An app a day … how m-health could revolutionise our engagement with the NHS

It seems like almost every day now we see in the news and read in newspapers about the increasing pressures on our NHS, strains on resources and the daily challenges facing already overworked GP staff.

Mobile health applications (m-health apps) are increasingly being integrated into practice and are now being used to perform some tasks which would have traditionally been performed by general practitioners (GPs), such as those involved in promoting health, preventing disease, diagnosis, treatment, monitoring, and signposting to other health and support services.

How m-health is transforming patient interactions with the NHS

In 2015 International Longevity Centre research found some distinct demographic divides on health information seeking behaviour. While 50% of those aged 25-34 preferred to receive health information online, only 15% of those aged 65 and over preferred the internet. The internet remained the favourite source of health information for all age groups younger than 55. And while not specifically referring to apps, the fact that many people in this research expressed a preference to seek health information online indicates that there is potential for wider use of effective, and NHS approved health apps.

A report published in 2019 by Reform highlighted the unique opportunity that m-health offered in the treatment and management of mental health conditions. The report found that in the short to medium-term, much of the potential of apps and m-health lies in relieving the pressure on frontline mental health services by giving practitioners more time to spend on direct patient care and providing new ways to deliver low-intensity, ongoing support. In the long-term, the report suggests, data-driven technologies could lead to more preventative and precise care by allowing for new types of data-collection and analysis to enhance understandings of mental health.

M-health, e-health and telecare are also potentially important tools in the delivery of rural care, particularly to those who are elderly or who live in remote parts of the UK. This enables them to submit relevant readings to a GP or hospital consultant without having to travel to see them in person and allowing them to receive updates, information and advice on their condition without having to travel to consult a doctor or nurse face-to-face. However, some have highlighted that this removal of personal contact could leave some patients feeling isolated, unable to ask questions and impact on the likelihood of carrying out treatment, particularly among older people, if they feel it has been prescribed by a “machine” and not a doctor.

Supporting people to take ownership of their own health

Research has suggested that wearable technologies, not just m-health apps, but across-the-board, including devices like “fitbits”, are acting as incentives to help people self-regulate and promote healthier activities such as more walking or drinking more water. One study found that different tracking and monitoring tools that collect and analyse health and wellness data over time can inform consumers of their baseline activity level, encourage personal engagement in health and wellbeing, and ultimately lead to positive behavioural change. Another report from the International Longevity Centre also highlights the potential impact of apps on preventative healthcare; promoting behaviour change and encouraging people to make healthier choices such as stopping smoking or reducing alcohol intake.

Home testing kits for conditions such as bowel cancer and remote sensors to monitor blood sugar levels in type 1 diabetics are also becoming more commonplace as methods to help people take control of monitoring their own health. Roll-outs of blood pressure and heart rhythm monitors enable doctors to see results through an integrated tablet, monitor a patient’s condition remotely, make suggestions on changes to medication or pass comments on to patients directly through an email or integrated chat system, without the patient having to attend a clinic in person.

Individual test kits from private sector firms, including “Monitor My Health” are now also increasingly available for people to purchase. People purchase and complete the kits, which usually include instructions on home blood testing for conditions like diabetes, high cholesterol and vitamin D deficiency. The collected samples are then returned via post, analysed in a laboratory and the results communicated to the patient via an app, with no information about the test stored on their personal medical records. While the app results will recommend if a trip to see a GP is necessary, there is no obligation on the part of the company involved or the patient to act on the results if they choose not to. The kits are aimed at “time-poor” people over the age of 16, who want to “take control of their own healthcare”, according to the kit’s creator, but some have suggested that instead of improving the patient journey by making testing more convenient, lack of regulation could dilute the quality of testing Removing the “human element”, they warn, particularly from initial diagnosis consultations, could lead to errors.

But what about privacy?

Patient-driven healthcare which is supported and facilitated by the use of e-health technologies and m-health apps is designed to support an increased level of information flow, transparency, customisation, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects for each user. However, it’s not all positive, and concerns are already being raised about the collection and storage of data, its use and the security of potentially very sensitive personal data.

Data theft or loss is one of the major security concerns when it comes to using m-health apps. However, another challenge is the unwitting sharing of data by users, which despite GDPR requirements can happen when people accept terms and conditions or cookie notices without fully reading or understanding the consequences for their data. Some apps, for example, collect and anonymise data to feed into further research or analytics about the use of the app or sell it on to third parties for use in advertising.

Final thoughts

The integration of mobile technologies and the internet into medical diagnosis and treatment has significant potential to improve the delivery of health and care across the UK, easing pressure on frontline staff and services and providing more efficient care, particularly for those people who are living with long-term conditions which require monitoring and management.

However, clinicians and researchers have been quick to emphasise that while there are significant benefits to both the doctor and the patient, care must be taken to ensure that the integrity and trust within the doctor-patient relationship is maintained, and that people are not forced into m-health approaches without feeling supported to use the technology properly and manage their conditions effectively. If training, support and confidence of users in the apps is not there, there is the potential for the roll-out of apps to have the opposite effect, and lead to more staff answering questions on using the technology than providing frontline care.


