Objectives We compared the health of people living in Roma settlements with that of the general population in Hungary. Methods We performed comparative health interview surveys in 2003-2004 on representative samples of the Hungarian population and inhabitants of Roma settlements. Results Above age 44 years 10% more people living in Roma settlements reported their health as bad or very bad than in the lowest income quartile of the general population. Of those who used any health services 35% of Roma persons and 4.4% of the general population experienced some kind of discrimination. The proportion of persons who thought that they could do much for their own health was 13-15% less; heavy smoking and unhealthy diet were 1.5-3 times more prevalent in Roma settlements than in the lowest income quartile of the general population. Conclusions People living in Roma settlements experience severe social exclusion, which profoundly affects their health. Besides tackling the socio-economic roots of poor health of Roma people, specific public health interventions including health education and health promotion programs are needed.