Introduction: health inequalities experienced by Gypsies and Travellers

Previous dearth of research evidence

The lack of reliable research evidence on the health of Gypsies and Travellers in the United Kingdom (UK) prior to 2004 had been widely acknowledged in reviews (Hajioff and McKee, 2000; Doyal et al, 2002; Smart et al, 2003; Zeman, 2003). In 2002, Doyal et al's comprehensive review of studies concerning the health of Gypsies and Travellers in the UK and Ireland reported that there had been no studies that had attempted any systematic comparison of the health status of Gypsies and Travellers with the wider population and that most studies in the review were small scale and anecdotal.

The focus of the studies was virtually limited to the area of maternal and child health, with a particular emphasis on immunisation, consanguinity and congenital anomalies. As Atkin and Chattoo (2006) observe, this particular limited health focus can be problematic, particularly if prior causal assumptions are made, and if the minority ethnic health experience is misrepresented by use of stereotypical myths to explain beliefs and behaviour: ‘this results in research often blaming ethnic minority communities for the problems they experience, because of their deviant, unsatisfactory and pathological lifestyles’ (2006, p 102).

Behavioural and cultural explanations for health inequalities can be used to avoid contextualised examination of structural explanations. Ahmad (2000) reviewed evidence of health and social care problems among minority ethnic communities that are identified as arising from cultural practices. By reifying and essentialising ethnic categories, such research suggests that ethnicity is a cause of health differences. This pathologisation of culture is an example of the risk of poorly designed and poorly interpreted research that fails to contextualise the broader issues. However, there are notable exceptions. For example, in studies of Gypsy and Traveller healthcare (Pahl and Vaile, 1986; Feder, 1989), the authors demonstrated high perinatal and infant mortality rates as important areas of health inequality, and they reported an association with poor environmental conditions and with the experience of oppression; they also focused on inequity in access to healthcare.

However, it is over 20 years since those studies and there had been scarce attention paid to the findings in respect of either further research or policy measures.