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Five blog posts that told the story of 2019

As the old year makes way for the new, it’s time to reflect on some of the topics we’ve been covering on The Knowledge Exchange blog over the past twelve months. We’ve published over 70 blog posts in 2019, covering everything from smart canals and perinatal mental health to digital prescribing and citizens’ assemblies. We can’t revisit them all, but here’s a quick look back at some of the stories that shaped our year.

Nick Youngson CC BY-SA 3.0 Alpha Stock Images

Tomorrow’s world today

Artificial Intelligence was once confined to the realms of science fiction and Hollywood movies, but it’s already beginning to have a very real impact on our personal and working lives. In February, we looked at the pioneering local authorities that are dipping a toe into the world of AI:

“In Hackney, the local council has been using AI to identify families that might benefit from additional support. The ‘Early Help Predictive System’ analyses data related to (among others) debt, domestic violence, anti-social behaviour, and school attendance, to build a profile of need for families. By taking this approach, the council believes they can intervene early and prevent the need for high cost support services.”

However, the post went on to highlight concerns about the future impact of AI on employment:

“PwC’s 2018 UK Economic Outlook suggests that 18% of public administration jobs could be lost over the next two decades. Although it’s likely many jobs will be automated, no one really knows how the job market will respond to greater AI, and whether the creation of new jobs will outnumber those lost.

Tackling violent crime

One of the most worrying trends in recent years has been the rise in violent crime. Figures released in January found overall violent crime in England and Wales had risen by 19% on the previous year.

As our blog reported in March, police forces around the country, along with health services, local government, education and the private sector have been paying close attention to the experience of Glasgow in tackling violent crime.

Glasgow’s Violence Reduction Unit (VRU) was launched in 2005, and from the start it set out to treat knife crime not just as a policing matter, but as a public health issue. In its first ten years, the VRU helped to halve the number of homicides in the city, with further progress in subsequent years.

In March, our blog explained that the VRU takes a holistic approach to its work:

“…staff from the VRU regularly go into schools and are in touch with youth organisations. They also provide key liaison individuals called “navigators” and provide additional training to people in the community, such as dentists, vets and hairdressers to help them spot and report signs of abuse or violence.”

 Protecting the blue planet

Environmental issues have always featured strongly in our blog, and in a year when people in larger numbers than ever have taken to the streets to demand greater action on climate change, we’ve reported on topics such as low emission zones, electric vehicles and deposit return schemes.

In August, we focused on the blue economy. The world’s oceans and seas are hugely important to the life of the planet, not least because they are home to an astonishing variety of biodiversity. In addition, they absorb large amounts of carbon dioxide emissions. But they are also a source of food, jobs and water – an estimated 3 billion people around the world rely on the seas and oceans for their livelihood.

Pollution is having a devastating impact on the world’s oceans, and, as our blog reported, governments are finally waking up to the need for action:

The first ever global conference on the sustainable blue economy was held last year. It concluded with hundreds of pledges to advance a sustainable blue economy, including 62 commitments related to: marine protection; plastics and waste management; maritime safety and security; fisheries development; financing; infrastructure; biodiversity and climate change; technical assistance and capacity building; private sector support; and partnerships. 

Sir Harry Burns
Image: Jason Kimmings

A sense of place

The ties that bind environmental factors, health and wellbeing are becoming increasingly clear. This was underlined at an international conference in June on the importance of place-based approaches to improving health and reducing inequalities.

One of the speakers was Sir Harry Burns, Director of Global Public Health at the University of Strathclyde. His research supports the idea that poverty is not the result of bad choices, but rather the absence of a sense of coherence and purpose that people need to make good choices:

“People who have a sense of purpose, control and self-esteem are more positive and secure about the places they live in, and a greater ability to make the right choices. Ask people to take control of their lives, build their trust, and people can make choices that support their health. We must create places that do that”.

Celebrating diversity

While it sometimes seems as if our society has made great strides in stamping out prejudice and supporting minority groups, at other times the stark reality of discrimination can shine a light on how far we still have to go.

In June, we marked Gypsy, Roma and Traveller (GRT) History Month with two blog posts that aimed to raise awareness of the many issues faced by GRT communities in the UK today:

“Research by Travellers Movement has found that four out of five (77%) of Gypsies, Roma and Travellers have experienced hate speech or a hate crime – ranging from regularly being subject to racist abuse in public to physical assaults. There is also evidence of discrimination against GRT individuals by the media, police, teachers, employers and other public services.”

But our blog also highlighted work being done to address these issues and to spread the word about GRT communities’ rich cultural heritage:

“Today, organisations and individuals such as The Traveller MovementFriends, Families and Travellers, and Scottish Traveller activist Davie Donaldson strive to promote awareness of and equality for the GRT community. The recent Tobar an Keir festival held by the Elphinstone Institute at Aberdeen University sought to illustrate traditional Traveller’s skills such as peg-making.”

 Back to the future

Since first launching in 2014, The Knowledge Exchange blog has published more than 700 posts, covering topics as varied as health and planning, education and digital, the arts, disabilities, work and transport.

The key issues of our times – climate change, Brexit and the economy haven’t been neglected by our blog, but we’ve looked at them in the context of specific topics such as air pollution, higher education and diversity and inclusion in the workplace.

