Mr. Jim Walsh:

I am the principal officer in the Department of Health with responsibility for co-ordinating policy on health services for Travellers. I am accompanied by my colleague, Ms Dairearca Ní Néill, who is the assistant principal officer with specific responsibility for Traveller health matters.

I am relatively new to the post but I come with much understanding of Traveller and inequality issues, having worked with the Combat Poverty Agency and the social inclusion division of the Department of Employment Affairs and Social Protection. I have much understanding of the issues and concerns raised by the previous speakers this morning.

The all-Ireland Traveller health study was an initiative of the Department of Health, which also funded it. It reflected a concern about the health status of Travellers. We have heard many of the figures. Travellers have more illnesses and die younger. They are at greater risk of substance misuse and mental health problems. The all-Ireland Traveller health study highlighted that these health inequalities are rooted in the social determinants of health which encompass accommodation, education, employment and discrimination. There is great acceptance of this, at least in the Department of Health.

The Department of Health provides funding of €10 million a year to the HSE for initiatives specifically targeting the improvement of health outcomes for the Traveller community. Other funding is provided by other sources, including the mental health budget from the social inclusion programme. A further €500,000 funding is provided through the Dormant Accounts Fund. As the HSE will attend the committee at a later stage, I will not go into the detail as to how these resources are spent in supporting primary healthcare initiatives. We must acknowledge, however, that the model of work developed through those primary healthcare initiatives highlighted here. This model of peer working and engagement with Travellers should be used across our public services. Much credit is due to those who have been pioneering those initiatives. It is part of our delivery of health services.

I want to focus on some examples of health policy at national level which support the Traveller community and illustrate the challenges in meeting the health needs of Travellers.

The first is the national positive ageing strategy. As we have heard, ageing is a key issue for Traveller health. The most recent figures we have are for 2018 and indicate that 3% of Travellers were aged over 65, compared with 13% of the general population. It is clear that Travellers die younger. A particular issue in addressing positive ageing for Travellers in the strategy is the lack of disaggregated data on ethic status, which are required to monitor and address their health needs. That issue has been highlighted at the committee. To address this deficit, the healthy and positive ageing initiative developed a bespoke set of 14 indicators of positive ageing for Travellers which was published in May following extensive consultation with members of the Traveller community. There are two interesting elements to the indicators developed. First, the threshold for positive ageing was reduced from 50 years to 40 years, reflecting the fact that Travellers die up to ten years younger than the general population. Second, they took on board very specific issues regarding Traveller accommodation which may not affect the rest of the population. We drew up customised indicators to monitor positive ageing for the Traveller population. This reflects a commitment in the national positive ageing strategy to change mindsets, promote social inclusion and pay particular attention to the needs of marginalised groups.

The second example to which I wish to refer is the national drugs strategy, an area for which I am responsible within the Department. The use and misuse of drugs and alcohol is an important concern for the Traveller population. More than 300 Travellers were treated for problem drug use in 2017, which represents 3.7% of all those attending for treatment and indicates that Travellers are five times more likely to receive such treatment compared with the general population. One of the actions of the national drugs strategy, Reducing Harm, Supporting Recovery, is to improve access to addiction services for people from the Traveller community who use drugs. There are particular challenges in engaging Travellers in drug services and these arise from the stigma associated with drug use among the Traveller community, especially among males. My written submission outlines some initiatives by task forces in particular to try to engage in a culturally appropriate way with Travellers facing addiction issues.