There are a number of groups that are especially vulnerable in terms of susceptibility to influenza and barriers to accessing vaccinations. This may lead to larger problems in case of a pandemic; for example, in the H1N1 2009 outbreak in Australia, indigenous Australians, a hard to reach group, were overrepresented in rates of hospitalisation (Seale et al 2010). Hard to reach groups may have adverse health outcomes, and the complex interplay of gender and social and economic marginalisation makes this a particular issue for women (Davidson et al 2011).
Since its creation in 2000, the National Human Rights Romeurope alerted the authorities to the need to take better account of difficulties of access to care of foreign Roma people living in France. Following extensive discussions and in order to verify the relevance of these recommendations for access to rights and health, the Directorate General of Health supported in 2008-2009 an action of project engineering intended to present plans of development of mediation pilot projects.
In 1991, a first mediation program was initially conceived by the Romani Criss NGO mainly focused as a conflict mitigation project. Mediators were being trained to improve communication between Roma communities, non-Roma population and local authorities. In 1996, supported by the Catholic Centre against Famine and for Development (CCFD), the NGO reoriented the program to a health-focused mediation, principally aimed at improving social conditions for Roma and facilitating communication between Roma communities and medical providers.
The Bulgarian health mediator model was developed based on the experience of the Dutch Institute of Public Health and on the Romanian model of health mediators, which was presented by the Romani CRISS Foundation and the Romanian Ministry of Health.
For a country, being ready to face an infectious disease outbreak requires, among other things, the capability to reach and involve all the components of the society. Especially those that are more exposed to health threats due to low quality housing, poor nutrition, lack of parental education and weak links to health services, as it happened in the 2010 measles epidemic in Bulgaria, where 90% of recorded cases occurred within the so-called Roma community.