As we head into a new year, the aims of The Knowledge Exchange blog remain: to raise awareness of issues, problems, solutions and research in public policy and practice.

We wish all our readers a very Happy Christmas, and a peaceful, prosperous and healthy 2020.

A long way from home: county lines, serious organised crime and exploitation in the UK

Gangs and serious organised crime groups are increasingly targeting vulnerable people, including children and young people to become involved in drug trafficking and other kinds of illegal activities. Police and local authorities assisted by third sector and charity partners are trying to stem the flow of vulnerable people leaving towns and cities and travelling elsewhere in the UK as part of a wider network of organised crime and exploitation. The aim is to break the chain of supply which is seeing organised crime move away from our inner cities to rural and coastal communities across the UK. From London to Liverpool, Glasgow to Cardiff, county lines practices have been growing, and solutions to prevent vulnerable people being targeted are needed urgently across the whole of the UK.

A growing emergency across the UK

Figures have shown a significant rise in the number of drug-related deaths across communities in the UK, with a significant rise in deaths among young people and among those in rural communities. While drug problems are widely considered an urban, inner-city issue, increasingly communities in rural and coastal areas are struggling with drug-related crime and deaths as new markets and channels for moving drugs across the country are opened up by organised crime groups and gangs.

Research has shown that, unlike in previous decades, these are not just the result of social, ad hoc sharing and transporting of drugs, but strategic and coordinated networks designed specifically to open new markets for drugs beyond city centres and expose more communities to markets of illicit materials, including drugs. The National Crime Agency (NCA) reports that the main driver of this “county lines” practice is fundamentally the demand and supply of controlled substances within the UK and the opportunity of “new” drug markets to make significant amounts of money. Analysis from the NCA indicates that an individual line can make profits in excess of £80,000 per year and can make thousands of pounds of profit from one single trip.

An easy target

One of the defining features now recognised as a key part of county lines drug trafficking is the exploitation of vulnerable and socially excluded people.This offers a degree of safety for those at the top of the network who avoid getting their hands dirty by delegating work to those further down the chain. Vulnerable groups, such as the homeless, care leavers or young people from disadvantaged backgrounds, are identified by county lines groups both as a target market for the drugs trade and for “recruitment”, involving them in the storage, transportation or selling of drugs in these new sites. This means that, on the whole, these groups are being disproportionately impacted. Many often don’t see themselves as victims or realise they have been groomed to get involved in criminality. Commentators and practitioners have stressed that an urgent and powerful response to safeguard these groups is needed.

A 2017 report from the Children’s Commissioner estimates there are at least 46,000 children in England who are involved in gang activity. It is estimated that around 4,000 teenagers in London alone are being exploited through child criminal exploitation or ‘county lines’. In March 2018, the Children’s Society published the second edition of Criminal exploitation and County Lines: A toolkit for working with children and young people. It summarised the risks to children and young people who become involved in county lines as including:

  • physical injuries: risk of serious violence and death
  • emotional and psychological trauma
  • sexual violence: sexual assault, rape, indecent images being taken and shared as part of initiation/revenge/punishment, internally inserting drugs
  • debt bondage – young people and families being ‘in debt’ to the exploiters; which is used to control the young person
  • neglect and basic needs not being met
  • living in unclean, dangerous and/or unhygienic environments
  • tiredness and sleep deprivation: the child is expected to carry out criminal activities over long periods and through the night
  • poor attendance and/or attainment at school/college/university

These challenges are also faced by other groups of vulnerable adults who are targeted in the same way. But while vulnerable children are subject to a compulsory referral process in relation to suspected exploitation, adults must consent to being referred, which research has suggested may be impacting the reported numbers of victims. This in turn indicates that the true number of vulnerable adults being exploited may be significantly higher.

Tackling county lines by working together

Partnership working between services which come into contact both with the county lines gangs and with the vulnerable people they exploit has been shown to be critical to facilitating an effective response and halting the spread and further development of county lines networks. However, it has also been highlighted that traditional approaches and mechanisms used to identify and safeguard vulnerable groups, particularly children, are no longer sufficient in the context of county lines child criminal exploitation (CCE), and that new guidance is needed to support practitioners in this field.

In September 2018 the National County Lines Coordination Centre was launched to crack down on drug gangs. The multi-agency team of experts from the National Crime Agency (NCA), police officers and regional organised crime units are working together, along with other partners in local areas, to build a national picture of the complexity and scale of the threat.

At a local level, pilot projects in several London boroughs, including Hackney, Islington and Lambeth and in other trial areas outside of London, such as Kent and Merseyside, have taken place. Evidence has shown that frontline services across the board play a key role in helping to identify and support those people at risk of exploitation from county lines gangs – not just police and prison service staff – but healthcare workers, social workers, teachers and youth work professionals from the public and third sectors. Working together as multi-agency partnerships, while challenging, results in the best outcomes and opportunities for intervention and support for children and vulnerable people who are at risk. It is essential that staff receive a high standard of training and that they themselves are given the time and resources needed to try and forge effective partnerships which in turn will help to identify and intervene with those at risk of gang exploitation more effectively and at an earlier stage.

