Health inequalities between Travellers and the general population have worsened since the 1980s, a report published on Monday warns.
The first National Traveller Health Action Plan (2022 to 2027) says bias within the health service and wider racism are leading to “unacceptable” health outcomes for a community whose lives are shorter and harder than those of their settled peers.
Covid-19 made things even worse, says the report, which quotes Dr Michael Ryan, executive director of the World Health Organisation’s Health Emergencies Programme. He said: “Ultimately there is a health consequence to racism, a direct psychological consequence, a denial of services consequence, a marginalisation consequence, a poverty consequence, and education consequence, all of these lead to ill health, so racism is a health issue.”
Drawn up by the Health Service Executive, in conjunction with the Department of Health and Travellers, the plan says Travellers, “are falling further behind the health of the general population in Ireland”.
The gap between life expectancies for Traveller men and settled men has widened since 1987 by 50 per cent, from about 10 years to 15 years. Among women the gap has narrowed slightly, by six months, to 11.5 years. In 2008, the average life expectancy of a Traveller man was 61.7 years, and for Traveller women it was 70.1 years.
The Traveller suicide rate is six times that of the general population, and suicide accounts for 11 per cent of Traveller deaths. The Traveller infant mortality rate is 3.5 times that of the general population. The community has higher levels of diabetes, cardiovascular disease, including high blood pressure and high cholesterol levels, and respiratory conditions, including bronchitis and asthma, than their settled peers.
Minister of State for public health Frank Feighan said Travellers had “the right to the highest attainable standard of health as is the norm in Irish society”.
“Regrettably, the improvements in the health of the Irish population have not benefited the Traveller community who continue to experience severe health inequalities, reflected in a shorter life and a poorer quality of health,” he said.
“I welcome in particular the initiative to address the social determinants of Traveller health in conjunction with the department’s Healthy Communities programme. This initiative tailors mainstream health policy to take account of the specific social factors influencing the health of Travellers.”
The report found self-reported mental health was far worse among Travellers too. Some 63 per cent of Traveller women described their mental health as “not good for one or more days” in the previous month compared with 20 per cent of woman medical card holders; 59 per cent of Traveller men said their mental health was “not good for one or more days” compared with 22 per cent of male card holders.
Improving the health service’s engagement with Travellers is important, says the plan, but it adds “social determinants can be more important than healthcare or lifestyle choices in influencing health”. Determinants include accommodation, education and employment.
The plan says: “Current approaches to addressing inequalities are clearly not serving Travellers well. A social determinants and whole-of-Government approach to addressing Traveller health is acknowledged, and planned for.”
It has a funding stream of €1.3 million, and among its four goals are to “enhance Travellers’ access to culturally appropriate primary healthcare through investment in Traveller health units and primary healthcare for Traveller projects”. It says Travellers’ specific needs must be explicitly considered in all strategies on mental health, maternity, disability, addiction, and, healthy living. It commits to including ethnic identifiers when gathering data from patients and service users.
Report author Martina Queally, who is chief officer with the HSE’s community healthcare east, said there was discrimination against Travellers in healthcare settings which was unconscious.
“But even when you – as a Traveller – are sitting and you don’t understand some of the words or [the healthcare worker] is giving you advice you know you can’t adopt, all of that becomes very uncomfortable. And when you’re uncomfortable or feel judged you won’t go back.”
Missie Collins, a Traveller primary healthcare worker, who was involved in the plan, said during the pandemic numerous sites had no running water.
“When the virus was there, how can we go and tell them to wash their hands and tell them to make sure the chiller has their hands scrubbed if you’ve not even got cold water, not alone hot water?” she said. “It’s not that much to ask to have a home over your head, to have running hot water to wash your children, to be comfortable and for children to go to school and not be intimidated.”