Health and Wellbeing of Travellers and Gypsies in the South West

O B S E R V A T O R Y
South West Public Health Observatory
S O U T H
W E S T
P U B L I C
H E A L T H
Health and Wellbeing of
Travellers and Gypsies in the
South West
October 2011

SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
Contents
Foreword ...................................................................................................................................... 2
1. Introduction .......................................................................................................................... 3
2. Review of literature summary ............................................................................................ 4
3. Questionnaire ....................................................................................................................... 6
3.1 Questionnaire methodology .............................................................................................. 6
3.2 Questionnaire summary ................................................................................................... 7
4. Caravan count ...................................................................................................................... 9
4.1 Caravan count summary .................................................................................................. 9
4.2 Caravan mapping exercise ............................................................................................. 10
4.3 Summary ........................................................................................................................ 12
5. Summary and recommendations ..................................................................................... 13
Appendix 1: Additional detail of the literature review ........................................................... 14
Appendix 2: Questionnaire ....................................................................................................... 17
Appendix 3: Questionnaire results .......................................................................................... 19
Appendix 4: Pacesetters Programme ..................................................................................... 24
Appendix 5: Useful contacts .................................................................................................... 24
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SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
Foreword
Systematic research and data on the health of Traveller and Gypsy communities,
and the size of these communities, is still lacking. The scarce evidence that does
exist suggests that the health and wellbeing of these communities and the
provision of health services to them is extremely poor.
This report presents the best evidence available about the extent of these health
needs. It highlights changes through time, the size and distribution of the Traveller
and Gypsy communities in the South West, and the services and interventions in
place to meet these needs.
Since the original report in 2002, the situation regarding the provision of most
services to these communities has improved, although there are still concerns over
the provision of sexual health, dentistry, and drugs and alcohol services.
Concern is also expressed regarding the sustainability of the short-term funding
commitments used to deliver a number of these services. To ensure continued
improvements long-term commitment must be secured.
Traveller and Gypsy communities in the South West have continued to grow and
their distribution has changed. This increases the importance of tackling health
issues that affect them and addressing the health inequalities between Traveller
and Gypsy communities and the population as a whole.
Statutory, community and voluntary organisations in the South West need to work
together to continue to improve services and increase their impact on the health
and wellbeing of the Traveller and Gypsy communities in the region.
I urge all those concerned to read this report and consider its implications for their
Traveller and Gypsy communities. As a starting point, it should be used to
establish whether current service delivery is adequate, given the persistent health
problems faced by these communities and the geographic distribution and recent
changes in Traveller and Gypsy populations.
Dr Gabriel Scally
Regional Director of Public Health for the South West
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Health and Wellbeing of Travellers and Gypsies in the South West
1. Introduction
In August 2002 the South West Public Health Observatory (SWPHO)
commissioned a report to look at the range and quality of evidence available on the
topic of the health of Travellers. There was a relatively small amount of research
available, all of which suggested that Travellers experienced worse health
outcomes than the general population and a range of problems in accessing
healthcare services.
The report addressed the current state of knowledge, and suggested strategies
that might lead to a more evidence-based approach to Traveller health and
healthcare. It concluded that the regional picture was one of relatively little activity
directed specifically at Traveller communities. With the exception of those
authorities with specialist liaison workers, there were few examples of specialist
services or of dedicated systems for data collection or needs assessment.
The Department of Health South West, with the support of the SWPHO, agreed to
update the original report. The aim of this is to:
• refresh the literature review of the original report and analyse any new material
pertaining to Traveller and Gypsy health published since the original study;
• use recent caravan count data to map Travellers and Gypsy populations in the
South West and to look at trends emerging from this exercise;
• investigate, via a questionnaire, how much work, if any, is being done by Local
Authorities and PCTs with regard to Traveller and Gypsy health;
• explore if this agenda has moved forward and whether any of the original
recommendations have been addressed.
Importantly, this report should be read in conjunction with the original document
which can be found on the SWPHO website at:
http://www.swpho.nhs.uk/resource/item.aspx?RID=9043
As with all research, issues of definition and terminology are at the forefront. After
consideration it was decided that the research would relate to those who define
themselves as English/Welsh and Roma Gypsies, Irish Travellers and Scottish
Travellers. The inclusive term 'Travellers and Gypsies' is used throughout to cover
all these groups and, as a generic term, to refer to people who have a historical
and cultural tradition based on a mobile lifestyle.
The aim of this report is to provide information on the extent and quality of the
evidence base relating to Travellers' health for those whose work relates to
providing health and other services for this group, as well as for those in policymaking
positions regarding the distribution and utilisation of resources. More
generally, it will be of interest to anyone concerned with understanding issues of
health inequality and social exclusion, particularly those with responsibility for
developing effective strategies for tackling health inequalities and improving the
health of the worst off groups in society.
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Health and Wellbeing of Travellers and Gypsies in the South West
2. Review of literature summary
A review of the literature on the health of Travellers and Gypsies published since
the previous report was conducted, and sources were assessed to gain an
overview of their health and needs.
In order to carry out this review, searches were conducted on five computerised
databases: Medline, PubMed, Ovid, CINHAL and the HEA. Search terms included
Gyps*, Traveller*, health* and Roma* and searches were limited to articles
published in English since January 2001, thus refreshing the search conducted for
the original report. In addition, Internet search engines were used to find the
caravan count details and to investigate if there was any work being done locally or
nationally regarding Traveller and Gypsy health. See Section 4 for links to the
count data. This fresh search identified 16 relevant additions since the previous
literature review. Details of these are shown in Appendix 1.