Partnerships which include opportunities for staff training and guidance from third sector specialists like St Giles Trust and Safer London make use of the significant knowledge and experience held within the third sector and help local authorities to apply these to their own statutory responses. They also encourage the sharing of effective practice and knowledge on tackling exploitation across the whole of the UK, which is helping to create a more effective and joined-up approach to tackling child exploitation and the links to county lines practices. Maintaining this sharing of knowledge and skills across different sectors and professions will continue to be vital in helping to develop practice and responses that can react more effectively to exploitation in the future.

Providing a safe place and a route forward for victims of county lines exploitation

In a county lines context, better safeguarding and early intervention practices with vulnerable people serves a dual purpose: preventing the person involved being exploited and engaging in criminal activity; and disrupting the county lines operation, and subsequently the flow of illicit materials into our communities. The networks are, by their own design, elusive and hard to trace. Those involved are threatened and often trapped in roles within the network which they would otherwise be unable to escape on their own. Providing a safe space for these exploited people is an important first step in the process of tackling county lines and organised criminal networks.

Local authorities are working closely with partners to try and provide this support at a local and very personal level while trying to fit into the wider strategic process of the national response to county lines. These national and local responses are both vital in tackling county lines and the exploitation that comes with it.


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‘Digital prescribing’ – could tech provide the solution to loneliness in older people?

Notruf und Hilfe für Rentner und Kranke

The number of over-50s experiencing loneliness could reach two million by 2026. This compares to around 1.4 million in 2016/7 – a 49% increase in 10 years.

It has also been estimated that around 1.5 million people aged 50 and over are ‘chronically lonely.’

With an ageing population and increasing life expectancy, it would seem likely that loneliness among older people is set to continue; unless something significant is done. According to Age UK, tackling loneliness requires more than social activities. A new report from Vodafone suggests technology could be the answer.

Impact

The impact of loneliness in older people can be immense, not only for the older people themselves but for those around them. It can also put strain on the NHS, employers and organisations providing support to people who are lonely; and have a negative impact on growth and living standards.

Research has suggested that those experiencing social isolation and loneliness are at increased risk of developing health conditions such as dementia and depression, as well as increased risk of mortality. The damaging health effect of loneliness has been shown to be comparable to smoking 15 cigarettes a day. Older people who are lonely are therefore more likely to use health services than those who are never lonely.

The economic impact is also significant. It has been estimated that increases in service usage create a cost to the public sector of an average £12,000 per person over the medium term (15 years). Vodafone’s report suggests that loneliness has a £1 billion a year impact on public services. It has also been found to cost employers £2.5 billion per year.

How tech can ease the burden

According to Vodafone, “new technologies are a key part of the solution” alongside more traditional public and community services. Two key routes through which technology can be used to reduce loneliness are highlighted:

  • by supporting older people to remain independent in their home and community; and
  • maintaining and building networks and contacts.

From wearable devices and touchscreens to personal robots that act as the eyes, ears and voice of people unable to present physically, these are all highlighted as viable and positive uses of tech to ease the burden of loneliness. And there are already a number of examples of innovative use of technology that can benefit older people.

1024px-AV1

No Isolation AV1 robot. Image by Mats Hartvig Abrahamsen, via CC BY-SA 4.0

Good practice examples

One such example is Vodafone’s smart wearable wristband, the V-SOS Band, which supports independent living while also increasing the wearer’s safety. It can directly alert family members via their phone if the wearer needs help. It also uses fall detection technology so that families can be alerted automatically if the wearer falls either in the home or when they are out.

Kraydel is another example. Its smart TV-top hub links elderly people to their carers or family members, through their TV screens, helping people be more independent and remain in their own homes for longer as well as helping them be more socially connected. It provides for user-friendly video calling via the TV and can help people return home from hospital earlier. Via connection to the cloud, the device interprets the data it receives to build up a picture of the user’s daily activities, health and wellbeing. It issues medicine and diary reminders, and alerts caregivers if it sees something amiss, or identifies potential risk.

Although aimed at children, No Isolation’s AV1 – a smart robot designed to reduce the risks of children and young adults with long-term illness becoming socially isolated – demonstrates the positive impact innovative technology can have on social isolation and loneliness. The robot avatar, with its 360 degree camera, acts as the child’s eyes, ears and voice in the classroom or at other events, keeping children closely involved with school and in touch with their friends.

Of course, loneliness is particularly prevalent among people who don’t use smart technology such as smart phones and tablets, one of the reasons cited by Kraydel for using the TV – probably the most familiar and widely used screen globally. This issue also led No Isolation to develop KOMP, a communication device for seniors that requires no prior digital skills. It enables users to receive photos, messages and video calls from their children and grandchildren, operated by one single button.

Another new project recently launched in Sweden – considered one of the world’s loneliest countries – uses a unique conversational artificial intelligence which enables older people to capture life stories for future generations while providing companionship. Memory Lane works with Google Voice Assistant and is able to hold meaningful conversations in as human a way as possible. A pilot test showed that the software “instantly sparked intimate conversations” and led to stories that hadn’t been told before.

Final thoughts

With a significant number of older people lacking confidence in their ability to use technology for essential online activities, support for digital skills is obviously still important. In response to this issue, Vodafone has launched free masterclasses across the UK, as part of a programme called TechConnect.

