Social exclusion of Gypsies and Travellers: health impact

Abstract

There are striking inequalities in the health of Gypsies and Travellers, even when compared with people from other ethnic minorities or from socio-economically deprived White UK groups. In this paper we explore the long-term health impact associated with a history of persecution, social pathologisation and social exclusion of Gypsies and Travellers. A society that has demonstrated entrenched and widespread hostility towards Gypsies and Travellers has contributed to wariness about trust in outsiders and contributes to the communication barriers with health staff that are implicated in their poor access to healthcare. Many of the problems identified by health staff mirrored those identified by Gypsies and Travellers, particularly with regards to mismatched expectations and resulting conflicts. Whilst the Department of Health has recognised the extreme health inequalities experienced by Gypsies and Travellers and the need for specific action to reduce them and improve access to health care, this paper emphasises the need for an associated improved effort at all levels to seriously tackle the wider determinants of health, including societal attitudes towards Gypsies and Travellers, as well as focusing on delivery of health services. Nurses are identified as needing to play a key part as role models in challenging prejudice and discrimination.

UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study

“…26 Barriers to uptake stem partly from a lack of consideration of Traveller culture by health providers when developing services, for example, reluctance by GP practices to register transient Travellers. 27 Further barriers include a history of discrimination leading to mistrust of people and institutions, poverty, low health literacy, language barriers, lack of knowledge of health systems in new countries to which they travel, 21 and, in some communities, strong beliefs of 'stoicism', 'self-reliance' and 'fatalism' about health. 27 The UK immunisation programme…”

“…27 Further barriers include a history of discrimination leading to mistrust of people and institutions, poverty, low health literacy, language barriers, lack of knowledge of health systems in new countries to which they travel, 21 and, in some communities, strong beliefs of 'stoicism', 'self-reliance' and 'fatalism' about health. 27 The UK immunisation programme…”

“…This enabled us to learn important lessons in wave 1 to inform wave 2, for example about gaining the trust of communities to facilitate recruitment and about the organisation of the phase 3 workshops. 97 Although they have different beliefs, customs and languages, they share common features of lifestyle and culture, 27 and are genealogically and linguistically related. 98 In contrast, the Scottish Showpeople are not recognised in the Race Relations Act 1976 96 or by the aforementioned communities to be part of the 'traditional Travellers' ethnic group.…”

“…This led to a minority preferring to use A&E or out-of-hours doctors, which has also been observed elsewhere. 25,27 These criticisms of primary care similarly feature in national surveys for England and Scotland 136 and are known to impact on people's use of services. As up to 40% of A&E attendances have been reported to be 'inappropriate or avoidable', 137 the reasons for using A&E are complex 138,139 and clearly are not solely the domain of Travellers.…”

Gypsies/Travellers and health: risk categorisation versus being ‘at risk’

“…These groups have been identified or have identified themselves as having different languages, beliefs and certain different cultural traditions but also many common features of lifestyle and culture that unite them collectively as distinct from the rest of UK society (Van Cleemput, 2010). Gypsies and Travellers have been defined as persons of nomadic habit of life, whatever their race or origin, (ODPM 2006) including such persons who have ceased to travel temporarily or permanently in order to access public services (Shelter 2008).…”