As with the previous report, literature in this area is very limited and there are still
huge gaps in research and data. The lack of research makes it difficult to draw
conclusions but the general consensus from the sources that are available is that
the health of Travellers and Gypsies is still worse than the national average. This is
echoed by Parry et al. (2007) who are the most published scholars on Traveller
and Gypsy health in England:
There is a lack of reliable research evidence on the health status of adult
Gypsies and Travellers in England and no well-designed epidemiological
research, most studies being small, localised and descriptive. These studies
indicate high infant mortality and perinatal death rates, low birth weight, low
immunisation uptake and high accident rate. 1
This view is supported by many of the other authors; for example, there is evidence
that:
• infant mortality rates are up to five times higher among this minority group when
compared to the national rate; 2
• the immunisation rates among Travellers‟ children are low compared with the
rest of the population. Some suggest that GPs are reluctant to register
Travellers as they are of no fixed abode, meaning they cannot be counted
towards targets and therefore remuneration; 3,2,1
• there is a high accident rate among the Traveller and Gypsy population, which
is directly related to the hazardous conditions on many Traveller sites: “they
have been stuck in places where no-one else would want to live”. 4 This is
particularly so as sites are often close to motorways or major roads, refuse tips,
sewage work, railways or industrialized areas. Health and safety standards are
often poor and there is repeated evidence of vermin infestation and basic
amenities that are unfit for purpose;
• Travellers have lower levels of breastfeeding; 5
• there is also a higher prevalence of many medical conditions when compared to
the general population, including miscarriage rate, 6 respiratory problems, 5
arthritis, 6 cardiovascular disease, 1 depression 7 and maternal death rates. 8
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Health and Wellbeing of Travellers and Gypsies in the South West
The literature review also identified a range of services that are not readily
available to the Traveller community:
• maternity services; 8
• GP services; 3
• sexual health services (including family planning services) 2
• smoking cessation services; 1
• dentistry services; 9
• mental health services; 10
• drug and alcohol services. 5
There is also anecdotal evidence concerning the risks of HIV, injecting drug users
and sex workers within these communities, though significant collection of data is
absent. 11
Another thread running throughout the literature reviewed was that among
Travellers and Gypsies, coherent cultural beliefs and attitudes underpin healthrelated
behaviour, and health experiences must therefore be understood in this
context. In this group, “ill health is seen as standard, an unavoidable consequence
of adverse social experiences, and is stoically and fatalistically accepted”. 6
Generally the communities have low expectations in regard to their health and life
expectancy. Studies have repeatedly shown that Travellers often live in extremely
unhealthy conditions, while at the same time using health services much less often
than the rest of the population.
The more recent literature published since the earlier report, continues to
document the adverse health conditions, adverse lifestyle factors and poor access
to services experienced by members of these communities. No new issues were
highlighted in the 16 papers reviewed and which are listed below:
1. Health status of Gypsies and Travellers in England. Glenys Parry, Patrice Van
Cleemput,Jean Peters, Stephen Walters, Kate Thomas and Cindy Cooper.
J.Epidemiol. Community Health 2007; 61;198-204
2. A literature review of the health of Gypsy/Traveller families in Scotland: the
challenges for health promotion. Helen Smart, Mike Titterton and Colin Clark.
Health Education; 2003; 103, 3; ProQuest Health Management pg.156
3. Networking for Traveller health. Bernadette Reid. Community Practitioner; Sep
2005; 78, 9; ProQuest Medical Library pg.312
4. The provision and condition of Local Authority Gypsy/Traveller sites in England.
P. Niner, London: ODPM. 2003. pg.23
5. Gypsies’ and Travellers’ health. Sarah Rhodes. Community Practitioner; Sep
2005; 78, 9; ProQuest Medical Library pg.303
6. Health-related beliefs and experiences of Gypsies and Travellers: a qualitative
study. Patrice Van Cleemput, Glenys Parry, Kate Thomas,Jean Peters and
Cindy Cooper. J.Epidemiol. Community Health 2007; 61;205-21
7. The crossroads of culture and health among the Roma. Carrie Vivian, Lauren
Dundes. Journal of Nursing Scholarship; First Quarter 2004; 36, 1; ProQuest
Medical Library pg.86
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Health and Wellbeing of Travellers and Gypsies in the South West
8. Travellers’ tale. Elizabeth Lynch. Nursing Standard; Jun 21-Jun 27, 2006; 20,
41; ProQuest Medical Library pg.20
9. On the road. Jane Henriques. Nursing Standard; Aug 1–Aug 7, 2001; 15, 46;
ProQuest Medical Library pg.16
10. Drive to improve mental health care for Travellers. Sarah Harrison. Nursing
Standard; Oct 15–Oct 21, 2003; 18, 5; ProQuest Medical Library pg.8
11. Health of the world’s Roma population. Andrew Green; Sally Ann Lynch; Nicola
Petrosillo; Georg Broring. The Lancet; Aug 12–Aug 18, 2006; 368, 9535;
ProQuest Medical Library pg.575
12. Health status of Gypsy Travellers. Patrice Van Cleemput, Glenys Parry. Journal
of Public Health Medicine; Jun 2001; 23, 2, ProQuest Medical Library pg.129
13. Campaign targets male Travellers. Anonymous. Nursing Standard; Aug 13–Aug
19, 2003; 17, 48 ; ProQuest Medical Library
14. Gypsy and Traveller groups have worse health than others. Anonymous.
Nursing Standard; Apr 11–Apr 17, 2007; 21,31; ProQuest Medical Library pg.15
15. The health of Europe’s most marginalised populations. Samuel Loewenberg.
The Lancet; Dec 16–Dec 22, 2006; 368, 9553; ProQuest Medical Library
pg.2115
16. Health impact of Gypsy sites policy in the UK. Patrice Van Cleemput. Social
Policy & Society; 7:1, 103-117. 2007 Cambridge University Press.
3. Questionnaire
3.1 Questionnaire methodology
The questionnaire design was based on the template used in the original report. It
was modernised somewhat to extract more detailed information from the Primary
Care Trusts and Local Authorities in the South West. For example, Question 7 was
added to acquire more information on the availability of those specific services
identified by the literature review as “not readily available” to the Travellers and
Gypsy communities in the region.
The revised template was circulated to colleagues in the Regional Public Health
Group for comment and these comments were incorporated into the final design.
See Appendix 2 for a copy of the final template.
The questionnaire was circulated to all the Directors of Public Health at the
fourteen Primary Care Trusts in the region. It was accompanied by a letter
explaining the nature and aim of the questionnaire for dissemination to the
Traveller and Gypsy lead either within the PCT or Local Authority, or in some cases
both.
