This study illustrated the true extent of health inequalities experienced by an indigenous minority in Europe, clarifying the importance of reducing the burden of non-fatal disabling conditions for addressing these inequalities. The health expectancy measure used has application for other similar indigenous minorities elsewhere.
Introduction: Irish Travellers are an indigenous ethnic minority (IEM) with poor health outcomes. Whilst they constitute less than 1% of the Irish population, they account for 10% of national young adult male suicide statistics. Methods: A rapid review of scientific publications related to mental health and suicide in Irish Travellers was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches of PubMed, PsycINFO and Google Scholar were performed. Eligibility criteria included: (i) Irish Travellers/Gypsy Travellers; (ii) information on mental health/suicide/self-harm; (iii) psychosocial anthropological perspectives of mental health; (iv) publications in english. Data on studies including design, methods, participants and key findings were extracted using a spreadsheet template. Results: From 5160 scientific references over the past 20 years, 19 papers made reference to Traveller mental health, and only 5 papers made specific data-based reference to suicide in Travellers. It was only when we qualified Travellers as being ‘Irish Travellers’ in our scientific review did we detect meaningful references to their existence as an IEM, and their health and well-being. Due to sample sizes and heterogeneity in design, results were synthesised narratively. Discussion: This paper draws together strands from the disciplines of psycho/socio/anthropological perspectives to gain deeper insights into mental health and suicide in Irish Travellers. In a knowledge vacuum, it behoves the scientific community to explain the value of scientific research and rigour to both policymakers as well as Travellers, shifting the existing discourse towards new knowledge and understanding around mental health and suicide in Travellers.
ObjectivesTo assess recent disparities in fatal and non-fatal injury between travellers and the general population in Ireland.DesignA cross-sectional population-based comparative study.SettingRepublic of Ireland.ParticipantsPopulation census and retrospective mortality data were collected from 7042 traveller families, travellers being those identified by themselves and others as members of the traveller community. Retrospective injury incidence was estimated from a survey of a random sample of travellers in private households, aged 15 years or over (702 men and 961 women). Comparable general population data were obtained from official statistical reports, while retrospective incidence was estimated from the Survey of Lifestyle, Attitude and Nutrition 2002, a random sample of 5992 adults in private households aged 18 years or over.Outcome measuresPotential Years of Life Lost (PYLL), Standardised Mortality Ratios (SMR), Standardised Incidence Ratios (SIR) and Case Fatality Ratios (CFR).ResultsInjury accounted for 36% of PYLL among travellers, compared with 13% in the general population. travellers were more likely to die of unintentional injury than the general population (SMR=454 (95% CI 279 to 690) in men and 460 (95% CI 177 to 905) in women), with a similar pattern for intentional injury (SMR=637 (95% CI 367 to 993) in men and 464 (95% CI 107 to 1204 in women). They had a lower incidence of unintentional injury but those aged 65 years or over were about twice as likely to report an injury. Travellers had a higher incidence of intentional injuries (SIR=181 (95% CI 116 to 269) in men and 268 (95% CI 187 to 373) in women). Injury CFR were consistently higher among travellers.ConclusionsIrish travellers continue to bear a disproportionate burden of injury, which calls for scaling up injury prevention efforts in this group. Prevention and further research should focus on suicide, alcohol misuse and elderly injury among Irish travellers.
healthy (OR 1.9, p¼0.02), going "on the road" at least twice in the last year (OR 2.3, p¼0.03) and a brisk walk at least once in the last week (OR 2.4, p¼0.000). Good SRH was inversely associated with increasing age-group (p¼0.000), smoking (OR 0.6, p¼0.03), activitylimiting ill health for $1 day in the last month (OR 0.4, p¼0.001), chronic health condition diagnosed by the GP (OR 0.4, p¼0.002), and having been screened for hypertension, high cholesterol or diabetes (OR 0.6, p¼0.03). Conclusion There is a clear relationship between established health determinants and SRH in the Traveller community, suggesting the importance of both material and psychosocial factors. The directionality of the relationship between cultural factors and lifestyle cannot be inferred in these models. Traveller mortality in ROI is nearly three and a half times higher than that of the general population (SMR 348; 95% CI 298 to 397). This compares with a corresponding SMR of 254 calculated in 1987. Though general population mortality (age-adjusted) has declined by 35% over the past 20 years, Traveller mortality has only dropped by 13%, thus widening the mortality gap. Males have a significantly higher mortality than females with an SMR of 469 (95% CI 387 to 552) compared to a female SMR of 232 (95% CI 175 to 289). With a standard set of general population mortality rates in those aged 15 years and over, Travellers had an SMR of 277 (95% CI 235 to 319) compared to an SMR of 232 (95% CI 227 to 237) in the lower socioeconomic group of the general population. Conclusion Mortality among Irish Travellers has declined over the past 20 years but at a slower rate than that of the general population; the gap between Travellers and the general population has widened, particularly in males. The current gap is larger than that between the lower socio-economic group and the general ROI population. The results highlight the value of mortality measurement in uncovering health trends and health inequalities. Objective Most women who stop smoking during their pregnancy will relapse within the first 6 months after birth, with health risks to the mother and family. There have been few UK-specific studies identifying factors associated with relapse. Such information would help health care providers identify those most at risk so that extra support and resources can be targeted. We examined whether a small set of factors that are potentially readily measured or observable in routine health care settings were associated with women at risk for relapse postpartum. Design and setting Analysis of the first wave of the Millennium Cohort Study. Variables in the final model were selected using backwards logistic regression weighted to account for the complex survey design. Participants 2353 natural mothers who reported quitting smoking during their pregnancy. Main outcome measure Postpartum smoking relapse. Results 58% of mothers who quit during pregnancy were smoking again at 9 months. Only 16.2% of smoking couples quit together. The strongest risk factors were rela...
Objectives: Irish Travellers are an indigenous ethnic minority population in Ireland, with poor life expectancy. This study aims to identify factors associated with reported discrimination and how this affects their experiences of accessing and quality of health services, including mental health. Methods: The All Ireland Traveller Health Study was a cross-sectional census study in 2010. All Traveller families completed a survey questionnaire (n = 6540), and at random an adult selected from the family completed either a health status (health status study = 1547) or health services utilisation survey (HSU = 1576). Experience of discrimination (EOD) from the census was analysed in relation to HSU data on services used in the previous 12 months and reported experiences of access and quality of that health service. Census variables were analysed in relation to EOD and perceived discrimination (PD). Results: In the final models, EOD and PD were significantly associated with socio-demographic, socio-cultural and living conditions. The multivariate odds of reporting EOD ranged from OR 1.84 to 2.13 and were significant for those reporting worse opportunities in accessing health services, mental health (p = 0.001), hospitals (p < 0.001) and public health nurses (p < 0.001). The multivariate odds of reporting EOD ranged from OR 1.95 to 2.71 and remained significant for those who reported they had poorer experiences than others when using health services, quality of experience (OR 2.18, p =< 0.001), trust in providers (OR 1.95, p =< 0.001) and appropriate information (OR 2.71, p =< 0.001). Conclusions: Travellers experience high levels of discrimination which negatively affects their engagement with health services. Culturally competent services need to be developed.
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