All Ireland Traveller Health Study Our Geels - Department of Health ...

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All Ireland Traveller Health Study Rationale for the Study Process The study accordingly adopted a holistic approach to health, using a social-determinants model that acknowledges the broader impact of social, economic, environmental and political policy on health (Figure 1) (Dahlgren and Whitehead, 1991). This strategy is in keeping with public policy on health in the Republic of Ireland dating back to 1986 when Health: the Wider Dimensions (Department of Health, 1986) was published. Successive strategies in the 2 decades since then for health promotion, disease prevention and provision of care have emphasised the importance of contextualising health experiences of groups and individuals and facilitating health choices. This led to the adoption in Quality and Fairness, a Health System for You (Department of Health and Children, 2001) of a focus on social inclusion, at policy and delivery level. The Traveller community presents a particular challenge, exemplifying as it does an identifiable group in Irish society with complex health needs and service delivery challenges. The international literature on health inequalities increasingly acknowledges the need to take account of both material factors such as access to education, housing and other amenities and so called psychosocial factors that can work either positively or negatively at the level of individuals or groups, such as social support, networks or engagement (Mackenbach et al., 2008; Berkman and Kawachi, 2000; National Economic and Social Forum, 2003). Successful health choices, whether in lifestyle or access to care, are contingent on empowerment, a fundamental principle of the Ottawa Charter for Health Promotion (WHO, 1986). It is increasingly clear also that a life-course perspective is essential to the understanding of how groups or individuals maintain wellness, or conversely, develop ultimately disease-specific outcomes. In 2007 the findings of the 7-year Health Research Board (HRB) of Ireland-funded Unit for Health Status and Health Gain were published (Kelleher, 2007). The outcome of this work programme corroborated that of others in Ireland, including the Institute of Public Health (Balanda and Wilde, 2001), that there is significant health inequality in Ireland, whether measured across social groups or in pockets or areas of disadvantage. Health is strongly socially patterned in Ireland as elsewhere and health policy requires cross-sectoral initiatives led by, but not confined to, the formal health sector (Middleton, 2001). Approach As with models of health inequalities and disadvantage generally, the burden of health problems experienced by Travellers is arguably strongly attributable to social conditions and educational and cultural opportunity and engagement (Quirke, 2006). The study approach also acknowledges the considerable influence that psychosocial factors potentially of specific relevance to Travellers, such as discrimination, can have on health outcomes (Krieger et al., 2005). Health policies overly dominated by disease-focused and reductionist solutions that operate at the level of the individual without a wider appreciation of social determinants are unlikely to be successful (Bradley and Corwyn, 2002; Marmot et al., 2008). 4
Health Survey Findings The key health issues identified for Travellers during the consultation process were as follows: • Environment and poor living conditions. • Issues related to equality of access to, participation in, and outcome of service provision. • Right of Travellers to appropriate access to services based on culture and way of life. • Lifestyle issues. • Lack of culturally appropriate provision. • Lack of data on Traveller health and health needs. • Lack of recognition of Traveller culture and identity. • Individual and institutional level racism. • Social exclusion. Figure 1: Social Determinants Approach Source: Dahlgren and Whitehead, 1991 5
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