A summary of the responses can be found in Appendix 3.
100% of the questionnaires were returned and in some cases a response was
received from both the Primary Care Trust and Local Authority. The following
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Health and Wellbeing of Travellers and Gypsies in the South West
section provides an overview of the responses from the Primary Care Trusts within
the South West region, and where appropriate, provides an update on changes
since the previous survey.
The authors acknowledge that there have been changes to the NHS and Local
Authority boundaries since the last report was published; nevertheless, we have
attempted to compare responses in a way that reflects these adjustments.
3.2 Questionnaire summary
XX
XX
XX
Denotes a question re-used from the original survey
Denotes a new question
Denotes expanded question
Q.1
Does your Local Partnership have a specific person designated to
deal with the health and wellbeing of Travellers and Gypsies?
Out of 14 respondents to this question 13 said Yes and 1 said No.
This has changed significantly from the original report, when only 4 Local
Authorities identified an individual charged with the task of liaising with
Travellers. Only 3 out of 7 Health Authorities from the original survey
named an individual with responsibility for Travellers. This has substantially
improved since 2002. See Appendix 5 for designated lead contact details.
Q.2
Does your partnership area have a specific Traveller and Gypsy
forum/network in which these communities can discuss health and
wellbeing issues/concerns?
Out of 14 respondents to this question 9 said Yes and 5 said No.
The original report did not identify any forums or networks focussed on
Traveller health.
Q.3
Has your Local Authority/PCT published any specific policy
statements relating to the health and/or provision of services to
Traveller/Gypsy communities?
Out of 14 respondents to this question 10 said Yes, 3 said No and 1 did
not answer.
There was no mention of specific policy statements in the previous report.
There has been a substantial improvement.
Q.4
Has your Local Authority/PCT considered Traveller and Gypsy health
within your JSNA? If so please specify how this has been built into
the JSNA.
Out of 14 respondents to this question 6 said Yes, 6 said No and 2 did not
answer.
This is a new question and therefore no comparison can be made to the
original study.
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Health and Wellbeing of Travellers and Gypsies in the South West
Q.5
Has your Local Authority/PCT produced any formal/informal reports
relating to the health of Traveller/Gypsy communities in the past five
years?
Out of 14 respondents to this question 6 said Yes and 8 said No.
Three of the seven Health Authorities from the original survey referred to
published reports, therefore there has been no substantial change.
Q.6
Does your Local Authority/PCT have specific partnership
arrangements/structures in place regarding the health needs of the
Traveller/Gypsy communities?
Out of 14 respondents to this question 11 said Yes and 3 said No.
There is no detailed data available from the previous report to which any
meaningful comparison can be made.
Q.7
Does your Local Authority/PCT provide any specific services for
Traveller/Gypsy communities? Please tick relevant boxes and where
possible provide further detail.
This question provided detailed breakdown of advice and information
services, preventative services and treatment services across a broad
range of themes.
Service provided
Access to GP
Immunisations
Injury prevention
Antenatal appointments
Mental health
Breastfeeding
Others
Smoking cessation
Dental health
Family planning
Sexual health
Drugs & alcohol
Chronic disease management
Number providing
services
19
15
14
13
12
11
10
8
7
6
5
5
4
Q.8
What information relating to the health and wellbeing of Travellers
does your Local Authority/PCT collect?
Out of 14 respondents to this question 9 said that they did collect
additional information, 4 said they didn’t and 1 did not answer.
The original report showed what appeared to be a relatively low level of
activity with regard to both data collection and service delivery directed
towards Travellers from both Health and Local Authorities. Details of the
types of information collected can be seen in Appendix 3.
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Health and Wellbeing of Travellers and Gypsies in the South West
Q.9
Are you aware of any local examples of work commissioned relating
to health and wellbeing of Traveller/Gypsy communities that you
would be happy for us to profile in the report?
Out of 14 respondents to this question 9 said Yes, 3 said No and 2 did not
answer.
In the original report a few Local Authorities cited examples of what they
defined as good practice. No Health Authorities claimed to be able to
identify examples of good practice with regard to Travellers and Gypsies.
Again, there has been a marked improvement since 2002.
4. Caravan count
4.1 Caravan count summary
The system of twice-yearly counts of Traveller and Gypsy caravans and families
was introduced in England in 1979. Local Authorities carry out the count and return
figures to the Department for Communities and Local Government. The count is
carried out on a specified date in January and July each year, giving a snapshot of
the number and location of caravans/families on those days. January and July
were selected to give an idea of winter and summer patterns, given the known
seasonality of travelling.
The count system was reviewed in 2004 but none of the recommendations have
been implemented (Niner, P. Counting Gypsies & Travellers: A Review of the
Gypsy Caravan Count System, February 2004, Office of the Deputy Prime Minister:
London). The primary concern with the count is the accuracy of numbers. Often,
when information is not available by the return date, a zero is entered. This is
exacerbated by the fact that the counts are voluntary. There are no rewards for
Local Authorities completing the returns or penalties for those who fail to do so.
The count is also based on the number of caravans and therefore does not give an
accurate number of Travellers but rather a record of Traveller units or families.
Data on numbers of adults and children in each caravan are not analysed, and
therefore are never published. The count also significantly does not count
Travellers and Gypsies living in houses.
Details of the caravan count can be found here:
http://www.communities.gov.uk/publications/corporate/statistics/caravancountjan20
09
A review of the caravan count system can also be found here:
http://www.communities.gov.uk/documents/housing/pdf/158004.pdf
The following section provides an overview of variations in the numbers and rates
of caravans, by geography and through time.
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Health and Wellbeing of Travellers and Gypsies in the South West
4.2 Caravan mapping exercise
Figure 1: Total count of caravans by Local Authority area, January 2009
Figure 1 shows the total number of caravans in January 2009. The ranges are grouped
in approximate quintiles, or fifths, according to the number of caravans counted.
