1. “Qualitative Methods and Health Research: Factors influencing uptakes of measles, mumps and rubella in site-dwelling Gypsies Roma and Travellers (GRT): a qualitative study of GRT parents’ beliefs and experiences” Dr. David Smith & Dr. Paul Newton Faculty of Education and Health 5th February 2016

2. …… Background Estimated 200-300,000 in the UK (not including est. 300-500,000 Roma from E and C Europe) and largest EMG in 13% of LA’s. Approx 2/3 in housing. ODPM 20-25k caravans in UK – between 85-90k people. 72% on authorised sites; 16% on unauthorised sites and 12% on unauthorised encampments where they own the land but do not have planning permission. Poorest educational status 23% of Gypsy and Traveller children and 42% of Irish Traveller children receive 5 GCSE’s grade A-C compared to 55% for the general population. Highest level of permanent exclusions, SEN diagnosis etc. By KS3 only 20-25% are registered or regularly attend school.

3. GRTs and health Results of the quantitative findings show that Gypsy Travellers have significantly poorer health status and significantly more self-reported symptoms of ill health than other UK-resident, English speaking ethnic minorities and economically disadvantaged white UK residents…with reported health problems between twice and five times more prevalent Parry, G. et al (2004) Greater health need yet lower access than other members of the population.

4. Mental health: 32% of Gypsies and Travellers suffer from depression or anxiety compared to 21% of the general population and low take up of mental health services (Goward, P. et al, 2006) Life expectancy: on average women live 12 years and men 10 years less than the general population (CRE, 2004) But GTAA’s give a more mixed picture highlighting the role of accommodation and access to medical care. Parry (2004) 1/3 of Gypsy women had experienced one or more miscarriages compared to 16% of non Gypsy women and 17% of women had experienced the death of a child (excluding miscarriage) compared to less than 1% of the comparator group.

5. Immunisation and MMR Lack of systematic evidence on MMR take up – small scale local studies. Twiselton and Huntington, (2009) Only 20 per cent of those living in caravans or trailers and 57 per cent of those in housing fully immunised. Dar et al (2013) only 4 of 22 PCTs estimated MMR coverage of 90 per cent or above on Gypsy/Traveller sites in their region. Clusters of measles outbreaks reported e.g in the Thames Valley region 63 per cent of outbreaks between 2006 and 2009 were in GRT communities, x100 higher than the general population (Maduma-Butsche and McCarthy, 2012). March - June 2007, of 173 cases of measles reported in seven UK regions 156 were in Irish Traveller communities (Cohuet et al, 2009).

6. Culture and Health Role of cultural attitudes, beliefs and practices in explaining poor health outcomes of GRTs e.g fatalism, stoicism, suspiciousness, concepts of hygiene and taboo (Vivian and Dundes, 2004; Dion, 2008). Critics – can complement a ‘cultural deprivation’ framework for explaining health inequalities. Alleyne (2002) the ‘ethnic community’ concept presents an ‘epistemological obstacle’ when used as an explanation rather than something to be explained. Minimises the role of social structural factors and obscures the direction of causal processes. Aim – to explore social/contextual issues that frame GRT parents decision making re: MMR and its relation to underlying social structures

7. Policy Implications Policy implications – stress on ‘cultural barriers’ and perception of GRTs as ‘hard to reach’ legitimises minimal progress in reducing inequalities. Replicated in views of many health professionals and practitioners. Structural inequalities, discrimination and exclusion main causes of poor health – policies should be focused on reducing social and economic inequalities. Lack of political will e.g UK government’s failure to develop a National Strategy for Roma Inclusion – mainstreaming approach In the UK we have a strong and well-established legal framework to combat discrimination and promote equality. That protects all individuals, including Roma, Gypsies and Travellers from racial and other forms of discrimination (UK National Strategy section 2)

8. BLAH

18.  Quality Improvement  Increasing Outputs  Streamlining processes  Cascading skills  Research Leadership  Targeting Resources e.g. Internal Peer Review, funding & publication ladder e.g. Sequentially-staged article ‘ladder’ e.g. Structured ‘in-house’ training, template and review processes e.g. Mentorship & peer-to-peer support and feedback Mapping of current skills with forward improvement plan e.g. Funding ‘ladder’, easily monitored and assessed Conclusions

19. Any questions?

20. Dr Paul Newton & Dr David Smith D.M.Smith@greenwich.ac.uk P.D.Newton@greenwich.ac.uk Tel: 0208 331 7768