[Marginality, ethnic groups and health].

Marginalized ethnic groups in Spain consist primarily of some 250000 gypsies and over half million immigrants from Third World countries who began to seek work in newly industrialized Spain beginning around 1970. The numbers of immigrants doubled between 1970-85 and immigration continues from Latin America Africa south of the Sahara North America and the Philippines. Over 300000 are believed to be undocumented and around 23% are under 16 years old. This large scale immigration in a traditional country of emigration has created previously unknown problems for the health services. Health personnel still lack adequate knowledge of the cultural patterns illnesses and needs of these groups and frequent difficulties of communication complicate problems. Immigrants frequently initiate contact with the health services in search of treatment for their children who are considered a population at risk. Imported diseases from the region of origin progressively lose importance as the immigrants are assimilated typically into the least prosperous classes. Their illnesses lose specificity and perinatal and early childhood problems emerge as the predominant concerns. Imported problems may include genetically determined illnesses such as sickle cell anemia infectious and parasitic diseases prevalent in the region of origin or pathologies contracted directly from indigenous medical treatments. Ailments of children acquired in Spain include the normal childhood diseases with respiratory and gastrointestinal infections most common dehydration caused by dietary errors rickets chronic lead poisoning caused by old paint in the dwelling and accidents. Pathologies of adaptation may include other diseases but are typically psychic disorders resulting from the 2 greatest disadvantages facing immigrants: poverty and racism. Greater perinatal morbidity and mortality and more frequent and longer hospitalizations of infants and children are 2 consequences. The degree of marginalization experienced by gypsies in Spain depends somewhat on their region of residence. In recent years they have tended to cluster in periurban zones outside the large cities where their neighbors live in similar poverty and share the same diseases of deprivation. Pediatric health problems are similar to those acquired in Spain by immigrant children. Gypsies have higher rates of fertility and infant mortality. Gypsy children are at higher risk of tuberculosis malnutrition accidents dental caries sand drug consumption and they are less likely to be immunized. They are a recognized risk group for iron deficiency anemia and lead poisoning and their rates of hospitalization and consultations in emergency rooms are elevated.