Figure 2: The percentage change in number of caravans between January 2007 and
January 2009
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Health and Wellbeing of Travellers and Gypsies in the South West
Figure 2 shows the difference between the January 2007 and January 2009 total,
expressed as a percentage. The ranges for display have been custom selected to
give a reasonable grouping of areas. Around half of Local Authorities in the South
West have seen a decrease in the number of caravans over this period. In
contrast, some areas have seen considerable increases in numbers with North
Dorset (265%), Mid Devon (330%) and, in particular, West Wiltshire (393%)
showing the biggest increases.
Figure 3: Cumulative rank of number of caravans in the South West between January
2007 and January 2009
The cumulative ranking for each area (Figure 3) is formed by ranking areas on the
total number of caravans at each measurement date. These rankings are then
summed to give a total overall ranking. This ranking should give an idea of which
areas have consistently had high/low numbers of caravans. A higher ranking
equates to a higher number. The ranges are grouped in approximate quintiles, so
that roughly the fifth of areas with the highest rank are shaded in the darkest
colour. Overall, there is no significant pattern; however, it is noted that the areas
with consistently lower numbers are scattered across the region and include rural
and urban areas.
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Health and Wellbeing of Travellers and Gypsies in the South West
Figure 4: Number of caravans per square mile, January 2009
Figure 4 shows the number of caravans per square-mile, based on the January
2009 totals. The ranges are grouped in approximate quintiles, so that roughly the
fifth of areas with the highest density of caravans are shaded in the darkest colour.
When looking at the density of caravans per square mile, a clearer pattern
emerges, with higher rates in Somerset, West Gloucestershire and the old Avon
area.
4.3 Summary
When considering all four maps together, there are two main conclusions which
can be drawn. The first is that over half of Local Authorities in the South West
exhibited a decline in the numbers of caravans. However, North Dorset, Mid
Devon, and West Wiltshire are notable for showing increases of 265%, 330% and
393%. Secondly, when the density of caravans in any Local Authority is taken into
account, a pattern of higher density in the North East of the region is apparent –
although there are exceptions in East Wiltshire and parts of Gloucestershire.
Generally speaking, densities are lower in the south-western parts of the region. It
is not clear why this may be but varying levels of access by road are likely to be a
factor.
It is important to note that in most Local Authorities the total number of caravans is
small and hence there is an inherent uncertainty in any conclusions drawn from the
data.
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Health and Wellbeing of Travellers and Gypsies in the South West
5. Summary and recommendations
As with the original report, the review of literature indicates that work in this area is
very limited and there are still vast gaps in research and data pertaining to the
health of Traveller and Gypsy communities. The lack of research on Travellers and
Gypsies makes it challenging to draw conclusions but the general consensus from
the sources that are available is that the healthcare of Travellers and Gypsies is
still worse than the national average.
The questionnaire results paint a far more positive picture regarding work being
done in the South West region to address the health inequalities experienced by
this minority group. For example, 13 of the 14 local partnerships have a specific
person designated to deal with the health and wellbeing of Travellers and Gypsies,
a significant change from 2002.
In addition 9 of the 14 local partnerships have a specific Traveller and Gypsy forum
or network in which these communities can discuss health and wellbeing issues
and concerns.
The questionnaire highlighted that specific services for Travellers have improved
significantly since the original study. For example, access to GPs, breastfeeding,
immunisations and injury prevention services are available to Travellers in almost
half of local areas.
Areas that need to be improved are sexual health, dentistry, and drugs and alcohol
services, all of which scored low on the questionnaire.
Despite not asking for specific information regarding the security of funding
available for the provision of Traveller-specific health interventions, a number of
respondents expressed concern that much of the current activity is based on shortterm
funding commitments and that to ensure continued improvements long-term
commitment must be secured.
There is considerable scope for improvement in terms of our ability to estimate the
size of the Traveller and Gypsy population within the region. The available data,
using caravan counts has obvious limitations, and being able to get a better handle
on the number of Travellers, and some demographic descriptions of the population
would prove useful in terms of service planning and delivery.
Despite these limitations local areas may wish to use this report as a starting point
to establish whether their current service delivery is adequate, given the
geographic variations and recent changes in the best estimate of Traveller and
Gypsy populations available.
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Appendix 1: Additional detail of the
literature review
Title
What is the paper about?
Conclusions and
recommendations
Health status of Gypsies and
Travellers in England
Glenys Parry, Patrice Van
Cleemput, Jean Peters,
Stephen Walters, Kate
Thomas and Cindy Cooper.
J.Epidemiol. Community
Health 2007; 61;198-204
The authors explore the first valid
and reliable estimate of the
health status of Travellers and
Gypsies in England by using
standardised instruments to
compare their health with that of
a UK resident non-Traveller
sample, drawn from different
socioeconomic and ethnic
groups, matched for age and
sex.
Improvements in the policy response
to the need of this neglected minority
needed in light of these findings.
Health data are important in
monitoring health and evaluating the
effects of health interventions, and
Travellers and Gypsies should be
included in routine ethnic monitoring.
The provision of effective healthcare
and improvement of poor health in
Travellers and Gypsies requires
multi-agency awareness and joint
working to discuss the negative
effects both of adverse social
experiences and attitudinal barriers
to health.
A literature review of the
health of Gypsy/Traveller
families in Scotland: the
challenges for health
promotion
Helen Smart, Mike Titterton
and Colin Clark. Health
Education; 2003; 103, 3;
ProQuest Health
Management pg.156
Findings of a detailed literature
review are presented as well as
suggestions on where „gaps‟
exist in related empirical
research.
Much of the existing research is out
of date and there are few thorough
empirical studies of the health of
Travellers and Gypsies in Scotland.
A key route to tackling social
exclusion may lie in adopting a
community development approach.
Networking for Traveller
health
Bernadette Reid. Community
Practitioner; Sep 2005; 78, 9;
ProQuest Medical Library
pg.312
The author explores the crossborder
collaboration between
practitioners in Ireland aimed at
improving health provision for the
Traveller community.
Future initiatives are vital to tackling
health inequalities as currently
experienced by Travellers.
The provision and condition
of Local Authority
Gypsy/Traveller sites in
England.
