Kerry Travellers Health & Community Development Project in partnership with HSE’s Local Health Office ran a number of Primary Health Care Training Programmes for Travellers in Kerry between 2002 and 2009. To consolidate what was achieved on these we decided to establish a Traveller Health Action Zone Project with the support of the HSE in late 2010.
The overarching goal of the team of Traveller Community Health Workers in this Project is to engage the Traveller Community and the Health Services in transforming Travellers’ health and well-being at local level. The HAZ is being used as a mechanism to improve the health and lifestyle of the Traveller community through a series health focused initiatives that build on existing services and facilities. Its core objectives are as follows:
- Improvement in the general health knowledge of Travellers
- Increase in community-based health initiatives to meet Travellers’ health needs
- Increase in health-promoting behaviour among Travellers
- Increase in Travellers’ awareness of Health Services and how to access them
- Increase in Travellers’ uptake of Health Services
- Enhancement in the delivery of health Services through increased awareness of Traveller-related issues within the Health Services, particularly among frontline staff
- Development in partnership structures with the local community, Health Services and relevant stakeholders
- Participation in the development of policy that affects Traveller health status
The Traveller Community Health Workers’ key responsibilities include:
- Targeting individual Travellers and Traveller families to identify the health needs of Travellers in different areas of the county.
- Working in partnership with the local Traveller Community, HSE staff and other relevant stakeholders to plan, develop, implement and evaluate community-based health initiatives to meet the health needs of the Traveller Community.
- Liaising with local community development workers, relevant health service personnel and other key stakeholders who work with the Traveller Community and in related work.
- Facilitating the identification and emergence of local Traveller volunteers and support their full participation on health initiatives and strategies that affect the Traveller Community.
- Supporting Traveller participation in health initiatives from a community development perspective.
- Identifying the steps needed to develop/enhance Travellers’ access to health services and their delivery at local level.
- Building up strategic links with and developing best practice guidelines with Primary Care Teams and health service providers to strengthen the capacity of frontline services to address and respond to Travellers’ health needs.
- Participating in meetings, reviews, evaluations and training sessions in order to develop best practice.
- Accessing and share information on health and the Health Services for the Traveller Community in co-operation with health service staff and other relevant stakeholders.
- Participating in the development of policy that affects Traveller health status.
ALL-IRELAND TRAVELLER HEALTH STUDY
It’s over 20 years since Traveller Health was examined in the Republic of Ireland. In fact the last study took place in 1987. The All-Ireland Traveller Health Study is the first study of Travellers’ health status and health needs that involved all Travellers living in the island of Ireland. The Study was named “Our Geels”, which means “Our Selves” in cant, the Traveller language.
The Study was launched in 2007 a huge undertaking, which took over 3 years to complete. It represents a major investment in the health of the Traveller community. It was essentially a Study for, with and by Travellers and that showed in the huge buy-in from Travellers with over 80% of families taking part.
Our local Steering Group here in Kerry and our team of 2 Study Co-ordinators and 13 Peer Researchers played a fundamental role in the mapping exercise which preceded the Study and in the actual Study itself. As you know the Study consisted primarily of a survey, using small portable computers. I would like to take this opportunity to acknowledge their significant contribution to the success of this Study and to acknowledge also and thank the 391 Traveller families who took part in the Study in Kerry for their trust and participation.
The Study looked at all the things that affect Travellers’ health including accommodation, employment, education, poverty, lifestyle, access and use of services, social networks and discrimination. Critically, both the Travellers and health service providers interviewed acknowledged that these Social Determinants were the main cause of the poor health status of Travellers.
Delightfully, there are very many positive findings in the Study. These include the strong extended family networks, the social support, the pride shown in Traveller culture, the support for religious beliefs and the priority Traveller families give to their children.
However, the key finding is that there is still a significant gap between the health of Travellers and that of the settled community. Alarmingly, Traveller life expectancy remains at levels last experienced by the general population in 1941 that is 70 years ago. A Traveller baby is almost 5 times more likely to die than a baby born to the Irish settled population. In 1987 the gap in life expectancy between Traveller men and settled men was 10 years; shockingly the gap in 2008 has increased to 15 years. A Traveller woman can expect to live to 70 years, whereas a woman in the general population can expect to live to 82 years.
Some Key Findings
- 9,056 families enumerated in Republic of Ireland (ROI)
- Participation rate 78% in ROI
- Estimated total Traveller population 36,224 on ROI
- Average Family Size: ROI 4
- 42% of Travellers under 15 years of age compared with 21% of the general population
- 63% of Travellers under 25 years compared with 35% of the general population
- 3% of Travellers are aged 65 years and over compared with 13% of the general population.
- Only 8 Travellers were found over 85 years of age
- In 1987 the gap in life expectancy between Traveller women and settled women was 12 years the gap in 2008 is 11 years
- In 1987 the gap in life expectancy between Traveller men and settled men was 10 years the gap in 2008 is 15 years.
- Traveller men have 4 times the mortality rate of the general population
- Traveller women have 3 times the mortality rate of the general population.
- If Travellers had the same health status as the general population, the number of deaths expected in the year would be 54, the actual number of deaths was 188.
- Suicide is 6 times the rate of general population and accounts for approx 11% of all Traveller deaths
- The infant mortality rate for Travellers is 3.5 times the rate of the general population (4 infant deaths per 1,000 in the national population compared to 14 infant deaths per 1,000 in Traveller population)
Causes of gap in levels of morbidity and mortality among Travellers
- Both Travellers and health service providers interviewed acknowledged that Social Determinants were the main cause of the poor health status of Travellers including Accommodation, education, employment, poverty, discrimination, lifestyle and access and utilisation of services.
- 4.8% of Travellers in ROI either employed or self-employed
- In ROI 38.5% of 30-44 year old Travellers and 25.8% of 45-64 year old Travellers had primary education only
- The majority of respondents, (75.9% in ROI), lived in family units of 5 or less.
- Difficulty in reading in 28.8% of Traveller families in the ROI
- Of those tested in the last 12 months a quarter was diagnosed as having High Cholesterol and over a third had High Blood Pressure.
- 66.3% said that illicit drug use is a problem in the community.
- 30.9% Travellers said price is a factor which prevents them to eat healthy.
- Overall there is a 15% higher rate of smoking among Travellers compared to the general population.
Adult Health Services
- Barriers identified were waiting list (62.7% ROI), embarrassment (47.8% ROI) and lack of information (37.3% ROI)
- Complete trust in health professional (41.0% ROI) was lower than general population (82.7%)