Health Inequalities in the Gypsy, Roma and Traveller Community – How we are making change happen? - Our blog

June is Gypsy, Roma, Traveller History month (GRTHM) - an opportunity to raise awareness of and celebrate Gypsy, Roma and Traveller history, culture and heritage. Kelly Muir, Senior Health Improvement Officer with the Inclusion Health team, explains what Public Health Scotland (PHS) and partners are doing to improve Gypsy/Travellers’ lives.

Scottish Government analysis of the 2011 Census data showed that when compared to the ‘White: Scottish’ group, Gypsy/Travellers were twice as likely to have a long-term health problem and were three times more likely to report ‘bad’ or ‘very bad’ health. In fact, the analysis showed that on every indicator of what is required to live a happy, productive and fulfilled life, Gypsy/Travellers were worse off than any other community in Scotland.¹

Much work has happened since the 2011 census to address the significant inequalities experienced by Gypsy/Travellers in Scotland. The Scottish Government Race Equality Framework 2016-2030 commits to ensuring equality of opportunity for all Scotland’s Gypsy/Travellers. The joint Scottish Government and COSLA national action plan, Improving the Lives of Gypsy/Travellers in Scotland 2019-2021 (external website), says that improving the lives of Gypsy/Travellers is crucial ‘if we are to tackle deep-rooted inequalities and deliver a fairer Scotland’.

Some of the inequalities experienced by the Gypsy/Traveller community are:

A higher suicide rate than the general population -
six times higher for Gypsy/Traveller women and almost seven times higher for Gypsy/Traveller men.²
Poorer mental health - often linked to poverty, social exclusion, stigma and hate crime. In a recent study one Gypsy/Traveller described experiences of hate crime as ‘as regular as rain’.³
Barriers when accessing health services -
These included difficulties registering with GPs, poor staff attitudes and lack of trust of services because of previous experiences.⁴
Lower uptake of preventative health services -
Including antenatal and postnatal care, childhood development assessments and dental services, and missed routine appointments because of lack of postal address.⁵
Living in unsafe environments -
Little or no access to basic amenities due to lack of adequate site provision can often lead to families living next to busy roads or waste ground.⁶

PHS has been working with partners for several years to help reduce inequalities experienced by the Gypsy/Traveller community. Thanks to the concerted effort by national and local partners to work innovatively and collaboratively, we are starting to see real change.

We’ve worked with Scottish Government and COSLA to shape and inform the national action plan, ensuring improving health outcomes is a key component, and working with partners on actions within the associated health and wellbeing delivery plan.

Improving Health Outcomes – on the ground

We’ve contributed to proposals that have seen pilot projects set up in local areas.

Community Health Matters (external website) is a project delivered by MECOPP, which has seen local Gypsy/Traveller women trained as Community Health Workers (CHW). The aim being to work with people in their community to understand and address health and wellbeing issues. It has been up and running for just over six months, with five CHWs in place and is making a difference. They provide support including: assistance with GP registration, accompanying people to healthcare and covid vaccination appointments, undertaking Mental Health First Aid training and raising awareness of services available to those with mental health conditions. They also identify and act on cross cutting issues such as accommodation and education to improve overall wellbeing. The project will be evaluated later in the year, but it is already showing the impact building trusted relationships can have on supporting people to access services.

Mums Matter in Fife (external website) (PDF) aimed to make maternity, health visiting and income maximisation services more accessible to Gypsy/Traveller women. An early key achievement of the Mums Matter project was that it identified that Badgernet, the national recording system for maternity care, did not include an identification code for Gypsy/Traveller ethnicity. This was raised at a national level and an identification code for Gypsy/Traveller ethnicity was added to the system.

Access to Healthcare – GP Registration cards which aim to make registering with a GP easier have been developed in partnership. Gypsy/Travellers have regularly reported difficulty when registering with a GP, often because they do not have a permanent address or identification, neither of which is needed to register. The cards inform patients and front-line staff of the right everyone has to primary care and have proved a popular aide.

A National Approach

Probably the most valuable achievement is the cross-sector relationships established and built between Scottish Government, COSLA, local health board and HSCP colleagues, and key third sector partners. PHS established and manages the NHS and HSCP Gypsy/Traveller Forum, which brings people working with Gypsy/Travellers in local areas together to share their learning and experiences. It also enables them to influence national policy. This joined up approach to the work has provided opportunities for collaboration such as:

Contributing to the Framework for Local Authorities and partners on keeping Gypsy/Travellers safe during the Covid-19 pandemic.
Developing an e-learning module for NHS and health and social care staff to raise awareness of Gypsy/Traveller culture, lifestyle and the inequalities they experience.
Providing advice on the aspects of place that support health and wellbeing to inform the development of a design guide for Gypsy/Traveller sites.

Partnership working with local areas and third sector organisations allows us to connect with and hear directly from local Gypsy/Traveller communities, which is essential when we’re planning and redesigning services.

We know there is still a way to go. Analysis of the 2022 census will give us some insight in to whether things have improved over the last 10 years for Scotland’s Gypsy/Travellers. In the meantime, PHS will continue to work with partners on improving access to services, particularly in primary care, supporting Gypsy/Travellers to understand their rights to healthcare, raising awareness of the inequalities experienced by Gypsy/Travellers and highlighting where change is needed.

If you’d like to learn more about Gypsy, Roma, Traveller History month visit Gypsy Roma Traveller History Month website (external website).

References

Photo credit: Susanna Hotham for Romano Lav.