P. Niner, ODPM London
2003 pg.23
A look at the provision and
condition of sites for
Gypsy/Travellers.
The author does not offer any
conclusions or recommendations.
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Gypsies’ and Travellers’
health
Sarah Rhodes. Community
Practitioner; Sep 2005; 78, 9;
ProQuest Medical Library
pg.303
This report examines why the
health status of Travellers and
Gypsies is significantly poorer
than that of other UK resident
English speaking ethnic
minorities and economically
disadvantaged white UK
residents.
The author does not offer any
recommendations.
Health-related beliefs and
experiences of Gypsies and
Travellers: a qualitative study
Patrice Van Cleemput,
Glenys Parry, Kate Thomas,
Jean Peters and Cindy
Cooper. J.Epidemiol.
Community Health 2007;
61;205-210
This paper presents a review of
findings of a survey of the health
status of Travellers and Gypsies
by exploring their health-related
beliefs and experiences.
Among Travellers and Gypsies
coherent cultural beliefs and
attitudes underpin health-related
behaviour, and health experiences
must be understood in this context.
In this group, ill health is seen as
normal, an inevitable consequence
of adverse social experiences, and is
stoically and fatalistically accepted.
The provision of effective healthcare
and improvement of poor health in
Travellers and Gypsies will require
multi-agency awareness of this
issue.
The crossroads of culture and
health among the Roma
Carrie Vivian, Lauren
Dundes. Journal of Nursing
Scholarship; First Quarter
2004; 36, 1; ProQuest
Medical Library pg.86
This paper aims to alert
healthcare providers to commonly
encountered cross-cultural
impediments to optimal
healthcare delivery for the Roma
and to offer suggestions for
avoiding culturally based
problems in treating this
subculture.
The Roma have some culturally
distinct beliefs and behaviours
related to their health and healthcare.
Knowledge of these characteristics
and accommodations to cultural
difference are important to their
healthcare.
Travellers’ tale
Elizabeth Lynch. Nursing
Standard; Jun 21–Jun 27,
2006; 20, 41; ProQuest
Medical Library pg.20
The author explores why Gypsies
and Travelling families face
discrimination in access to
healthcare as well as in the wider
community, with the result that
infant mortality rates remain high
and child immunisation rates low.
The author does not offer any
recommendations.
On the road
Jane Henriques. Nursing
Standard; Aug 1–Aug 7,
2001; 15, 46; ProQuest
Medical Library pg.16
Outreach work in Gloucestershire
bringing healthcare to travelling
families.
The author does not offer any
conclusions or recommendations.
Drive to improve mental
health care for Travellers.
Sarah Harrison. Nursing
Standard; Oct 15–Oct 21,
2003; 18, 5; ProQuest
Medical Library pg.8
The paper is concerned with the
details of a project that helps
Travellers overcome the fear of
discrimination from health
professionals and to deal with
their mental health problems.
More training for health professionals
relating to the needs of Travellers.
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Health of the world’s Roma
population
Andrew Green; Sally Ann
Lynch; Nicola Petrosillo;
Georg Broring. The Lancet;
Aug 12–Aug 18, 2006; 368,
9535; ProQuest Medical
Library pg.575
Clarification on distinction
between Irish Roma and Irish
Traveller populations. Discussion
regarding HIV Aids risks within
the Traveller and Gypsy
population.
Sustainable long-terms projects
needed to bridge health gaps and
fight the spread of HIV among these
vulnerable populations.
Health status of Gypsy
Travellers
Patrice Van Cleemput,
Glenys Parry. Journal of
Public Health Medicine; Jun
2001; 23, 2, ProQuest
Medical Library pg.129
The study compares the health
status of the traditional Gypsy
Travellers with norms from the
UK population, and with a
concurrent comparison group
using the Euroqol health status
measure.
Quantitative assessment of health
status in the Traveller community is
feasible.
Campaign targets male
Travellers
Anonymous. Nursing
Standard; Aug 13–Aug 19,
2003; 17, 48 ; ProQuest
Medical Library
This report details the launch of a
campaign encouraging men in
Travelling communities to take an
active interest in their health.
The author does not offer any
recommendations or conclusions.
Gypsy and Traveller groups
have worse health than
others
Anonymous. Nursing
Standard; Apr 11–Apr 17,
2007; 21,31; ProQuest
Medical Library pg.15
Significant health inequalities
exist between Traveller and
Gypsy populations and their non-
Gypsy counterparts, even when
compared to other socially
deprived groups or ethnic
minorities.
The author does not offer any
conclusions or recommendations.
The health of Europe’s most
marginalised populations
Samuel Loewenberg. The
Lancet; Dec 16–Dec 22,
2006; 368, 9553; ProQuest
Medical Library pg.2115
An investigation of the health of
Romany Gypsies in Hungary.
The author does not offer any
conclusions or recommendations.
Health impact of Gypsy sites
policy in the UK
Patrice Van Cleemput. Social
Policy & Society; 7:1, 103-
117. 2007 Cambridge
University Press.
This paper illustrates the social
and health consequences of the
politics and policies of Gypsy
sites in the UK.
Gypsies and Travellers need to be
meaningfully consulted on site
design, location management and
the process of determining allocation.
16

SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
Appendix 2: Questionnaire
Health and wellbeing of Travellers and Gypsies in the
South West Questionnaire, 2008
Q.1
Does your Local Partnership have a specific person designated to
deal with the health and wellbeing of Travellers and Gypsies?
Yes
No
If YES please provide contact details.
Q.2
Does your partnership area have a specific Traveller and Gypsy
forum/network in which these communities can discuss health and
wellbeing issues/concerns?
Yes
No
If YES please provide details of the working structures.
Q.3
Has your Local Authority/PCT published any specific policy
statements relating to the health and/or provision of services to
Traveller/Gypsy communities?
Yes
No
If YES could you please provide us with copies.
Q.4
Has your Local Authority/PCT considered Traveller and Gypsy health
within your Joint Strategic Needs Assessment? If so please specify
how this has been built into the Joint Strategic Needs Assessment.
Yes
No
If YES could you please provide us with copies.
