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A policy proposal written for an international agency detailing ways to improve the health and well being of the residents of a real community. The purpose of this Policy Proposal is to highlight, and bring to public attention, the inequalities in health status between Gypsy Traveller populations and non-Gypsy Traveller populations and to propose ways in which these inequalities can be addressed, tackled and reduced. To produce a valid, constructive proposal I will consider the health service priorities and health improvement targets, as well as experiences, beliefs and attitudes towards health of Gypsy Travellers.
I will be using the generic term ‘Gypsy Traveller’ to encompass the four separate groups; English Gypsies, Welsh Gypsies, Scottish Gypsy Travellers and Irish Travellers. Although each of these groups has a separate ethnic identity, evident from the different languages spoken by each group, they also share many aspects of a common cultural identity as traditional Travellers or Romani people. For the purposes of this study I will not be including New Age Travellers, as they have opted to take on this alternative lifestyle and are not of the same culture.
There have been a few studies that find Gypsy Travellers (who are described variously as Gypsies, Travellers and Romanies, as well as other terms throughout these relatively small investigations) have an inferior health status to non-Gypsy Traveller communities. However, there is very limited, dependable evidence and data that proves this.
At the moment health policy is focussing on trying to reduce the inequalities in health, in particular aiming at groups that are socially excluded. The department of health published a policy document in 1999 titled; Reducing Health Inequalities: an Action Report, claiming that “one of the key aims of the Government’s health strategy for England is to improve the health of the worst off in society and to narrow the health gap” (Department of Health. 1999: 2). However, this proposal did not include any mention of the health, or health needs of Gypsy Travellers. This could be seen as an example of the extent to which Gypsy travellers are socially excluded. Gypsy Travellers are a socially excluded, ethnic group and, according to the small scale research already undertaken, require specific health needs that have not been met, or even recognised by the Health department.
An investigative study that was undertaken in 2004 by Parry G et al, titled The Health Status of Gypsies and Travellers in England: A report of Department of Health Inequalities in Health Research Initiative Project 121/7500. The findings from this study confirm the concerns stated by authors of the reports that focus on the health of Gypsy Travellers. Parry G et al’s project backs up the smaller scale reports’ findings, and shows that there is a requirement for concern and action in this field. The report indicates that the health problems seem to be more serious among the highly nomadic persons within the Gypsy Traveller community (Parry G et al. 2004)
Their report informs us that the results found for the health of the Gypsy Traveller’s that were being studied (study population) is significantly poorer than the results that were obtained from people of the same age and sex but from different ethnicities and social groups (UK general population). We are informed that the study group were between twice, and five times worse off than the general UK population, which cannot just be put down to the correlations with age, education and smoking. There was also some evidence that the people that required the health service the most were the ones using it the least; this is an inverse relationship (Parry G et al. 2004).
Other results and findings from this report included every respondent mentioning that accommodation was a major factor. Not only is it the actual living conditions that are crucial to well being, but the fact that the ability to decide the type of accommodation they have, and whether or not they wish to continue a traditional travelling way of life is incredibly important and crucial to their sense of independence. Many of the respondents spoke about their lack of choice and the ‘intolerable conditions’ they are in; another exemplification of the negative view the non-Gypsy Traveller has. (Parry G et al. 2004)
Parry et al’s report noted that Gypsy Traveller’s find it hard to access healthcare, something which Feder touches upon in the 1989 ‘Traveller gypsies and primary care’ in the Journal of the Royal College of General Practitioner. Feder tells us that gypsy Travellers often have trouble registering with a GP because the GP practices often reject them (Feder. 1989). Even when the Gypsy Travellers are able to register with a GP there is often “communication difficulties between the health worker and Gypsy Traveller with experiences of, and also defensive expectation of, racism and prejudice” (Parry et al. 2004).
If improvements are to be made in Gypsy Traveller health, there needs to be a clearer idea of who is responsible for their health, i.e. is it all down to the Gypsy Traveller themselves to sort out health care or should it be the health authorities making sure any Gypsy Travellers that live within their region are accounted for and supplied with full healthcare options. My belief as to why there are such clear healthcare issues within the Gypsy Traveller community is that the healthcare officials have very little guidance when it comes to treating Gypsy Travellers, as well as the priority of the health of Gypsy Travellers being relatively low. These issues all need to be looked in to and resolved. Having said that however, for these issues to be overcome the overall problem of the Gypsy Travellers ‘invisibility’ needs to be addressed first.
However, including a category for Gypsies and Travellers on ethnic monitoring forms is not something that can just be added on. It should be done in consultation with the Gypsy Traveller communities and requires careful staff training.
From the studies that have been mentioned above we can see that the health needs of Gypsy Traveller communities are currently not being met. The plans and provisions that are in place at the moment are not effectively tackling the problem and need to be analysed and updated. Methods need to be put in place that would improve both access to healthcare by Gypsy Travellers, as well as the service the Gypsy Traveller receives.
There are some options we can look at that will greatly aid the cause. The idea of setting up a partnership with the Gypsy Traveller communities in the delivery of healthcare has been looked at before. An example of a partnership model was developed in the form of a pilot primary health care project in 1994 in Ireland. Traveller women were given training to develop their skills in providing community based health services to their own community in partnership with public health nurse co-ordinators (Parry et al. 2004). Partnership models also imply that Gypsy Travellers be actively consulted and involved in local health planning and service development. There are examples of this working well in Cambridge, Newark and Leeds where Gypsy Travellers are working in community development and in close partnership with health workers.
Another way in which the Gypsy Traveller ‘voice’ will be heard is to periodically invite Gypsy Travellers to participate in any forums that exist for Black and other Ethnic Minorities. This would mean that their needs are constantly out for the public to be aware of and eventually this would decrease the negativity that is witnessed towards Gypsy Travellers, and reduce any barriers the Gypsy Travellers may have come across in accessing public healthcare.
Improving the cultural awareness of healthcare staff is a priority but with the very little evidence to support the effectiveness of ‘cultural awareness training’ that is currently provided, this change should be evaluated in terms of its effectiveness at changing the negative attitudes that are at the centre of a lot of the discrimination.
The Traveller Health Strategy 2003-05 of the Republic of Ireland is an example of ‘inter-departmental coordination’ in regards to the gypsy traveller health. A similar inter-departmental Task Force in England would command wide support.
It was clear from my research that dedicated health visitors for Travellers were highly valued and played an important role in being able to supply access to other health services. Targeted service provision has long been a practice for a range of groups, and should be practice for Gypsy Traveller groups as well.
A compelling point was made in one of my research articles; if all doctors and health staff were “trained to respect people” then there would be less need for dedicated services and some participants were quite emphatic that there should be no specialist provision – that Gypsy Travellers should be treated with the same respect and care as others in the population.
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