Many of the above innovative examples bypass the traditional barriers to realising the potential of technology in reducing loneliness as most:

  • don’t rely on older people engaging directly with the technology; and
  • are based on mobile technology that can be constantly connected, whether inside or outside the home.

However, there is still the issue of awareness of such technologies and their accessibility to older people. The Vodafone report suggests that access could be improved through social and digital prescribing and revitalising support for independent living, and calls for a challenge fund to support innovation. It is suggested that these innovative ideas are just the start and that combined action is needed from across all levels of government, business and community groups, amongst others.

Perhaps if such action is taken to address existing barriers, we will see a reverse in the loneliness trend over the next 10 years.


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Guest post: Some countries have introduced mandatory nutritional labelling on menus – here’s why the UK should follow suit

Olga_Moroz/Shutterstock

 

Guest post by: Dolly Theis, University of Cambridge

Would you eat a burger if you knew it contained almost 6,000 calories? Some would gladly tuck in while others would recoil in horror. But if you have calories on the menu, at least you know what you’re biting into. And as our latest research shows, menu labelling, as it is called, may be a powerful way to change the nation’s eating habits.

Research shows that the British public is increasingly eating out and ordering takeaways, rather than preparing food at home. Our earlier research estimates that a quarter of UK adults and a fifth of children eat at a restaurant or order a takeaway at least once a week. Food that isn’t prepared at home tends to be less healthy, more calorific and higher in fat, sugar and salt than food prepared at home. While eating out is a triumph for a large and important commercial sector, it is also contributing to the obesity crisis and the increase in diseases such as type 2 diabetes and cancer.

Still not mandatory

Unlike nutrition labelling on pre-packaged food, which has been around for years and mandated under EU law since 2016, menu labelling is still not mandated in the UK. The government included voluntary menu labelling in its Public Health Responsibility Deal in 2011, and several establishments have since introduced menu labelling.

Of the top 100 chain restaurants in the UK, we recently found that 42 publish nutritional information on their websites, and of these, 14 voluntarily provide menu labelling in their establishments. A proposal for mandated menu labelling was included in the UK government’s Childhood Obesity Plan, and a public consultation closed last December, but no announcement on a final policy has been made so far.

Mandatory menu labelling has been introduced in other countries, including the US in 2019 and parts of Australia.

Calories explained.

Labelled menus mean healthier food

We found that food and drink sold at the top largest UK chain restaurants whose menus display energy information are lower in fat and salt than those of their competitors.

Menu labelling has often been touted as a way to provide information that helps people choose healthier dishes, but several reviews, including a recent Cochrane review, found only modest, poor quality evidence of an effect of menu labelling on purchasing and consumption. Our evidence suggests that the benefit of menu labelling may not necessarily be in helping consumers make healthier choices, but in incentivising restaurants to serve healthier food and drink. Without nutritional information, it is difficult to know where improvements are needed.

Nutritional information is only helpful if it is accurate. A 2018 study on the views of Irish food-service businesses towards voluntary menu labelling found that key barriers to implementing it included concerns about potential inaccuracies in calorie information and the lack of training on how best to provide quality calorie information.

If food outlets are mandated to provide menu labelling, they will need greater support and training to do so. But it may also increase the demand for more accurate, efficient and accessible methods of data collection (typically laboratory or electronic database analysis), promising easier ways to account for the nutritional quality of what’s on restaurant menus.

Should nanny stay at home?

Mandatory labelling will not be popular in all corners. After all, who doesn’t enjoy blowing out at the occasional all-you-can-eat buffet? The challenge is that eating out is not occasional anymore. It is has become habitual.

Fortunately, as we increasingly ditch the kitchen for the restaurant and takeaway, government has found that there is strong public support for menu labelling. Through the Childhood Obesity Plan, the government is exploring many ways to help make it easier for us all to make healthier choices and menu labelling should be considered as one of many policies, not as a silver bullet.

The 6,000-calorie burger is an extreme example. But think about it, when you last ate out, did you know how many calories you were consuming?The Conversation

Dolly Theis, PhD Candidate, University of Cambridge

This article is republished from The Conversation under a Creative Commons licence. Read the original article.


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Supporting perinatal mental health: from peer-support to specialist services

There is a societal expectation that pregnancy and the arrival of a new baby are happy and exciting times.  However, it may come as a surprise to learn that up to 1 in 5 women develop a mental illness during pregnancy or within the first year after having a baby (also known as the ‘perinatal period’).

Up to 1 in 10 women may develop postnatal depression, however, there are actually a number of other mental illnesses that can affect women during pregnancy or following birth.  These include:

  • Antenatal depression
  • Perinatal anxiety
  • Perinatal obsessive compulsive disorder
  • Post-traumatic stress disorder (PTSD)
  • Post-partum psychosis

These illnesses can range from mild to severe.  Left untreated, perinatal mental illnesses can have a devastating effect on mental and physical health.  In fact, suicide is the leading cause of death for mothers during the first year after pregnancy.

The wider impact on children and families

Perinatal mental illnesses can also impact upon children, partners and significant others.  Research shows links to depression in partners, higher rates of divorces, lower levels of emotional and cognitive development and higher levels of behavioural problems and psychological disorders among children.