Q.5
Has your Local Authority/PCT produced any formal/informal reports
relating to the health of Traveller/Gypsy communities in the past five
years?
Yes
No
If YES could you please provide us with copies.
Q.6
Does your Local Authority/PCT have specific partnership
arrangements/structures in place regarding the health needs of the
Traveller/Gypsy communities?
Yes
No
If YES please provide details.
17

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Health and Wellbeing of Travellers and Gypsies in the South West
Q.7
Does your Local Authority/PCT provide any specific services for
Traveller/Gypsy communities? Please tick relevant boxes and where
possible provide further detail.
Advice Preventative Treatment
& Services Services
Information
Access to GP
Child health
• Breastfeeding
• Immunisations
• Injury prevention
Chronic disease management
(cardiovascular, respiratory, skeletal)
Dental health
Drugs & alcohol
Family planning
Maternity
• Antenatal appointments
• Smoking cessation
Mental health
Sexual health
Smoking cessation
Other (please specify)
Q.8
What information relating to the health and wellbeing of Travellers
does your Local Authority/PCT collect?
Please provide copies.
Q.9
Are you aware of any local examples of work commissioned relating
to health and wellbeing of Traveller/Gypsy communities that you
would be happy for us to profile in the report?
Yes
No
If YES please provide examples of commissioned work.
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Health and Wellbeing of Travellers and Gypsies in the South West
Appendix 3: Questionnaire results
Presented below are summaries of responses from each PCT in alphabetical
order. Text comments are drawn from the written statements provided by each
PCT as part of the questionnaire.
Bath & North East Somerset Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes No No No No Yes Yes Yes Yes
Summary
Bath & North East Somerset are putting together a network of professionals to
support Traveller education, health, housing and social services.
The PCT is part of an Avon-wide network focusing on a strategic approach to the
health needs of Travellers.
A health visitor service is now in place and will provide outreach to the transient
population.
The coterminous Local Authority is considering providing a static site for Travellers.
Bournemouth & Poole Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes No Yes Yes Yes Yes No No Yes
Summary
A specialist health visitor/public health practitioner is designated to unauthorised
sites.
The health of Travellers and Gypsies is mentioned in the overall JSNA (2008) and
will feature in the locality Joint Strategic Assessments currently being prepared.
The health visitor with a remit for Travellers and Gypsies has completed a Masters
Dissertation on the subject and a copy was provided.
Minority Ethnic & Traveller Achievement Service (METAS) in place. It supports and
contributes to the raising of the educational achievement of minority ethnic and
Traveller pupils. The service provides training, advice and support for school
leadership, teaching and support staff and staff from other agencies.
19

SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
Bristol Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Yes Yes No Yes No Yes Yes
Summary
The Health Unite service is offered to all Travellers and Gypsies on permanent or
transient sites by the mainstream Health Visiting service. A post is in the process of
being set up solely for Travellers on transient sites.
Bristol is a pacesetter PCT (see Appendix 4 for details) of which Gypsy and
Traveller health is a core work stream. There are also links into a sub-regional
strategic group for Gypsy and Traveller health, chaired by the Director of Public
Health for North Somerset.
In the process of developing a handbook for Travellers about health services.
Scoping for specialist Health Visiting services.
Cornwall & Isles of Scilly Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Yes Yes Yes Yes Yes No No
Summary
There is a multi-agency group working with the Wheal Jewel group of Travellers
and Gypsies.
A health visitor is employed one day per week to cover the Wheal Jewel Traveller
site.
The PCT‟s health promotion department held a general health awareness day with
a group of Travellers, women and children earlier this year. Items included sexual
health awareness and cancer awareness. Healthy eating was also covered.
Devon Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Yes Yes Yes Yes Yes No Yes
Summary
Section in Annual Public Health report on Travellers and Gypsies.
Recommendation for a health needs assessment.
Report published in 2003: Travellers’ wellbeing – multi agency approaches.
Support for South West Ambulance Service Gypsy and Traveller health survey
under pacesetters programme (see Appendix 4 for details).
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Health and Wellbeing of Travellers and Gypsies in the South West
A Traveller and Gypsy health needs assessment has been undertaken and will be
forwarded once the document has been agreed.
Dorset Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Yes No No No No No No
Summary
Dorset highlighted that there is a Gypsy and Traveller group, chaired by the Local
Authority (Dorset County Council).
Gloucestershire Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Yes No Yes Yes Yes Yes Yes
Summary
Two reports have been published by Gloucestershire PCT:
• Evaluation of Health Service Provision for the Travelling Population in
Gloucestershire, Dr Janet Maxwell, December 2004.
• The Wider Determinants of Health that Contributed to Health Inequalities in
Gypsies and Travellers in the County of Gloucestershire, Caryn Laura Hall,
December 2004
NHS Gloucestershire provided a mobile GP surgery to the May Stow Horse Fair
with GP, nurse, health visitor, and oral health promoter on board for the day.
Health cards with essential contact numbers for health services distributed to
Travellers.
Culturally appropriate and easy-to-read leaflets on arthritis, heart disease and
stress, diabetes and children‟s health also distributed.
PCT contributed recently to countrywide Gypsy, Traveller and show people
accommodation needs assessment with health questions/data collections.
NHS Gloucestershire are exploring with a GP surgery becoming a pilot to use the
newly published Primary Care Service Framework for Gypsies and Travellers. The
project would be evaluated with a view to rolling this out across each locality.
North Somerset Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Yes No Yes Yes Yes Yes Yes
Summary
North Somerset PCT has completed West of England Gypsy and Traveller
Accommodation and Other Needs Assessment.
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Health and Wellbeing of Travellers and Gypsies in the South West
There is also a corporate Traveller and Gypsy group and a PCT-led Traveller and
Gypsy health group.
Plymouth Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes No Yes ? No Yes Yes Yes Yes
Summary
Work with Travellers and Gypsies is coordinated through the Social Inclusion Unit
in Plymouth.
Somerset Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes No Yes ? No Yes Yes Yes Yes
Summary
Romany Advisory Group for Somerset, facilitated by Somerset Racial Equality
Council Taunton Deane Area Advisory Group.
