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Review of national data sources on Travellers’ health
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Travellers’ health
A review of national data sources was conducted and sources were assessed for their potential value in understanding the realities of Traveller health in the region. Similar to the conclusions of earlier researchers the results of this review suggest that sources in this area are very limited (Chartered Institute of Environmental Health, 1995; Feder, 1989; Hajioff and McKee, 2000; McKee, 1997; Morgan and McDonald, 1999; Morris, 1998; Van Cleemput, 2000; van Cleemput and Parry, 2001). Despite many commentators having identified huge gaps in the available knowledge on this group of people, very little has been done to fill these gaps.
The lack of well-designed research on Travellers makes it difficult to draw overall conclusions but the general findings suggest that the health of Travellers is markedly worse than the national average (van Cleemput, 2000; van Cleemput and Parry, 2001). Studies of Traveller children have suggested that they experience high infant mortality and perinatal death rates as well as low birth weight and a high child accident rate (Feder, 1989; Hajioff and Mckee, 2000). Very few studies in the UK have examined the health status of adults in the Traveller population but a study of Irish Travellers showed a higher mortality rate across all cause groups (Barry
et al
., 1987). Many studies have shown that Travellers often live in extremely unhealthy conditions while at the same time using health services much less often than the rest of the population (Hawes, 1997).
Enumerating Travellers: exclusion from routine data sources
The Census remains the most basic source of information for local authorities and health authorities on the population groups for whom they are responsible. However, Travellers have never been separately identified in the Census. Although there was some debate about their possible inclusion in the 1991 Census - when the question on ethnicity was first included - they were not actually allocated a separate category in the final survey. Despite the ‘Count me in’ rhetoric of the 2001 Census, Travellers were again excluded. A question was added on caravan dwellers, but the results are unlikely to be published and Travellers will remain unidentifiable. This group is also absent from other key data sources, such as the Labour Force Survey, the National Dwellings and Household Survey and the General Household Survey, which have included questions on self-defined ethnicity since the late 1970s (Smaje, 1995).
Given their invisibility in these broader data sets it becomes all the more important that specific groups such as Travellers should be identifiable in the routine monitoring of health and social services. But again there are considerable lacunae here. This reflects the situation of most other minority groups but is exacerbated in the case of Travellers for whom no separate ethnic category is used. Despite a frequently expressed commitment to the elimination of inequalities in health and health care, successive governments have so far done little to address the issue of ethnicity in data collection. This is true both of routine mortality and morbidity data and also of statistics relating to service use.
Surveys including ethnicity, but not Travellers
One of the main projects undertaken to remedy this deficit was the special survey of minority ethnic groups in the 1999 Health Survey for England (Erens
et al
., 2001). Significantly, this did not include Travellers. Nor was there any mention of this group in the
Guidance on Assessing the Health Needs of People from Minority Ethnic Groups
issued by the Department of Health in 1998 or in the
Action Guide on Health Inequalities
(DoH, 1999). One justification for these exclusions might be that Travellers make up only about 5% of the ethnic minority population in the UK. However, this is around the same size as the Chinese population. Moreover, a number of studies have suggested that Travellers are among the most unhealthy of all minority ethnic groups (Bunce, 1996; Hawes, 1997; van Cleemput, 2000; van Cleemput and Parry, 2001).
The national data source on Travellers, and its weaknesses
The only national data source on Travellers remains the biannual DETR/DTLR Count. This survey is carried out by local authorities on behalf of central government and has been widely criticised by those concerned with the interests of Gypsies and Travellers (Green, 1991; Kenrick and Clark, 1999; Drakakis-Smith and Mason, 2001). The most immediate deficiency with the Count is that it estimates the number of caravans rather than the number of people. It also excludes those Travellers living in houses (estimated to be about 50% of the total, see below) and those living on temporary sites. The methodological rigour with which the survey is conducted also leaves much to be desired. Though OPCS made recommendations for a standard methodology across all local authorities few attempts have been made to implement this (OPCS, 1997).
Because of their timing, these surveys do not measure seasonal variations in numbers, which can be very large in particular areas. Above all, they do nothing to assess any of the needs of Traveller communities. This reflects the fact that the Count was originally designed to assess the number of caravans for planning and environmental control purposes rather than to measure the circumstances of the people living in them. Hence it remains an extremely rudimentary source of information. For purposes of this report the Count was useful only as a data set from which estimates of the number of Travellers in the South West region could be drawn and for offering some indication of their distribution between authorities.
The best estimates of the total number of Travellers in the UK is between 120,000-150,000 of which around 50% now live in houses (Morris and Clements, 1999; Kenrick and Clark, 1999). In July 2001 the DETR count showed 13,802 caravans in England, 44.9% on authorised council sites, 30.8% on authorised private sites and 24.2% on unauthorised sites elsewhere. In the South West the total figure was 1,758 caravans (12.7% of the national total) with 34.7% on authorised council sites, 26.8% on authorised private sites and 36.6% on unauthorised sites. Caravans in the South West are therefore more likely to be on unauthorised encampments (chi-squared = 177.179, significant at p<0.001). (See Table 1 for full information from the DETR count which shows the uneven distribution of sites across the South West region.) There is appreciable variation between the proportion of unauthorised sites of the total in different parts of the south West ranging from 35/263 (13.3%) of sites to 268/325 (82.5%) in Dorset.
In the South West the total figure was 1,758 caravans (12.7% of the national total) with 34.7% on authorised council sites, 26.8% on authorised private sites and 36.6% on unauthorised sites. A total of around 12-15,000 Travellers can therefore be assumed to live in the South West
.
Anecdotal reports suggest that there are likely to be seasonal variations in this number both because of migration from and to other parts of the country and also because some Travellers spend the winter in houses and are thereby excluded from counts based on caravans. However, there are no available figures on the extent of these variations.
