Clare Daly (Dublin North, United Left)
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771. To ask the Minister for Health his views on the research done by Pavee Point that infant mortality rates for Travellers is 3.6 times higher than the national average for settled persons and 1.4 times higher for Roma children. [41970/14]

Leo Varadkar (Dublin West, Fine Gael)
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Healthy Ireland, A Framework for Improved Health and Wellbeing 2013-2025is the national framework for action to improve the health and wellbeing of the country over the coming generation. Healthy Irelandincludes a high-level goal to reduce the health inequalities experienced by many people in Ireland, including Travellers.

The All Ireland Traveller Health Study 2010 found that the infant mortality rate for Travellers is 3.5 times the rate of the general population (4 infant deaths per 1,000 in the national population compared to 14 infant deaths per 1,000 in the Traveller population). The Birth Cohort Follow-Up Report of the All Ireland Traveller Health Study showed that Traveller mothers have a shorter birth gap between pregnancies, and higher parity and stillbirth rates, when compared to the general population.

These findings form part of a number of related figures confirming the poor health status of Travellers in comparison to that of the general population, acknowledging that Social Determinants are a major cause of the poor health status of Travellers, with aspects of accommodation, education, employment, poverty, discrimination, lifestyle and access and utilisation of services being cited as key sociodeterminants in this regard.

Traveller health continues to be a priority for the HSE and they continue to work in collaboration with the Traveller community with the common goal of improving the health outcomes of this group, including reduction of infant mortality. There are a number of targeted structures and interventions in place to address the disadvantaged status of Travellers and these include:

- From a health service perspective, the HSE National Traveller Health Advisory Forum - comprising HSE staff, Traveller Health Unit and Traveller representatives – is a key body coordinating and driving a series of health related actions aimed at improving the overall health status of Travellers.

- The HSE supports improvement in Traveller health through working in partnership with Travellers via Traveller Health Units (THUs) towards addressing priority areas.

- In terms of child health, Public Health Nurses and Public Health Specialists work with THUs in relation to any awareness of risk to the community and also provide support around immunisations and development needs of Traveller children.

- The development of Traveller Primary Healthcare Programmes whereby Traveller Community Health Workers are employed as liaison staff with their own community is a proven model of good practice.

- Peer-led health education and awareness raising programmes among Travellers are key elements of this approach. Examples of particular initiatives aimed at improving child health and reducing mortality include provision of leaflets on Post-Natal Depression and a Galactosaemia awareness leaflet

Promoting access to antenatal care is an important area of work for Traveller Community Health Workers, and associated HSE staff, and while there are still concerns that 2.1% of Traveller mothers had no ante-natal care (compared to 0.2% of the general population) the following figures illustrate that there is some of the progress in this area, with:

- 22.5% of Traveller mothers now present for the first booking visit to the hospital for antenatal services, this rates is almost the same as the general population (28% at 3 months) and

- 81.5% of Traveller mothers share ante-natal care between maternity hospitals and General Practitioners compared to 76.6% of the general population.

Continuing to support Traveller mothers to access obstetric services remains a priority action. An example of a Traveller specific intervention here is an antenatal programme through which Traveller Community Health Workers support key messages of antenatal care and link Travellers into local classes through focussed education and appropriate support.

Another key initiative in relation to Traveller children that has been successfully developed and delivered includes the Traveller specific Child Safety Awareness Programme - this is a structured programme covering many areas of risk and safety for Traveller parents with the aim of reducing and preventing ‘unintentional injury’ to children in the 0-5 age group within the home.

The goal in Healthy Irelandto reduce health inequalities requires not only interventions to target particular health risks but also a focus on addressing these wider social determinants of health. The Framework provides for new arrangements to ensure effective co-operation between the health sector and other areas of Government and public services that are concerned with these broad determinants of health, including those of importance and relevance to all of those persons who experience health inequalities, including Travellers. Empowerment of communities is a particularly relevant principle in respect of supporting members of the Traveller community to response to challenges around their health and health needs. In this context, the new structures established under Healthy Ireland to enable and support its implementation will provide a focus on addressing the health needs of all groups experiencing health inequalities, including Travellers, and provides an opportunity to take a new approach to tackling issues such as health inequalities and the social determinants of health more effectively.