Ms Deirdre O'Reilly:

On silos and a lack of proper access to health services, one of the big questions for me is how we address the historical marginalisation and racism that has impacted on the community. I work in counties Cork and Kerry and have the privilege of working with some of the other delegates who are present. Silos can occur and people can be left out or marginalised further. If we wish to address the marginalisation of the community, we must take two approaches, namely, a targeted approach and a mainstream approach. Those types of approaches run the risk of becoming worse or siloed unless there is genuine commitment to Traveller leadership, Traveller voice and community development through an empowering model. Those of us in the HSE must listen when we are told that we are getting it wrong or that the Traveller community has an approach which it knows works within its community. It is always very important to explore such options. One can look at the issue through equality frameworks and analyse whether the targeted work we are doing is genuine or indirectly creating worse situations. The latter is something we never want to happen. It is a very good question. In counties Cork and Kerry, we try to work from a community development approach. We do not view the social determinants of health as aspects of health that are outside the control of the HSE but, rather, try to work closely and, it is to be hoped, respectfully with Traveller organisations in the area to see what we can do to address the health inequalities caused by discrimination, lack of education or poor accommodation. We explore whether there is something we can do to influence these factors or ensure the voices of various groups are heard. People have differing understandings of these matters. It is a very good question. There are many ways we can ensure that, rather than creating another silo, we genuinely address historical marginalisation.