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Traveller Health

Background

The Traveller population experiences a level of health which compares poorly with the general population, for example, life expectancy among Travellers is lower than that of the general population. Travellers have a right to appropriate access to healthcare services which takes into account their particular needs, culture and way of life. The involvement of Travellers in the delivery of health services for Travellers is considered crucial in bridging the gap between the Traveller Community and the health services. This has been achieved to some extent through the involvement of Travellers and Traveller organisations on the Department's Traveller Health Advisory Committee and in the HSE's Traveller Health Units and Primary Health Care for Travellers Projects.

Traveller Health Advisory Committee

In response to a recommendation in the Task Force Report on the Traveller Community, the Traveller Health Advisory Committee (THAC) was established in 1998 and consists of representatives from the Department of Health and Children, the HSE and Traveller organisations. The Committee advises the Minister for Health and Children on Traveller health policy. The Committee's brief includes ensuring that Traveller health is a priority area within the Department of Health and Children, and the formulation of national policy. The Social Inclusion Unit in the Department of Health and Children supports the Traveller Health Advisory Committee.

The work of the Committee was crucial to the production of the Traveller Health Strategy ‘Traveller Health - A National Strategy 2002-2005’, which was launched in 2002 and set out a recommendations for specific actions.

Traveller Health Units

Traveller Health Units have been set up in each HSE region. The brief of the Traveller Health Units includes monitoring the delivery of health services to Travellers and setting regional targets against which performance can be measured. They also work to ensure that Traveller health is given prominence on the agenda of the HSE and support the development of Traveller specific initiatives either directly by the HSE, or indirectly through funding appropriate voluntary organisations.

The terms of reference of the Traveller Health Units are:

• Monitoring the delivery of health services to Travellers and setting regional targets against which performance can be measured
• Ensuring that Travellers' health is given prominence on the agenda of the HSE
• Ensuring co-ordination and liaison between the HSE, and other statutory and voluntary bodies, in relation to the health situation of Travellers
• Collection of data on Travellers' health and utilisation of health services
• Ensuring appropriate training of health service providers in terms of their understanding of and relationship with Travellers
• Supporting the development of Traveller specific services either directly by the HSE, or indirectly through funding appropriate voluntary organisations.

All-Ireland Traveller Health Study

In July of 2007 the All Ireland Traveller Health Study was launched. It is the first such study of the health status of Travellers since 1987 and the first that directly involved Travellers from both the North and South. The Study was jointly funded by the Department of Health and Children and the Department of Health, Social Services and Public Safety in Northern Ireland and was supported by the Health Service Executive. The Study took 3 years to complete and the report of the Study was launched in Dublin Castle by Minister Harney on 2nd September 2010. The findings will provide a framework for policy development and practice in relation to Traveller health.

The study included a census of the Traveller Population and an examination of their health status and their utilisation of health services in order to identify the factors which influence mortality and health status. The findings of the Study place a strong emphasis on the impact of the social determinants of health, particularly on the importance of education. .

Key findings of All Ireland Traveller Health Study

• The Traveller population in the island of Ireland was estimated at 40,129 in 2008; 36,224 in the Republic of Ireland and 3,905 in Northern Ireland.
• Life expectancy at birth for male Travellers has remained at the 1987 level of 61.7 which is 15.1 years less than the current life expectancy of men in the general population, representing a widening of the gap by 5.2 years. This is equivalent to the life expectancy of the general population in the 1940s. There are, however, marginal increases in male Traveller life expectancies at later ages.
• Life expectancy at birth for female Travellers is now 70.1 which is 11.5 years less than women in the general population, and is equivalent to the life expectancy of the general population in the early 1960s. This has improved from 1987 when life expectancy was 65 years.
• Traveller infant mortality is estimated at 14.1 per 1,000 live births. This is a small decrease from an estimated rate of 18.1 per 1,000 live births in 1987. Over the same time period the general population infant mortality rate has reduced from 7.4 to 3.9 per 1,000 live births.
• Travellers, in particular males, continue to have higher rates of mortality for all causes of death.
• Male Travellers had a higher Standardised Mortality Ratio (SMR) in 2008 (372) compared with 1987 (351), while in the same period the SMR of males in the general population has reduced from 161 to 100.
• The SMR for female Travellers in 2008 reduced to 309 compared with 472 in 1987, while in the same period the SMR of females in the general population has reduced from 150 to 100.
• There have been improvements in Traveller women’s health, notably (1) a narrowing the gap in life expectancy between Traveller and non-Traveller women of 0.4 years, (2) reduction in fertility rates to 2.7 per 1,000 population and (3) uptake of cervical screening at rates higher than the general ROI population and uptake of breast screening at rates similar to the general ROI population.
• Access to health services is good, with Travellers stating that their access is at least as good as that of the rest of the population. Access to primary care services is an important element of health services delivery. Over 94% of Travellers in ROI have a Medical Card with this figure rising to 99% in the older age group and nearly 97% of all Travellers in ROI are registered with a GP. The Traveller Primary Health Care workers are part of the HSE Primary Care Team. However, the research reports that the healthcare experience is not as good as the general population, with communication cited as a major issue by both Travellers and service providers.
• Just under half of all Travellers feel discriminated against. This is experienced in all aspects of life. However, least discrimination is experienced in sport, followed by the health sector. Travellers have a strong sense of community and high levels of community/family support.
• Suicide rates are nearly 7 times higher in Traveller men compared with the general male population.
• Education levels are very low with only about half of Traveller adults having completed at least primary school education. However, more than 90% of 14 year olds are now in school or training centres.

The full reports of the All Ireland Traveller Health Study can be downloaded here