Ms Breda O'Donoghue:

I thank members of the joint committee for inviting us here today and giving us this opportunity to speak. I have been asked to discuss the key issues relating to Traveller health and its impact on our community. When looking at the key issues impacting Traveller health and the community, we must first look at the root cause of these issues. Putting another way, we must ask what is killing Travellers today. There is one answer which is racism. Over the past 50 plus years, specifically since the 1963 Commission on Itinerancy, Travellers have lived in a hostile environment, where our culture and identity was to be absorbed into the settled community and our very existence repeatedly seen and referenced as a problem. While we understand that this commission's report is out of print and, as some of us would argue, is obsolete, its legacy has affected the lives of Travellers to this day. We are seeing the product of a systemic cultural denial and discrimination in our public services from education to social welfare, private enterprises, employment opportunities, accommodation and media. The effect of this historical assimilation programme on mental and physical health has impacted the Traveller community severely, leading to suicide and mental health being at crisis point, which has been rightly recognised as such by the Minister of State at the Department of Health, Deputy Jim Daly.

At the Traveller Visibility Group, TVG, our primary healthcare workers meet on a daily basis with Travellers living in Cork. They see how a mistrust of public services, based on discriminatory attitudes and behaviours of staff, and how policies have deterred Travellers from using these services effectively. Travellers feel they are constantly struggling and resisting discrimination in their daily lives, where they witness their children struggling in schools and have their own issues with employment opportunities and appropriate accommodation.

While the social determinants of health and their effect on the general Traveller community are all important factors, accommodation is widely acknowledged as the key issue causing health inequalities for Travellers. As reflected in the social determinants of health, if one's living conditions are poor, this directly impacts on one's physical and mental health, education, employment and general well-being. The vast majority of local authority halting sites are overcrowded, badly-managed, poorly serviced, under-funded and unhygienic. Put simply, these halting sites are not fit for purpose and lead to illness, injury and stress caused by an overcrowded and high-risk living environment. We note that in some cases these confined conditions can lead to community disputes around sharing very limited spaces and facilities. As noted above, poor living conditions lead to poor health. Cardiovascular, dietary and respiratory problems are common within the Traveller community and can be directly linked to poor living conditions.

Suicide and mental health within the Traveller community is at crisis point. This can again be linked to the poor living conditions and isolation felt as a result of the poor management of Traveller accommodation. The situation is clear. Travellers living conditions and the social determinants of health have worsened since the 1963 commission. The lives of Travellers are directly impacted by an accommodation and a mental health crisis that directly impacts their physical health and many of these issues are caused by historic assimilation and discrimination. We need to distance ourselves now from reports and recommendations and start a genuine programme of legislation by creating sanctions to ultimately fix the cultural denial and racism issues that impact so drastically on Travellers lives and their children's future.

In general, Travellers tend to use health services as a last resort, often ignoring ailments or health issues until they are at emergency point. Prevention and early intervention are key to improving and addressing health inequalities and this is directly linked to improving relationships and communication between health services and the Traveller community. The statistics featured in reports such as the All Ireland Traveller Health Study paint a clear yet stark picture that Travellers are dying younger than the settled community.

They are seven times more likely to commit suicide and 50 times more likely to finish school without a leaving certificate.

While this information may sound alarming today, the sad fact is that it is not shocking news within the Traveller community. In fact, it is almost identical to the statistics in the last Traveller health study in 1987. As Travellers, we can see this in front of our eyes every day. We have a situation where many Travellers are not accessing health services, for various reasons. However, it has been reported that when Travellers access these services, they often feel the services do not reflect the needs of the Traveller community. One example is that written correspondence is often delivered to another person on a halting site or maybe not delivered at all. Whether this is for genuine reasons or otherwise, the fact remains that most Travellers on halting sites miss very important appointments due to lack of postal delivery.

When using health services, Travellers have a fear of the response they will get when presenting with an issue, particularly around children's health, at accident and emergency units. Many Travellers fear the hospital staff will make assumptions about an injury or illness that has occurred and fear blame for the situation. There is an increasing fear of hospital staff contacting Tusla or other social welfare services because of assumptions that are made about the way Travellers treat their children. While we appreciate and welcome the need to be vigilant for children's safety, time and again we see instances of Travellers being treated with distrust and suspicion within the health services, and this creates fear and mistrust among the Traveller community.

To look at health initiatives to support the Traveller community, there is clear evidence that Traveller-led health initiatives, organisations and peer-support workers build trust within the community and, from this, there is a willingness to engage more with public services. The primary health care programme and the development workers in Traveller organisations play a vital role in assuring Traveller engagement with public services. There is better uptake of health initiatives and services like screening and health checks when communicated by peers to the community. When provided with supportive and accessible information, it has been noted that there is a higher uptake and use of such services. For example, more Traveller women take part in cervical smear tests and breast checks than settled women, which is directly linked to the support of Traveller primary health care workers.

The strong relationship and knowledge sharing within the Traveller organisations is a huge support to the Traveller community on a local and national level. The support and representation of national Traveller organisations in policy and advocacy work is hugely valuable, and continued investment and support is essential. Training and capacity building within the Traveller community is vital to promoting health and well-being. Currently, Travellers are more inclined to engage with health awareness programmes or other training when Traveller organisations are directly involved in delivering the training. More support of such programmes is necessary and would have productive outcomes.

While we acknowledge that this peer support is vital, we need to see development within the public services to encourage Travellers to be able to use these services directly, with reduced or little support from Traveller organisations. Traveller cultural awareness training should be funded properly and adapted to ensure that all public service staff, especially customer facing officers, are fully aware of Traveller culture and can engage with their customers in a culturally appropriate manner. In order for Traveller culture to be understood and appreciated, Traveller cultural awareness training should be mandatory as part of public service staff induction training. Refresher training for longer-term staff should take place on a regular basis in such services as health, education, social welfare and local authority services, which are the main areas affecting the social requirements of Traveller health and well-being.

It is not good enough for front-line public staff who work directly with Travellers to have no understanding or background knowledge of the Traveller community. Travellers are part of Irish society and need to be treated as such, with the same understanding and nuance that would be afforded to any individual coming in, looking for assistance from a public service.

I have spoken to the committee today about the key issues affecting Traveller health and the community. At its root is an historic policy that has been in play for over 50 years. This needs to change and everybody has a responsibility to drive this change. There is an institutional prejudice that has been passed down from a group of people who saw us as a problem, not a people.

We have moved a lot in some ways, in that Travellers are recognised as an ethnic group and not something to be absorbed into the general community as the 1963 commission hoped for. While on paper we are recognised as an ethnic minority, the reality is the deep-rooted feelings of mistrust towards my community have not changed or moved on. Until they do, then and only then will we start to see a positive change in the health status of the Traveller community.

For the past 20 or 30 years, Travellers have consulted with Government bodies on what can be done for the Traveller community. We have sat on countless committees and boards to advise and assist. While we must recognise there has been some positive change in this period, we must also agree the process is slow and, in some areas, ineffective. The time for recommendations is over. We need real support and resolute actions where the recommended budgets, guidelines and plans are fully realised and brought into everyday life. There is no more we can do to assist in the societal change that is necessary to improve the lives of Travellers in Ireland. We consult but who decides?