Mr. Patrick Reilly:

On behalf of Pavee Point Traveller and Roma Centre, I warmly welcome the opportunity to speak today on this historic day when Travellers take the floor in the Seanad Chamber. We acknowledge Senator Flynn for her leadership to date on promoting Traveller and Roma rights, particularly in the Seanad and through her work on the Oireachtas joint committee.

Given the limited time and the complexities of the issues we wish to highlight, we will focus on key issues and recommendations as related to Traveller health. Nearly 40 years since Pavee Point was established, we have always undertaken a social determinants approach to health, with the need to ensure both targeting and mainstreaming of Travellers in policy and service provision.

We know that 90% of what affects a person’s health happens outside of the medical system. That means living conditions, poverty, employment, educational attainment, racism and discrimination all affect Travellers' health outcomes. Travellers' health is affected by Travellers not getting jobs, not being supported in school and living in bad conditions, with no services. If we are to realistically address Traveller health inequalities, other Departments have to also address the determinants.

Next year will mark 15 years since the publication of the very comprehensive All Ireland Traveller Health Study, which took three and a half years to complete, cost the taxpayer €1.3 million and involved a significant amount of work between Traveller organisations, Traveller researchers and researchers in UCD. This study had an 80% participation rate, which is unheard of, particularly with a so-called hard-to-reach group. The study showed that Travellers have one of the lowest life expectancies of any other minority ethnic group in Ireland. The overall Traveller life expectancy is 66 years. This is 15 years less for Traveller men and 12 years less for Traveller women. Infant mortality is almost four times higher than the national rate and Traveller mortality is three and a half times higher. Traveller suicide is seven times higher and accounts for 11% of Traveller deaths. The study found that only eight Travellers were over the age of 80 years.

The study also showed that systemic racism exists within the health services. Less than half of all Travellers had complete trust in healthcare professionals compared with the trust level found in the general population. More than half of Travellers were concerned about the quality of care they received when engaging with health services. Some 40% of Travellers reported discrimination in accessing health services and this finding was supported by the almost seven out of ten service providers who agreed that their services discriminated against Travellers. We know from the study that Travellers are dying of the same causes as the general population, not of some rare or exotic diseases. We are talking about cancer, CVD and respiratory issues, but in far greater numbers. What does that tell you? Travellers are not getting access to timely or quality care and, as a result, we are dying.

While the All Ireland Traveller Health Study was published in 2010, its findings have been endorsed by a number of State surveys and research reports, including recent census research and research conducted by the European Union Agency for Fundamental Rights in 2019. Traveller organisations do not need another All Ireland Traveller Health Study to tell us what we know - that Traveller health status is poor. What we need is the State to use this evidence to prioritise and resource Traveller health so that we can have better outcomes.

We also need evidence from the State through ethnic data to show where the gaps are and where things are working well.

In 2022 after years of lobbying, the HSE published a long-awaited national Traveller health action plan. It was welcomed by Travellers and Traveller organisations, particularly for the fact that it had an accompanying budget and monitoring structure, the first time since 2008 that Traveller health has received additional core funding. If fully implemented, the plan has the potential to address key concerns relating to Traveller health. However, there is an urgent need for new core funding to implement the plan. Traveller organisations and primary health care projects cannot realistically be expected to deliver on these actions with once-off funding and without any additional core funding. Traveller community health workers, mostly Traveller women, employed by these projects, are working on the minimum wage, for 12 hours a week and expected to deliver on a range of actions while also responding to emerging issues on the ground. These workers are living and working within the community and work far beyond the 12 hours for which they are paid. We are seeing good workers leave the sector as a result and there is an urgent need to address this. These projects, which have been in existence for almost 30 years and operating throughout the country, are recognised as the cornerstone of which health services are delivered effectively to Travellers. In fact, the vast majority, some 86% of Travellers, report accessing health information from the primary healthcare Traveller projects. These projects need to be valued and strengthened so that this vital work can continue and be sustained in the future.

We saw through Covid-19 what can be achieved when there is political will and cross-departmental work and partnership. Travellers and Traveller organisations effectively saved Travellers’ lives during

this time and there was goodwill, support and collaboration from colleagues in the HSE and other Departments in working with us. We need to continue this approach moving forward. Where there is a will there is a way.

Despite these challenges, we remain hopeful that we can work together to address the issues I have spoken about. Traveller organisations are ready, willing and able. The Seanad has an important role

to play in showing leadership and ensuring that those who are marginalised have a voice. We hope from today that the Traveller voice from this Chamber will be stronger and can affect real change on the ground. It is in this context that we recommend: fully implementing the recommendations in the Final Report of the Joint Committee on Key Issues affecting the Traveller Community; fully implementing and resourcing the national Traveller health action plan; ensuring Traveller health is prioritised within the Department of Health and a whole-of-department approach to addressing Traveller health inequalities. We also recommend that the Traveller-specific health infrastructure, including Traveller health units and Traveller primary health care projects, should be protected and receive increased resources for their

expansion and development in line with the national Traveller and Roma inclusion strategy under action 76; and that ethnic equality monitoring be implemented across all routine administrative data collection

systems to support the development of health indicators to monitor Traveller and Roma access, participation and outcomes in health.

I want to end on some positive news regarding a colleague of ours, Missie Collins. In recognition of her trailblazing work and decades-long track record in addressing Traveller rights and equality, specifically in the area of Traveller health, Missie Collins will be awarded an honorary degree of doctor of science by University College Dublin in September 2024. This is a significant achievement for Missie. It is also an important acknowledgement of the work of Pavee Point and all the Traveller primary healthcare workers, including those who are no longer with us, in their work to advance Traveller rights. We congratulate Missie Collins. From September onwards, she will be knows as Dr. Missie Collins.