As well as the high human cost, there are also a number of economic costs associated with failing to address perinatal mental health needs. Research commissioned by the Maternal Mental Health Alliance found that perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

In comparison, it would cost only an extra £280 million a year to bring the whole pathway of perinatal mental health care up to the level and standards recommended in national guidance.

Access to specialist services is a ‘postcode lottery’

The good news is that most mothers who experience mental ill health can and do make a full recovery.

At present, mild to moderate cases of mental ill health in pregnancy and following birth are treated by the GP through anti-depressants, talking therapies and/or support from a community mental health team.  For more complex or serious illnesses, GPs can make a referral to specialist perinatal mental health services for expert advice and support.  This may involve staying in a specialist psychiatric Mother and Baby Unit (MBU) – where mothers and their baby can be admitted together.

However, despite the high prevalence of, and risks associated with, perinatal mental illness, access to specialist perinatal mental health services across the UK is a postcode lottery.

Maps by the Maternal Mental Health Alliance show that women in around half of the UK have no access to specialist perinatal mental health services.  There are currently no MBUs in Wales or Northern Ireland, meaning mothers with more serious or complex mental illnesses often face either being admitted to a MBU far from home, or being admitted to a general psychiatric ward without their babies, in order to receive treatment.

For those with mild to moderate mental illness, waiting times for NHS talking treatments can be many months.  Lack of awareness means that many cases of mild to moderate mental ill health go undiagnosed and untreated.  There is an urgent need for both greater awareness of mental illness and better access to mental health services across the country.

The role of peer-support

In recognition of and response to the need for better access to mental health support for pregnant and new mothers, a number of local ‘grassroots’ peer-support projects have been established by dedicated volunteers and campaigners.

One such project is Blank Canvas.  Blank Canvas is a creative journaling workshop in Lanarkshire, aimed at women during pregnancy or in the first two years since birth, who are experiencing mental health difficulties.

The project was set up earlier this year by midwife Elaine Connell, together with some of her midwife colleagues, who shared her dedication to improving mental health support for women in the perinatal period.

Elaine was keen to start her own peer support group following her own personal and professional experiences of perinatal mental ill health, and was inspired by the success of other projects focusing on art and creativity, such as Maternal Journal.

As Elaine explains:

It is free… …to access, and each attendee is given their own art kit to keep. We have a different theme each week and have guest speakers coming to do sessions also. During the group they can explore new art materials and create reflections in their journal, whilst chatting over some tea and cake. Each session they will take home a prompt card which can inspire their journalling during the week until the group meets next.”

Blank Canvas is free to access and works on a self-referral basis, with advertising mainly through Facebook.  A local shop and community space (Swaddle in Hamilton) donated a venue space, and all other costs (including materials) have been raised by volunteers committed to the project, through fundraisers such as coffee mornings and participation in the Kiltwalk.

Elaine has conducted an evaluation of the first 10-week block and feedback from participants has been extremely positive.  Word about the project has spread and the next block of Blank Canvas – which started on the 18th September – is fully subscribed (with a waiting list).  As Elaine notes, this is fantastic for the project, but highlights the high level of demand that exists for mental health support among new mothers.

The long term plan is to run 6-week blocks frequently throughout the year, moving to separate antenatal and postnatal sessions in 2020.  Elaine also hopes to start up a creative journaling group aimed at fathers too – noting that father’s mental health is often overlooked.

One of the key things Elaine has learned from the creation of Blank Canvas is that there is a lack of support available for people who want to establish their own peer-support groups:

What has been clear when forming the group, is that there is very little support to establish peer support. There are lots of people who want to help others but who won’t because they don’t know where to begin, or how to access funding, or lack of training opportunities.”

Grassroots peer-support groups are an important source of support for mothers in the perinatal period, particularly in cases of mild to moderate mental ill health, where NHS capacity is strained.

Attending peer-support groups such as Blank Canvas may also have a preventative effect for mums who attend during pregnancy. Statistically, women who experience antenatal anxiety are more likely to develop postnatal depression, and so early intervention could help to reduce that risk.

Urgent need for better access to specialist services

While these projects have been successful, they are aimed predominantly at women experiencing mild to moderate mental ill health.

For those experiencing more complex or serious mental ill health, there remains an urgent need for better access to specialist treatment and support.  The Maternal Mental Health Alliance ‘Everyone’s Business’ campaign calls for all women throughout the UK who experience perinatal mental ill health to receive the care that they and their families need.  Specifically, it demands that:

  • perinatal mental health care should be clearly set at a national level and complied with
  • specialist perinatal mental health teams meeting national quality standards should be available for women in every area of the UK
  • training in perinatal mental health care should be delivered to all professionals involved in the care of women during pregnancy and the first year after birth

Promising signs of progress

There have been some promising signs of progress.  NHS England recently announced their plans to rollout specialist perinatal community services across the whole of England, including the opening of four new Mother and Baby Units.

And in Scotland, the Scottish Government recently announced the rollout of an initial £1 million for perinatal mental health services, as part of a wider £50 million investment in mental health services.  This initial investment will support a range of areas, including supporting the third sector to provide counselling, befriending and peer support for women and their families.  It will also help provide more consistent access to psychological assessment and treatment, by increasing staffing levels and training at Mother and Baby Units, for women with the most serious illnesses.

