Irish Travellers are a minority ethnic group, with a distinct culture, traditions, and history within Irish society. Despite representing less than 1% of the national population, Travellers remain one of the most marginalised and disadvantaged groups in Irish society, experiencing significant health inequalities, including disproportionate rates of morbidity and mortality compared to the general population.(1) Travellers have a distinctive population profile; with higher birth rates, a younger population, and higher mortality rates at a younger age. Similar population profiles can be found among other indigenous and minority ethnic groups such as the Inuit in Canada and the Aboriginal community in Australia.
Travellers have unique health needs and GPs are often trusted by their Traveller patients to provide healthcare and health information in a collaborative, culturally appropriate, and sensitive manner.
Traveller women have a life expectancy on average 11.5 years shorter than that of women in the general Irish population, while Traveller men have a life expectancy around 15 years shorter.(1) The Infant mortality rate for Travellers is 3.5 times the rate of the general population while 10% of Travellers do not reach their second birthday.(2) The suicide rate amongst Travellers is six times that of the general population, although Traveller organisations report that this may underestimate the true burden.(3) Racism, discrimination and the wider social determinants of health (e.g. poor living conditions, severe overcrowding, poverty, unemployment, poor educational attainment, and limited transport access), create significant barriers in relation to engagement with mainstream health services.(4) Literacy challenges remains a significant challenge, with poorer educational outcomes (5) and 50% of Travellers in the All-Ireland Traveller Health Study reporting poor functional literacy, that is, comprehension of the written instructions provided with prescription medicines. This would constitute a significant health concern, particularly for older Travellers.
Travellers have particular healthcare needs and preferences that healthcare professionals should be aware of in order to provide respectful and effective care. Privacy and confidentiality are highly valued, and Travellers may be reluctant to discuss sensitive issues, particularly with non-clinical staff. Fear and fatalism surrounding illnesses such as cancer may delay presentation and help-seeking.(4) Embarrassment when discussing intimate health concerns may also lead some Travellers to prefer healthcare professionals of a particular gender. In addition, some Travellers may not reliably receive post, and may therefore be unaware of pending appointments.
Trauma is a risk factor for adverse health outcomes and can have complex impacts upon the therapeutic relationship. Trauma Informed Care recognises the impact that trauma and adversity have on health and seeks to address trauma by shifting the focus from ‘what is wrong with you?’ to ‘what happened to you?’. Many Travellers have experienced systemic trauma e.g. racism, poverty, and, in addition, are affected by inter-generational trauma. GPs can help by screening for trauma, avoiding retraumatising patients, and referring for support services where necessary.
Traveller organisations and Primary Health Care Projects, which are peer-led projects operating across the country are re often the first point of contact for Traveller families in accessing health information and signposting; with 83-86% Travellers accessing health information from these projects. They are a trusted source of information for Traveller families and therefore, strong working relationships and partnerships with these projects are vital for GPs. GPs play a central role in providing accessible, continuous, and culturally safe clinical care across Travellers’ lifespan. The Traveller Health section of the curriculum aims to guide GP trainees in developing the knowledge, skills, and attitudes required to provide effective and respectful care to Traveller patients and their families. Emphasis is placed on avoiding assumptions or stereotyping, recognising Traveller diversity and promoting equitable, patient-centred care. Through clinical experience, reflective practice, tutorials, and structured teaching, trainees can develop a deeper understanding of Traveller health and their role in addressing inequities within Irish healthcare.