Acknowledging Travellers as an ethnic minority
Bearing these conceptual challenges in mind, we can identify certain key policies that will need to be put into practice if a better knowledge base is to be developed. The first is that Travellers will need to be properly acknowledged in the wider debate on the health of ethnic minority groups. This will provide an essential starting point for ensuring that they are made visible in the collection of national data, including the Census, and also in the routine monitoring of health status and service delivery. As part of this process, the DETR Count could be replaced or complemented by an assessment of Traveller needs as part of local authority housing strategies.
Including Travellers in routine monitoring
Initiatives of this kind would be in line with current policies for dealing with inequalities in health. Under section 25 of the Health Act 1999, for example, health authorities are required to prepare Health Improvement Plans in conjunction with local authorities. These plans require the collection of accurate data on the health status and health needs of all relevant communities, particularly those deemed to be at greatest risk. This should include Travellers, despite the obstacles posed by their low levels of registration with general practitioners.
The need for culturally sensitive studies
Alongside this routine monitoring there is also the need for individual studies to explore the circumstances of particular groups of Travellers. The cultural dimension of preferences in service delivery require that individuals’ perceptions of their health care needs are sought. This will necessitate the development of more creative techniques for ensuring that Travellers themselves (and subgroups within the Traveller population) are more active participants in the research process. This will not be an easy task since there is often considerable reluctance on the part of Traveller communities to talk to researchers. However, local authorities need to take seriously their responsibility to optimise consultation and levels of participation.
Systematic evaluations of local policy initiatives
More work is also needed on the evaluation of local policy initiatives. As we have seen, the literature is now full of accounts of small scale interventions, often carried out by primary care workers. Because very few have included an independent evaluation, there have been few opportunities for critical learning. If appropriate lessons are to be drawn from these initiatives, more systematic evaluations will be required. There are obvious difficulties in putting this into practice, not least of which is the increased cost. These projects are usually conducted with very few resources and adding to the price tag may mean that they do not happen at all. But if they are to be given the value they deserve then this must be taken seriously as part of the broader pursuit of quality evidence.
Understanding the determinants of Traveller health
Alongside needs assessments and evaluations of service delivery there is also a need for research to provide a clearer understanding of the determinants of health in Traveller communities. Starting from the important work being undertaken by researchers at ScHARR (van Cleemput and Parry, 2001) more detailed studies are needed to make sense of the complex mix of factors shaping the well-being of particular groups of Travellers and of individuals within those groups. This will not be achievable at local level but will need a commitment from central government to ensure that adequate resources are available.
Addressing responsibility and accountability
If improvements are to be achieved in the evidence base for Traveller health, much clearer patterns of responsibility and accountability will need to be established for the commissioning of research and for routine data collection. The current situation is one where lack of central guidance, fragmentation of services and the sometimes conflicting aims of different parts of the same authorities mitigate against effective evidence gathering. Unless these functions are clarified and Travellers are given greater visibility, their health will continue to be very low on the public health agenda both locally and nationally.
