Irish Travellers and Cancer Awareness: Focusing on individual behaviours diminishes the significance of the social determinants of health.

Background: The vision for integrated care is a system that is coordinated and person-centred. However, many people experience fragmented and inequitable care. Irish Travellers, a minority ethnic group with around 45,000 people, face reduced life expectancy, poorer health outcomes, systemic racism, and the effects of broader social determinants of health. Systemic racism within mainstream health services contributes to inequalities in access, participation, and outcomes for Irish Travellers.

Although often unconscious or hidden, racism is frequently systemic and structural. 3 Braverman suggests that systemic and structural racism can exist within systems, laws, and policies—both written and unwritten—and result in negative health effects, often remaining invisible to those unaffected. Our study aimed to understand cancer awareness among Irish Travellers and to identify barriers and facilitators to cancer awareness and preventive screening.

 

Approach: Qualitative interviews were undertaken with Travellers [November 2023 to February 2024] following ethical approval [RCPI RECSAF 191] as part of a larger multi-method co-designed study with Pavee Point Traveller and Roma Centre, a national Traveller organisation with recognised expertise in Traveller health.

Recruitment and organisation of interviews were led by Traveller Health Workers working in Traveller organisations and Traveller Primary Health Care Traveller Projects in partnership with UCD researchers. Face-to-face interviews were digitally recorded by researchers, with consent, and transcribed verbatim. We conducted 22 interviews, employing thematic analysis methods, identifying barriers and facilitators to cancer awareness.

 

Results:Participants highlight the influence of family, traditions that encompass religion and personal values, and the need for individual privacy. Religiosity among Travellers can result in "burying [one’s] head in the sand' or praying for a miracle cure. However, structural racism was evident when Travellers were accessing primary care and is demonstrated in the following three examples: 1) a lack of gender appropriate services for men if it’s prostate cancer and if it’s a woman GP, … there’s some concerns and sensitivities there for Traveller men and [..] for Traveller women if they’re seeing a male doctor’; 2) appointment delays ‘ it's nowadays the doctor you could be waiting up to a week for an appointment’ 3) a lack of privacy ‘how can you tell your problems, especially private problems, to a secretary, not the doctor’.

 

Implications: Structural and systemic racism limit Travellers’ cancer awareness, equality of access to healthcare and health outcomes. Working in partnership with Traveller organisations and Traveller Community Health Workers is critical to reduce systemic inequity; targeted efforts and mainstreaming of Traveller health are required.

 

References

1. All-Ireland Traveller Health Study [Internet]. gov.ie. 2020. Available from: https://www.gov.ie/en/department-of-health/publications/all-ireland-traveller-health-study/
2. Health Service Executive. National Traveller Health Action Plan 2022-2027. Working together to improve the health experiences and outcomes for Travellers. [Internet]. 2022. Available from: https://www.hse.ie/eng/services/publications/socialinclusion/national-traveller-health-action-plan-2022-2027.pdf
3. Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic And Structural Racism: Definitions, Examples, Health Damages, And Approaches To Dismantling: Study examines definitions, examples, health damages, and dismantling systemic and structural racism. Health affairs. 2022 Feb 1;41(2):171-8.