Traveller community registered at two surgeries – routine HIV input plus accurate
prevention, immunisation and health promotion supporting people programme.
Somerset PCT/practice-based commissioning have a Service Level Agreement
with the Robert Barton Trust in Glastonbury who work with the Travellers,
homeless and non-brick and mortar dwellers in Glastonbury and surrounding
areas. This is to provide advice and information, advocacy, health promotion
services, signposting and working closely with local surgery and public health –
Glastonbury Health inclusion project.
Somerset Gypsy and Traveller Accommodation Assessment (GTAA) is a joint
venture commissioned by Somerset County Council and the districts. This
assessment of need will form a fundamental evidence base for influencing planning
policy the districts are currently developing, not only identifying need but the
allocation of sites.
South Gloucestershire Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
No Yes No Yes Yes Yes Yes Yes Yes
Summary
A regular network meeting is held on one of the Local Authority sites attended by
various agencies and residents to discuss site issues. These discussions often
identify health issues which can then be taken forward.
A community development worker has been specifically appointed to focus on
mental health for BME groups, including Travellers and Gypsies, in South
Gloucestershire.
22

SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
South Gloucestershire has a local multi-agency Traveller and Gypsy forum and
links into a strategic Avon-wide group for Traveller and Gypsy health.
Swindon Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes No No No No No No Blank Blank
Summary
Swindon has not provided anything of note in their questionnaire return.
Torbay Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Yes No No Yes Yes Yes No
Summary
Multi-agency group meets quarterly.
Health needs assessment under development.
Wiltshire Primary Care Trust
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
Yes Yes Blank Yes No No No Yes Blank
Summary
South Wiltshire Traveller Forum established.
Voluntary organisation „Shrine‟ runs a play bus to engage young people in
activities.
Joint Strategic Needs Assessment has highlighted the need for greater research
and improved methods to gather evidence to direct services for Travellers and
Gypsies.
23

SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
Appendix 4: Pacesetters Programme
The Department of Health has recently launched a new initiative, the Pacesetters
Programme, to deal with health inequalities among minority groups.
One of the facets of this programme is engagement with the Traveller and Gypsy
community. Contact has been made with the programme leads to source more
information on how the initiative will target Travellers in the South West region but,
as the programme is at an early stage, no information has yet been made
available.
More detail on this programme can be found here:
http://www.dh.gov.uk/en/Managingyourorganisation/Equalityandhumanrights/Paces
ettersprogramme/index.htm
Appendix 5: Useful contacts
Below are the contact details of the Directors of Public Health for each of the
Primary Care Trusts in the South West and also the contact details for the named
Traveller and Gypsy Lead(s).
Bath & North East Somerset Primary Care Trust
Director of Public Health
Dr Pamela Akerman
Director of Public Health (Acting)
Bath & North East Somerset PCT
Trust Headquarters
St Martins Hospital
Midford Road
Bath
BA2 5RP
Tel: 01225 831800
pamela.akerman@banes-pct.nhs.uk
Traveller Lead
Denice Burton
Assistant Director – Health Improvement
Bath & North East Somerset PCT
Trust Headquarters
St Martins Hospital
Midford Road
Bath
BA2 5RP
Tel: 01225 831800
denise.burton@banes-pct.nhs.uk
24

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Health and Wellbeing of Travellers and Gypsies in the South West
Bournemouth and Poole Primary Care Trust
Director of Public Health
Dr Adrian Dawson
Director of Public Health
Bournemouth and Poole PCT
Canford House
Discovery Court Business Centre
551-553 Wallisdown Road
Poole
BH12 5AG
Tel: 01202 541400
adrian.dawson@bp-pct.nhs.uk
Traveller Lead
Xena Dion
Health Visitor
Herbert Avenue Surgery
Tel: 01202 722746
Bristol Primary Care Trust
Director of Public Health
Dr Hugh Annett
Director of Public Health
Bristol PCT
South Plaza
Marlborough Street
Bristol
BS1 3NX
Tel: 0117 9766600
hugh.annett@bristolpct.nhs.uk
Traveller Lead
Christina Gray
Associate Director of Public Health – Equality & Inclusion
NHS Bristol
Tel: 0117 9002489
christina.gray@bristol.nhs.uk
Cornwall and Isles of Scilly Primary Care Trust
Director of Public Health
Ms Felicity Owen
Director of Public Health
Cornwall and Isles of Scilly PCT
Sedgemoor Centre
Priory Road
St Austell
Cornwall
PL25 5AS
Tel: 01726 77777
felicity.owen@ciospct.cornwall.nhs.uk
25

SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
Traveller Leads
Phil Eaton
Cornwall County Council
Gypsy & Traveller Liaison Officer
Tel: 01209 614234
peaton@cornwall.gov.uk
Neal Chambers
Patient & Public Involvement Manager
Sedgemoor Centre
Tel: 01726 627895
Devon Primary Care Trust
Director of Public Health
Dr Virginia Pearson
Director of Public Health
Devon PCT
Commissioning Headquarters
County Hall
Topsham Road
Exeter
EX2 4QL
Tel: 01392 267628
virginia.pearson@nhs.net
Traveller Leads
Nicola Glassbrook
Health Inequalities Programme Manager
County Hall Public health
County Hall
Topsham Road
EX2 4QL
Tel: 01392 267649
Nicola.glassbrook@nhs.net
Penny Dane
Community Development Worker
Gypsies & Travellers
Tel: 07979838138
penny@devonrec.org
Jacinta Jackson
Health Improvement Specialist Advanced
Manager Health Trainer Service & BME-Community Development Workers –
Emotional Health & Wellbeing
