 50 and over (Government of the Republic of Croatia 2007). Figure 3. BMD values according to age and sex group in Bayash population 650 600 550 Estimated BMD 500 450 400 Age groups: 1 < 18 2 = 18-24 3 = 25-34 4 = 35-44 5 = 45-54 6 = 55-64 7 = 65+ 350 300 250 1 2 3 4 5 6 7 1 2 MALES 3 4 5 FEMALES 213 6 7 Mean Mean±0,95 Conf. Interva INTENSIVE COURSE IN BIOLOGICAL ANTHROPOLOGY 1st Summer School of the European Anthropological Association 16–30 June, 2007, Prague, Czech Republic Figure 6: BMD values according to age and sex group in Bayash – Baranya population (Government of the Republic of Croatia 2007). Discussion The studied Bayash population in Croatia is mainly autochtonous and sedentary. As many as 84% of the Bayash in Croatia receive social welfare in comparison to, for example, only 10% in Romania, 40% in Hungary, 56% in the Czech Republic, 83% in Slovakia (Zajc et al. 2006). The high number of social welfare beneficiaries among Croatian Bayash testifies modestly to their social inclusion, but at the same time to their dependence on the state. The large unemployment rate of the Bayash in Croatia is within the limits of the reported unemployment rates of the Roma throughout Central and Eastern Europe (Zajc et al. 2006). On one side, the majority of the Bayash are very poor educated - unskilled for the jobs that are in demand in Croatian economy. It is also sometimes coupled with discrimination and the lack of confidence in the Roma as reliable employees. But on the other side, social benefits for families with children usually exceed the minimum wages for the workers with low qualifications and the Bayash tend to lean to their social benefits while searching to improve living standard by working in street sales, metal collection and seasonal agricultural work. Only 51% of the Bayash included in the study reported to have health insurance. It may be related to their exclusion from the formal labor market but also health attitudes shaped by traditional and fatalistic views towards illness, health and death. The main mechanism for obtaining health care in the Bayash is reported to be either motherhood or serious illness. Elsewhere in Central and Eastern Europe the number of Roma receiving health insurance ranges between 54% (in Bulgaria) to 97% (in Slovakia; Zajc et al. 2006). A large proportion of the studied Bayash dropped out from school after only 3.6 years on average – if they were enrolled in school at all. The biggest problem in continuing education seems to be the very strong belief that children can contribute more to their families by working than by continuing school. Low education level has consequences on general quality of life, living conditions and health. Whereas some Bayash families report to live side by side with the majority population of Croatia, most of the population lives in large groups, segregated from the rest of population - usually in the outskirts of villages or small towns without facilities such as sewage, waterworks, garbage collection, roads etc. The tradition of keeping multi-child families is preserved in the Bayash population in which women marry young (16.8 years) and give birth to many children (3.9). The average fertility is very prominent if we compare it to 1.5 children per woman, which is average in the population of Croatia (Turek 2001). However, traditional attitudes towards female reproductive health as well as the diffucult access to health services lead to extremely high rate of induced abortions (especially in Baranya) that appear to be main regulators of delivery. The results of bone mineral density show substantially lower bone mineral density in all age groups in both sexes (with exception of 55-65 year old males), in comparison to the manufacturer’s reference ranges. It may be partially due to the diminutive body size of the Roma compared to that of the Caucasians. Since body-size effects can not be overseen, the normative values that would be appropriate for the Roma population are necessary to be further explored. The findings indicate that in addition to exceptionally high prevalence of osteoporosis found in older subjects, the Bayash population is characterized by low bone mineral density in all ages. Acknowledgments This research was supported by the grants of the Ministry of Science, Education and Sports of the Republic of Croatia “Molecular-genetic portrait of the Roma – an isolated founder population model” (196-1962766-2763) to Branka Janićijević and “Complex trait variation and health in children, adults and centenarians” (196-1962766-2747) to Nina Smolej Narančić as well as by the Wenner-Gren Foundation grant “Population Structure and Genetic History of Western Balkan Roma” (7349) to IMK. References Central Beureau of Statistics of the Republic of Croatia. Statistical Yearbook 2005. Available from: http://www.dzs.hr. Accessed: May 15, 2007. Fraser A. The Gypsies. Oxford: Blackwell Publishers; 1992. Government of the Republic of Croatia. National programme for Roma of the Government of the Republic of Croatia. Government of the Republic of Croatia, 2003. Available from: http://www.vlada.hr/nacionalniprogramromi. 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Zajc M, Smolej Narančić N, Škarić-Jurić T, Miličić J, Barbalić M, Meljanac Salopek K, et al. Body mass index and nutritional status of the Bayash Roma from Eastern Croatia. Coll Antropol. 2006; 30: 783-787. Mailing address: Matea Zajc Institute for Anthropological Research, Gajeva 32 10000 Zagreb,Croatia [email protected] 215