South West Public Health Observatory
The Health of Travellers in the South West Region: a review of data sources and a strategy for change
 

 

 

    

Introduction: What is this report for?

This report is concerned with the range and quality of evidence available on the topic of the health of Travellers. There is a relatively small amount of research which suggests that Travellers experience worse health outcomes than the general population, and that they experience a range of problems in accessing health care services. However, this research has a number of limitations. This report addresses the current state of this area of knowledge, and suggests strategies which might lead to a more evidence-based approach to health and health care issues for Travellers. The focus is upon, but not exclusive to, Travellers in the South West region of England.

As with all research, issues of definition and terminology are at the forefront. After consideration it was decided that the research would relate to those who define themselves as English/Welsh Gypsies, Irish Travellers and Scottish Travellers. The inclusive term 'Travellers' is used throughout to cover all these groups and is used as a generic term to refer to people who have a historical and cultural tradition based on a mobile lifestyle. In the process of this research some sources were also uncovered relating to those communities known as 'New Travellers', referring to people who have opted for a similar nomadic lifestyle but have very different social and cultural backgrounds. However it was decided to exclude this latter group from the main analysis since the differences between the two groups were deemed likely to be confusing rather than helpful. [1]

The report is presented in five parts:

1. A review of national data sources on Travellers' health.
2. A methodological review of recent studies on Travellers' health in the UK.
3. A survey of relevant health and local authorities in the region on data sources and activities related to Travellers.
4. Methodological critique of strategies for the creation of a better evidence base on Travellers' health.
5. Conclusion: towards a more effective, and ethical, evidence base.

Who is this report for?

The aim of this report is to provide information on the extent and quality of the evidence-base relating to Travellers' health for those whose work relates to providing health and other services for this group of people, as well as for those in policy-making positions regarding the distribution and utilisation of resources. More generally, it will also be of interest to anyone concerned with understanding issues of health inequality and social exclusion, particularly those with responsibility for developing effective strategies for tackling health inequalities and improving the health of the worst off groups on society.

  [1] Further information on 'new Travellers' can be found in Webster and Millar (2001)

 

Summary

 

There are estimated to be 120,000–150,000 Travellers in the UK of whom approximately half live in caravans and half in houses; many move in and out of housing.

Around 10% of the total number of Travellers live in the South West. A greater proportion of Travellers in the South West region live on unauthorised sites (36.6%) compared to the rest of England (22.4%).

Evidence suggests that Travellers and their children experience worse health than the general population, and that accessing health care is problematic.
However, the research on this topic has a number of limitations:

  • Travellers are not counted in the Census or other routinely collected data sources.

  • Travellers are not included in studies of ethnicity and health, despite Romani Gypsies being defined as an ethnic group in the Race Relations Act of 1976.

The bi-annual DETR/DLTR Count of Travellers counts the number of caravans rather than the number of people, and excludes Travellers living in houses.

The only source of data on Travellers' health is one-off studies, which suffer from a range of weaknesses:

  • Most are small-scale, many are anecdotal, few compare Travellers to the general population.

  • Those looking at health service use focus almost exclusively on primary care.

  • Evaluations of interventions lack rigour and impartiality.

Health and local authorities in the South West region reported relatively little activity directed specifically at Traveller communities in terms of data collection or needs assessment, with only a few exceptions.

As local authorities have a statutory responsibility to provide education services provision in this area is far more complete; this may provide a form of contact that could be developed for the additional provision of health services.
Improving the knowledge base on Traveller health faces a number of challenges, including:

  • Addressing the process and politics of definitions and classifications of 'Travellers'.

  • Cultural and behavioural factors affecting traveller health need to be distinguished from material factors.

  • The effects of low socio-economic position, a highly mobile lifestyle and marginalisation from mainstream society need to be disentangled.

Moving towards a more effective evidence base will assisted by:

  • Acknowledging Travellers as an ethnic minority

  • Including Travellers in routine monitoring

  • Ensuring studies are culturally sensitive

  • Systematically evaluating local policy initiatives

  • Attempting to understand the determinants of Traveller health

  • Addressing issues of responsibility and accountability

  • Considering ethical issues specific to researching this group.