The recently announced study designed to determine why the health of Travellers is worse than that of the general population must not avoid examining sensitive cultural and lifestyle issues, argues Felim O'Rourke
The setting up of the All Ireland Traveller Health Study is to be welcomed. This study may however present greater difficulties than that normally found in studies of health issues.
Health studies are usually not directly political and it is easy to reach evidence-based conclusions. Prof Cecily Kelleher of UCD, who is the team leader, has emphasised that the conclusions of this study will be "evidence based". This may not be easy with this study as its conclusions will have direct political implications.
In addition to addressing the particular health issues facing Travellers, the study will have to assess the degree to which the community's culture and lifestyle, including nomadism, impacts on Travellers' health.
If this study concludes that the community's culture and lifestyle impacts adversely on Travellers' health, then this conclusion will be strongly resisted by service providers and Travellers' organisations.
Many of the service providers and Travellers' organisations are committed to a view that Travellers' culture and lifestyle must be preserved and most of the people involved subscribe to the view that Travellers should be regarded as a distinct ethnic group.
If this study concludes that Travellers' culture and lifestyle adversely impacts on the com- munity's health, then it will significantly undermine the case for special treatment for Travellers and provide strong support for a policy shift towards an objective of full integration of Travellers into the overall community.
In her remarks at the launch of the study, Minister for Health Mary Harney stated that the study will build on the 1987 Health Research Board (HRB) study, which was led by Dr Joe Barry.
The difficulty with this study is that although it provided insights into Travellers' health issues, it also provided evidence that culture and lifestyle impacted adversely on the community's health. The study in particular drew attention to the very high death rate in accidents and the higher mortality associated with living in caravans. It also, by focusing on the very high rate of childhood metabolic defects, drew attention to the sensitive issue of marriage between close blood relatives.
The report of the Taskforce on the Traveller Community in 1995 questioned the HRB's findings. This can be seen clearly on page 136, where it argued against the validity of the findings of the HRB in the areas of the suitability of caravans and consanguinity.
The Traveller Health Strategy, produced by the Department of Health in 2002, ignored the work of the HRB and reached what can only be described as "ideology-based" conclusions instead of conclusions based on evidence.
The strategy, in discussing the health problems and reduced life expectation of the community, said on page 4 that "among the most important factors contributing to this situation are social exclusion, the influence of a harsh living environment and racism".
The department ignored the HRB's findings about accidents, living in caravans and consanguinity. It also ignored issues closely linked to health such as diet, exercise and education in favour of "ideology-based" conclusions.
There is one other interesting finding from the HRB study that has been consistently ignored. The 1986 census recorded a total of 15,888 Travellers. The HRB's research group attempted to record all births and deaths in that community during 1987. In 1987, the research group recorded 554 live births and 84 deaths. Therefore, the death rate for the community was 5.3 per thousand, compared with a death rate of 8 per thousand in the settled population.
This inconvenient fact, which has been ignored, is easily explained by the age structure of the population. Travellers have large families and therefore the age distribution of the community's population is quite different to that of the settled population. Due to the relative youth of its population, it is only to be expected that the overall death rate should be lower that that of the settled community and no conclusions about Travellers' life expectancy should be reached by looking at this figure out of context.
However, there has been widespread misunderstanding and misuse of information on the age distribution of the Traveller community in another context. The Report of the Commission on Itinerancy in 1963 noted the age imbalance within the Traveller community and took this as evidence of reduced life expectancy.
More recently, the Central Statistics Office's (CSO) release, The Demographic situation of the Traveller Community in April 1996 found that only 1.3 per cent of Travellers were aged over 65, compared with 11.4 per cent of the total population. The CSO release concluded that "just over 1 per cent of the Traveller community survived beyond 65 years of age in 1996".
This conclusion by the CSO is clearly absurd. It is not possible to derive life expectancy data from looking at the age structure of a population. For example, in the total population only 11.4 per cent were aged over 65 years, but the CSO's own life tables indicate that in 2002, about 86 per cent of people survived into their 65th year.
There is widespread acceptance that only 2 per cent of Travellers live to be 65 years. This figure is based on the incorrect conclusions of the CSO.
This error has been drawn to the attention of the CSO, but their error has never been admitted and now has widespread currency. It is used to emphasis the short life expectancy of Travellers, but it is incorrect.
The very small percentage of Travellers who are aged over 65 compared with the percentage within the settled population is influenced both by life expectancy and birth rate. As an example, we can look at a particular Traveller family in the northwest.
The grandparents, both alive and in good health are in their 70s, have 19 children, over 100 grandchildren and many great-grandchildren. A family gathering of this family involves over 150 people, of whom only two are over 65. Any group with large families and a rapidly growing population will have a low percentage of older persons and no conclusion about life expectancy can be reached by looking at the age structure of that population.
The recent report entitled Travellers' Last Rites, published by the Catholic Parish of the Travelling People, made a similar error when it used information on the age of deaths among Travellers to reach conclusions about Traveller health. There is no doubt that the facts gathered in this study are accurate, but the interpretation of these facts is misleading.
The report found that 50 per cent of Travellers' deaths occurred in people under 39 years. This fact, taken out of context, implies that that the life expectancy of Travellers is very low. However, the Traveller population is very young, with about 89 per cent of all Travellers under 39 years, so one could expect that a high percentage of Traveller deaths would be from among the 89 per cent who are under 39 years.
At the release of this report last month, Jacinta Brack, according to an article by Kitty Holland in The Irish Times said that "it was vital Travellers were legally defined as an ethnic minority if their health status was to be improved". This conclusion is clearly ideology-driven.
The age structure of any population is influenced by life expectancy and birth rate. Some time ago, I attempted to build a simple population model to separate these two influences. What I tried to determine was what the age structure of a population would be if the group had the very high birth rate of Travellers and the life expectancy of the settled population. The model assumed that the population in question had the number of births growing at 4 per cent per annum, which is roughly the annual growth in births over the past 40 years in the Travelling community, and the life expectancy of the settled community based on the CSO's life tables for 1963. Remarkably, this population only has about 2 per cent aged over 65 years. The model is fairly robust in that different assumptions about birth growth rates, as long as they assume a rapid increase in births, do not substantially affect the outcome.
For the last 20 years, the particular health problems of Travellers have been used to drive an ideological agenda. There has been selective use of facts, misinterpretation of facts and attempts to discredit inconvenient facts in pursuit of special recognition for the Traveller community and latterly in pursuit of recognition of Travellers as a separate ethnic group.
The alternative approach would be full integration of Travellers into the overall community with full rights and full responsibilities. Integration of Travellers into the overall community may be beneficial both to Travellers and the overall community.
It is therefore to be welcomed that at last an attempt is being made to study in an objective and evidence-based manner the real situation with regard to Travellers' health.
Felim O'Rourke is a lecturer in economics who has written on Traveller policy occasionally over the last 30 years.