Published: 16/12/2004, Volume II4, No. 5936 Page 26 27 28

Marginalised and on the move, gypsies' access to health services range from sparse to non-existent. Jake Bowers reports on a unique challenge.

Meynells Gorse in Leicester is typical of Britain's 350 council-owned gypsy sites. Crammed between industrial units on land no-one else would choose to live on, its tethered horses and top-of-the-range caravans are a scene familiar to any of Britain's 300,000 Romani gypsies and Irish travellers (collectively known as gypsy travellers). But shuttling between its mobile homes, weighing babies and reading appointment letters is a very rare sight indeed: a traveller health visitor.

Lynne Hartwell is head of the Travelling Family Service, run by Leicester City West primary care trust but covering all six PCTs in Leicestershire and Rutland. She is one of only a handful of such specialists in the country. 'Access to healthcare is a fundamental human right that everyone is entitled to, ' she says.

It is an approach that wins Ms Hartwell and her colleagues nothing but praise. 'Wherever I am I'll ask them to come and see me because I trust them, ' says Romani Julie Price.

But the residents of Meynells Gorse all have stories to tell about how the right articulated by Ms Hartwell has been denied. As members of one of Britain's most excluded ethnic minorities, all say they have experienced hostility and discrimination at the hands of receptionists, health visitors and GPs.

'When my kids were little, they [doctors] used to be really ignorant, ' recalls Margaret Smith.

'They'd say, 'We do not want to look at you, go to another doctor.' On one occasion we had to get the police out to force a doctor to look at my sister's little boy who had meningitis.' Such discrimination, and other factors, has had a huge impact on the community's health. But until recently, no-one knew exactly how big.

In the winter of 2002, academics from Sheffield University's school of health and related research began the first national study into gypsy traveller health. The study was funded by the Department of Health, with researchers working in partnership with gypsy travellers.

'We interviewed 293 gypsy travellers across five locations in England, ' says one of the report's authors, Glenys Parry. 'Of these, 260 were matched for sex and age with a comparator, including British people in white, Pakistani and black Caribbean ethnic groups, urban and rural environments and those who were economically deprived. The main finding was that gypsy travellers had much worse health than people living in similar situations.' More specifically, the research found that health problems among gypsy travellers are two to five times more common than in settled communities.

The heart of the problem But why is there this large health inequality? The impact of smoking (57 per cent were current smokers), education (average school leaving age was 12.6) and GP service (79 per cent had seen a GP over the previous 12 months) is important, but the study made it clear that these were not the only reasons. Environmental hardship, social exclusion and cultural attitudes also played a part.

Although dedicated or specialist health workers are one solution, a gypsy traveller commented to researchers that if doctors and health staff were 'trained to respect people' there would be less need for specialist provision.

The logic is that gypsy travellers should be treated with the same respect and care as others in the population, but the Sheffield report says: 'The ideal of a generalist service achieving this aim appears to be a long way from being met.' At the beginning of October, hundreds of gypsy travellers and health professionals gathered in London to hear the results of the study. Some were shocked at the findings, but the community itself seemed pleased in a way.

For Richard O'Neill, gypsy health campaigner and founder and director of National Men's Health Week, this is because the report provides much-needed evidence of the problems.

'This is the first survey to really look at gypsy traveller health in a way that the government can't ignore because it has been funded by the government and written by some very well-respected experts, ' he says. 'It gives us the facts to demand that the government does something to change the situation.' Among the many recommendations in the report that Mr O'Neill is keen to see the DoH act on are improving gypsy traveller access to health services, increasing GP registration and improving coverage of gypsy travellers in NHS ethnic monitoring.

'The root causes of many of these problems are ignorance and invisibility, ' says Mr O'Neill. 'Many people within the health service are not aware that we are an ethnic minority.' He is so keen to see traveller cultural awareness included in NHS diversity training that he is using his motivational skills to develop a package for every PCT in the country. In October he spoke to health professionals at a traveller-led cultural awareness seminar in Cambridgeshire - home to the greatest concentration of traveller sites in the country.

An example of best practice highlighted by the report is to be found in the West Country. Like Lynne Hartwell, Sarah Rhodes is a specialist gypsy traveller health visitor. Although employed by South Gloucestershire PCT, her Travellers' Health Project covers five PCTs in the Avon area.

She helps gypsy travellers with everything from immunisations to dental treatment. But even she was disturbed by some of the report's findings: 'What shocked me the most was the fact that 30 per cent of women travellers said they had lost children. That really is a shocking statistic.' Ms Rhodes says the issue of gypsy traveller health is intimately connected to the sites on which they are forced to live. She started working with travellers in 1994 when the government removed the statutory duty on local authorities to provide caravan sites. The resulting decline in the number of legal stopping places, she says, has had a dramatic effect on gypsy traveller health.

'The situation has had a very negative impact on people's health. You can't work with gypsy travellers without getting involved in site issues.' Even the legal sites that remain have an impact on health. Jackie Mosley, health visitor for Norwich PCT, has seen how damaging living on the sites can be. The Mile Cross travellers' site in Norwich is bordered by a tip, a council depot and a dirty river. Once she helped the residents cope with a fly infestation after the pumping station failed to clear the site's drains and sewers A recent grant has improved conditions on the site, but cannot change its location.

'Travellers' sites are built in places where nobody else would want to live, ' says Ms Mosley. 'This has a huge impact on people's health, not just in terms of infections but also on self-esteem and mental health.' But Ms Rhodes says it is not the conditions she has to work in or the gypsy travellers that make her life difficult. 'It is incredibly rewarding working with the community, but there is rarely much support, ' she explains. 'There seems to be an intense fear of taking any action to really address the health needs of gypsy travellers.' As the current chair of the National Association for Health Workers with Travellers, she is setting up health forums involving travellers. Like Mr O'Neill, she says the ScHARR report is already proving useful in getting the attention of others in the health service.

'What's really needed is the active involvement of gypsy travellers in planning, ' she says.

Find out more

The Health Status of Gypsy Travel lers in England

www. shef. ac. uk/scharr/sections/ir/library/ publications. html

Information about traveller-led cultural awareness

www. thegypsymediacompany. co. uk

Key points

A Sheffield University report found gypsies' health problems to be two to five times worse than in other communities.

Anecdotal evidence suggests NHS staff prejudice often denies travelling communities access to healthcare.

The appointment of gypsy traveller health visitors has made solid progress with a difficult-to-reach population.