Abstract Background Roma populations experience significantly poorer health than majority populations. Health outcomes are often worse than for others in similar social positions, suggesting differences are not simply the effect of poverty. Roma women are thought to be worst affected. However, data pertaining to the multiple social inequalities affecting Roma populations, their interaction and cumulative effect on health over time, have yet to be synthesised. Methods We searched four bibliographic databases (MEDLINE, Science Citation Index, Social Sciences Citation Index and Scopus), screened reference lists, consulted key informants and searched organisational websites for studies providing empirical evidence on more than one determinant of health for Roma populations in Europe. Two reviewers carried out screening, data extraction, quality appraisal and performed a narrative synthesis. Results From 2,043 bibliographic records, 37 studies met our inclusion criteria. The median number of influencing factors explored through qualitative and quantitative methodologies was 2 (range 1 - 5) and 3 (range 1 - 11), respectively. Quantitative studies focussed on poverty (10 studies) and other indicators of socio-economic status including education (13 studies), housing (9 studies) and employment (9 studies). Very few studies unpicked interactive effects instead testing each factor’s contribution to poor health independently. Qualitative studies tended to explore “Roma culture” (11 studies) and the impact of discrimination/racism on health behaviour (10 studies). There is a lack of gender-disaggregated data and little analysis of the impact of social policy on the health of Roma populations. Conclusions Evidence for associations between determinants and health outcomes among European Roma populations is patchy. Research needs to pay more attention to the health impact of social policies that have the potential to reinforce (as well as mitigate) the exclusion of Roma populations. Key messages This systematic review critically analyses the state and shape of research evidence on the multiple interacting axes of inequality that contribute to poor health among Europe’s Roma populations. There is a divergence between qualitative and quantitative studies, with the former providing some evidence on socio-economic status and the latter exploring aspects of culture and discrimination.