The Scottish Government also established a Perinatal and Infant Mental Health Programme Board earlier this year.  The PIMH Programme Board aims to help implement the commitments to improving perinatal and infant mental health set out in the 2018/19 Programme for Government and Better Mental Health in Scotland.

Clare Thomson, Everyone’s Business Co-ordinator for Scotland, says “It’s fantastic to see the evidence-based approach to developing community perinatal mental health services and look forward to hearing about the first steps – particularly in the North of Scotland“.

Perinatal mental health is Everyone’s Business

However, there is still much to do, including ensuring that this funding translates into services on the ground.  Wales and Northern Ireland are still without MBUs and there is a pressing need to raise awareness of and address mental illness among fathers.

The cost to the public sector of perinatal mental health problems is 5 times the cost of improving services.  It clearly makes sense to invest in improving this care – not only from an economic perspective, but to help improve the lives of women, their children and families across the country. And while more funding is essential to achieve this, raising awareness of the importance of perinatal mental health really is ‘everyone’s business’.


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Rolling the dice with sexual health? New challenges for STI services

Today is the start of Sexual Health Week, which aims to raise awareness about services for the testing and treatment of sexually transmitted infections (STIs). The UK has a strong track record in the provision of STI services. But they are now facing new challenges, including a rise in demand, significant cutbacks in public health funding, and the emergence of infections that are resistant to treatment.

A historical perspective

STIs go back a long way. Syphilis first became widely reported in Europe during the late fifteenth century, while gonorrhoea was first described 3,500 years ago. For a long time, these diseases were incurable, afflicting millions of people and leading to infertility, disfigurement and insanity. Early attempts at treatment with mercury often proved fatal. With the development of penicillin in the 1940s, along with improvements in sex education, the rates of STIs fell dramatically. More recently, new drugs have revolutionised the treatment of people living with HIV.

A growing problem

Today, the instances of STIs are rising. In Australia, rates of syphilis, gonorrhoea and chlamydia are the highest since the 1990s. It’s a similar story in the United States and Canada, while in the European Union reported syphilis cases have continued to grow. HIV remains a major public health concern, with recent data indicating a significant number of new infections in eastern Europe.

In the UK, a 2019 report by the House of Commons Health and Social Care Committee found that overall STIs fell between 2013 and 2017. But more recent figures have revealed worrying developments:

  • In 2017 there was a 20% increase in cases of syphilis in England, and a 22% increase in gonorrhoea.
  • In Scotland, the number of cases of syphilis recorded has reached a 15-year high.
  • Public Health Wales has reported a 79% increase in syphilis cases in the country between 2016 and 2018.
  • The number of people in Northern Ireland diagnosed with gonorrhoea in 2018 was the highest on record.

The committee found that the impact of STIs in England is greatest among young people. Men who have sex with men are also disproportionately affected by STIs, while in black and minority ethnic populations, the rates of STI are higher than in the general population.

Along with the rise in the number of infections, the demand for sexual health services is increasing. At the same time, sexual health services say they are facing unprecedented threats from government cuts to local authority public health budgets.

In 2017, a Public Health England survey highlighted the concerns of commissioners of sexual health services. Respondents raised concerns about a decrease in capacity and an increase in demand, in both primary care and specialist services. They believe the consequences could include a worsening of health inequalities and a shift from prevention to treatment.

Debbie Laycock from the Terence Higgins Trust HIV charity told BBC News:

“The number of people accessing sexual health services has continued to rise, demand is on the increase and we’re hearing day-to-day more and more people are saying they’re being turned away from sexual health clinics. When it becomes harder to get an appointment, this is likely to deter people who don’t have symptoms, but just want a routine test. Those routine tests pick up infections at an early stage and stop them being spread to too many other people.”

Services at “breaking point”

There are concerns that this situation will worsen: from April 2020, previously ring-fenced sexual health, drug and alcohol services, which in England are funded by local authorities, will be competing for increasingly scarce funds alongside other council services such as social care.

The Health and Social Care Committee argues that budget cutbacks are not only bad for individuals’ health, but also increase overall costs to the NHS:

“Cuts to spending on sexual health, as with other areas of public health expenditure, are a false economy because they lead to higher financial costs for the wider health system. Inadequate sexual health services may also lead to serious personal long-term health consequences for individuals and jeopardise other public health campaigns such as the fight against antimicrobial resistance.”

This last point refers to a worrying new issue in the treatment of STIs. In recent months, several cases have been reported of new infections that have developed resistance to antibiotics.

Dr Tim Jinks, head of Wellcome’s Drug Resistant Infection programme, believes that increasing resistance to antibiotics will make treating and curing STIs harder:

“Untreatable cases of gonorrhoea are harbingers of a wider crisis, where common infections are harder and harder to treat. We urgently need to reduce the spread of these infections and invest in new antibiotics and treatments to replace those that no longer work.”

Some health professionals, such as Duncan Stephenson from the Royal Society for Public Health have warned that sexual health services are already at breaking point:

“With continued increases in rates of STIs such as syphilis…and the future threats posed by issues such as drug resistant gonorrhoea, the government is rolling the dice with the public’s sexual health.”

