Health care needs of Travellers

Abstract

Who are Travellers?The 1968 Caravan Sites Act ignored ethnicity and cultural distinctiveness by defining Travellers as: "persons of nomadic habit, whatever their race or origin". 1 However, in 1989, when the Commission for Racial Equality determined that Gypsies formed a distinct ethnic group, diVerences between "real Gypsies" and other more recent groups of Travellers were emphasised. 2 There are two main groups: new Travellers and traditional Travellers.The inclusive term "Traveller" is acceptable to most and is used here.New Travellers are people from the settled community, who for various reasons have decided to adopt a nomadic lifestyle similar to that of traditional Travellers.Traditional Travellers are not a homogenous group.In the British Isles they mainly comprise English and Welsh Romanichal or Romany Gypsies, Irish Travellers, and Scottish Travellers, in addition to a growing number of European Romanichals (Roma).They each have their own language, beliefs, and cultural heritage.Linguistic and genetic evidence suggests that Gypsies originated in north India and began to migrate about 1000 years ago, first into Eastern Europe and eventually across the world.The first written description of Gypsies in England was in 1514.3 The first anti-Gypsy law was passed in 1530 under Henry VIII and persecution and hostility have continued to the present day.Pahl and Vaile noted that: "distinctions between Travellers are less important than acceptance of the long tradition of Travellers living a marginal existence beside the settled population, with continuing antipathy between them".4 Health care issuesGypsies and Travellers either "choose" to be mobile, or else they have settled and live like everyone else, so why should they receive any special services?Do they have any particular health problems?Would special provision improve the health of this disadvantaged group, or just increase their isolation and discourage the use of mainstream health care services?Research on Travellers' health is mainly localised to particular geographical areas in the UK.Estimating the numbers of Travellers is diYcult because of their nomadic lifestyle and the lack of any ethnic coding.There are no national morbidity statistics and only fragmen- Ivy Lodge Clinic,