Health Promotion Devon
Tel: 01395 282037
jacinta.jackson@nhs.net
26

SWPHO
Health and Wellbeing of Travellers and Gypsies in the South West
Dorset Primary Care Trust
Director of Public Health
Dr David Phillips
Director of Public Health
Dorset PCT
Little Keep Gate Offices
Bridport Road
Dorchester
Dorset
DT1 1AH
Tel: 01305 361176
david.phillips@dorset-pct.nhs.uk
Traveller Lead
Sarah J Austin
Health Inclusion Project Manager/Gypsies, Travellers, Rural & Older People
Dorset Cancer Network (DCN)
Mob: 07825975502
Sarah.Austin@dorset.nhs.uk
Gloucestershire Primary Care Trust
Director of Public Health
Dr Shona Arora
Director of Public Health
Gloucestershire PCT
Sanger House
5220 Valiant Court
Gloucester Business Park
Brockworth
Gloucestershire
GL3 4FE
Tel: 08454 221642
shona.arora@glos.nhs.uk
Traveller Lead
Caryn L Cox
Consultant in Public Health
Tel: 08454 221633
Caryn.cox@glos.nhs.uk
North Somerset Primary Care Trust
Director of Public Health
Ms Becky Pollard
Director of Public Health
North Somerset PCT
Waverley House
Old Church Road
Clevedon
BS21 6NN
01275 546770
becky.pollard@nsomerset-pct.nhs.uk
27

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Health and Wellbeing of Travellers and Gypsies in the South West
Traveller Leads
Mark Hughes
Head of Adult Social Services & Housing
Tel: 01934 426320
Mark.Hughes@n-somerset.gov.uk
Lynn Formby
Clinical Nurse Specialist for Vulnerable Families
lynn.formby@nsomerset-pct.nhs.uk
Plymouth Primary Care Trust
Director of Public Health
Ms Debra Lapthorne
Director of Public Health
Plymouth PCT
Building One
Derriford Business Park
Brest Road
Plymouth
PL6 5QZ
Tel: 01752 315777
debra.lapthorne@plymouth.nhs.uk
Traveller Leads
Bronwyn Prosser
Social Inclusion Manager
Community Services Directorate
Tel: 01752 304315
bronwyn.prosser@plymouth.gov.uk
Kevin McKenzie
Social Inclusion Unit
Community Services Directorate
Tel: 01752 304321
Kevin.mckenzie@plymouth.gov.uk
Kathryn Hooper
Health Visitor
Seventrees Clinic
Baring Street
Plymouth
PL4 8NF
Tel: 01752 314175
Somerset Primary Care Trust
Director of Public Health
Dr Caroline Gamlin
Joint Director of Public Health
NHS Somerset and Somerset County Council
Wynford House
Lufton Way
Yeovil
Somerset
BA22 8HR
Tel: 01935 384000
caroline.gamlin@somersetpct.nhs.uk
28

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Health and Wellbeing of Travellers and Gypsies in the South West
Traveller Lead
Margaret Grizzell
Head of Patient Experience
NHS Somerset
Wynford House
Lufton Way
Yeovil
BS22 8HR
Margaret.grizzell@somerset.nhs.uk
South Gloucestershire Primary Care Trust
Director of Public Health
Dr Chris Payne
Director of Public Health
South Gloucestershire PCT
1 Monarch Court
Emerald Business Park
Emersons Green
South Gloucestershire
BS16 7FH
Tel: 0117 3302433
chris.payne@sglos-pct.nhs.uk
Traveller Lead
Lindsey Thomas
Assistant Director of Public Health (Health Improvement)
South Gloucestershire Council Offices
Badminton Road
Yate
South Gloucestershire
BS37 5AF
Tel: 01454 864664
lindsey.thomas@sglos-pct.nhs.uk
Swindon Primary Care Trust
Director of Public Health
Cherry Jones
Acting Joint Director of Public Health
NHS Swindon
North Swindon District Centre
Thamesdown Drive
Swindon
SN25 4AN
Tel: 01793 708806
cherry.jones@swindon-pct.nhs.uk
Traveller Lead
Tony Wescott
Traveller Liaison Officer
twescott@swindon.gov.uk
29

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Health and Wellbeing of Travellers and Gypsies in the South West
Torbay Care Trust
Director of Public Health
Ms Debbie Stark
Acting Director of Public Health
Torbay Care Trust
Bay House, Unit 2
Riviera Park
Nicholson Road
Torquay
TQ2 7TD
Tel: 01803 210500
debbie.stark@nhs.net
Traveller Lead
Julie Hughes
juliehughes@nhs.net
Tel: 07810 151399
Wiltshire Primary Care Trust
Director of Public Health
Mrs Maggie Rae
Director of Public Health
Wiltshire PCT
Southgate House
Pans Lane
Devizes
Wiltshire
SN10 5EQ
Tel: 01380 728899
maggie.rae@wiltshire-pct.nhs.uk
Traveller Lead
Jason Morris
Lead Traveller Liaison Officer
Tel: 01722744440
jason.morris@wiltshire.gov.uk
30

Further information
This report is available at: www.swpho.nhs.uk
Main author:
Philip Gallagher, Department of Health South West
Contributing authors:
Dr Brendan Yates, Department of Health South West, Paul
Brown, Deputy Director and Julia Verne, Director, South
West Public Health Observatory
South West Public Health Observatory
Grosvenor House
149 Whiteladies Road
Bristol BS8 2RA
T: 0117 970 6474
F: 0117 970 6481
E: info@swpho.nhs.uk
Publications details
Published by: South West Public Health Observatory
Publication date: October 2011
ISBN: 978-0-9569224-4-1
About the South West Public Health
Observatory
The South West Public Health Observatory (SWPHO) is
part of a network of 12 public health observatories working
across the five nations of England, Scotland, Wales,
Northern Ireland and the Republic of Ireland. The nine
Public Health Observatories in England work together
through a single work programme which contains both
national and local elements. We produce information,
data and intelligence on people’s health and health care
for practitioners, policy makers and the wider community.
Our expertise lies in turning information and data into
meaningful health intelligence to support decision makers.
On behalf of the Department of Health, the SWPHO works
in partnership with the NHS, local authorities, researchers,
national agencies as well as agencies in the South West.
The SWPHO incorporates the National Drug Treatment
Monitoring System South West (NDTMS-SW), and in April
2005 merged with the South West Cancer Intelligence
Service (SWCIS).
For more information about the SWPHO and its partner
organisations, please visit www.swpho.nhs.uk
© South West Public Health Observatory 2011