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Reducing health inequalities

Gypsy and Traveller communities, along with other socially marginalised groups such as sex workers, immigrants and the homeless, often experience barriers to health and social care provision. Researchers at Northumbria University, and the four other universities that make up Fuse, are examining the factors responsible for exclusion, as well as the effectiveness of existing strategies that tackle the issue. The work is having a significant impact – innovative tools are assisting healthcare providers in the development of outreach interventions for vulnerable groups and research findings are influencing national advice services and policy makers.

Compared to the general population, socially marginalised groups, such as Gypsy and Traveller communities, suffer from poorer health and lower life expectancy. These groups have higher rates of infant and maternal mortality, mental health issues and long-term illness such as diabetes and asthma, and life expectancy is significantly reduced. Gypsies and Travellers experience a range of barriers and issues to healthcare provision, particularly primary care services – they often experience discrimination and therefore distrust health professionals to provide adequate care. Sophisticated strategies are required to tackle health inequalities and improve the life chances of such groups.

A team of Fuse researchers, including Professor Susan Carr, Professor of Public Health Research at Northumbria University and Associate Director of Fuse, in collaboration with public health practitioners and third sector organisations, is conducting research that aims to identify the factors responsible for the discord between health and social care providers and the disenfranchised communities they serve. The team is investigating the effectiveness of response strategies such as outreach and peer interventions, together with the impact of lay health advisers on healthcare provision uptake within vulnerable groups. This large body of research has significant implications for the management and delivery of healthcare provision for marginalised populations.

The researchers continue to take opportunities to work with health and social care providers to create effective outreach interventions for vulnerable groups. To facilitate success, the team has produced a pioneering decision-making template to guide the design, implementation and commissioning of such programmes. The tool was distributed to public health directors and third sector organisations and was made available online. It was also shared with corporate government stakeholders in the Northern Territory of Australia, who have commented positively on its applicability. Those that work with remote indigenous communities, where the strength of the relationships with children, their families and the community elders/leaders is highly valued, appreciated the comprehensive guidance the tool provided on working with vulnerable people and communities. Professor Carr and her colleagues are currently in discussions with a range of public health agencies regarding the tool’s utility on a national scale.

Research findings have been used by advice services, notably, Citizens Advice (CA), in strengthening impact reports and marketing materials, and securing funding that might otherwise have been lost. This includes two Clinical Commissioning Group contracts, valued at around £70K. These services reach an average of 500 clients per year, who would have been personally affected by the withdrawal of this funding. In addition, the research itself, along with the engagement of Professor Carr and her team, have positively impacted CA staff confidence and research capacity. It has also fed into wider strategic conversations, including within a regional health partnership, and been circulated nationally within the CA network.

At the policy level, the research has been cited by the Department of Health funded National Gypsy and Traveller Inclusion Health project, which “makes actionable recommendations to Government” and by Involve as a case study for good patient and public involvement. Furthermore, Professor Carr and other researchers submitted written evidence to the Women and Equalities Committee of the House of Commons’ open inquiry into the inequalities faced by Gypsy, Roma and Traveller communities. The work may also have implications for the National Inclusion Health Board.


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