 Sexual health services for people with disabilities

This year, Sexual Health Week is focused on people with disabilities, who often face barriers that prevent access to information and support. To overcome these obstacles, sexual health services need to make changes, such as providing longer consultation periods for people with learning disabilities, and training for health professionals in advising and treating patients with special needs. With sexual health services already under pressure, the challenges of meeting the particular needs of people with disabilities are all the greater.

Final thoughts

In its report, the Commons Health and Social Care Committee recommended that Public Health England should collaborate with the sectors involved in commissioning and providing sexual health services to develop a new strategy. The report’s authors believe that this strategy:

“should help both providers and commissioners in their attempts to deliver sexual health services to a high quality and consistent level, in the face of the challenges of fragmented structures and reduced funding.

The committee also identified priority areas to be addressed by the strategy, including:

  • the provision of services which meet the needs of vulnerable populations
  • testing for the full range of sexually transmitted infections
  • access to pre-exposure prophylaxis (PrEP) for those at risk of contracting HIV
  • preventative interventions within all aspects of sexual health

Sexual health is an important part of physical and mental health, as well as ensuring emotional and social well-being. Modern, rapid testing can reduce the rate of onward transmission, and ensure that patients receive the right care, leading to long and healthy lives. Ensuring that those benefits continue will be the greatest challenge facing sexual health services now and in the future.


Effective clinical management for sexual health services

Effective record-keeping is an understated, but fundamentally important element of sexual health services. Increasingly, sexual health clinics are turning to electronic systems to maintain records, improve services and deliver cost savings.

Lilie is a clinical management software system specifically designed by Idox Health for sexual health services. Its electronic patient record (EPR) system provides fast access to patient information and greatly reduces administrative functions.

The system also provides sexual health services with a range of options, including:

    • patient communication via SMS
    • modules for contraceptive and reproductive health, chlamydia screening, HIV, and prescribing services
    • laboratory test results automatically received and entered into the electronic patient record

This market-leading software is now in use in more than 140 sites.

Further information about Lilie is available from Idox Health.

Daily exercise can boost children’s exam grades – new research

Guest post by Michael McCluskey, Keele University

 

Most parents are aware that physical activity is good for children – as it can help to improve their sense of self and have a positive impact on their mental health and well-being. But it’s less well known that being fit and active can also help to boost children’s academic performance.

Our recent review of primary school children from Stoke-on-Trent, England, shows that children who are more active perform better in key stage one results in reading, writing and mathematics than less active children – achieving grades that were either average or above average for each subject.

We also looked at how the children’s weight and height changed over the school year in our enjoy exercise. All the children gained weight, but less active children appeared to gain weight at a steeper rate than active children. This may mean these children – who currently have a normal weight and body mass – may be at risk of becoming overweight or obese in the future.

Not enough exercise

A report from Sport England shows that children who enjoy exercise, have confidence in their physical abilities and understand why exercise is important, are more likely to be active regularly. The same report also shows that these children do, on average, twice as much physical activity compared with children who don’t enjoy sport and exercise.

The Department of Health recommends children do at least 60 minutes of physical activity every day – but many children fail to meet these recommendations. This is in keeping with national figures that show only 17.5% of English, 38% of Scottish, 51% of Welsh and 12% of Northern Irish children meet the recommended minimum exercise levels.

But inactivity is not just a problem in the UK. Levels of childhood physical activity have recently been described as a global crisis by the World Health Organisation. Increasing urbanisation, changing patterns in transport, increased use of technology and high levels of poverty are considered to be reasons for the decline.

Of course, not all children naturally love exercise – and many dread PE lessons. Indeed, research shows that children who get regular encouragement and who have access to affordable facilities are more likely to be and stay active.

Be a role model

Given that our research shows the impact physical activity can have on academic performance and growth, it’s clear that children need to be encouraged to be active and given time to play regularly at home, in school and in the local community.

Children should walk more, run, cycle, use their scooter, go to their local playgrounds, dance, swim and play sports. Children should also be encouraged to travel to school on foot or by bike where possible and sit less often and for shorter periods of time.

Playing outdoors can help children to develop creative thinking Rawpixel.com/Shutterstock

Importantly, children also need to have positive role models. They need to see parents, family members, teachers and members of the community, enjoying being physically active on a regular basis.

 

This is important because children who are active regularly during childhood are more likely to develop into adults who are active and exercise. And adults who exercise regularly are more likely to live happier and healthier lives than those who do not.The Conversation

Michael McCluskey, Lecturer in Physiotherapy, Keele University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


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A road less travelled: celebrating Gypsy, Roma and Traveller History Month – part 2

June is Gypsy, Roma and Traveller History Month (GRTHM), which aims to raise awareness of and promote GRT history and culture.

It is widely recognised that raising awareness of different cultures is a key part of addressing prejudice and discrimination.

In this post – the second of two for GRTHM – we look at the inequalities and discrimination that GRT face across education, employment and health.  We also highlight work to address these inequalities and raise awareness of GRT communities’ rich cultural heritage.

GRT communities experience many educational and health inequalities

The recent House of Commons report, ‘Tackling inequalities faced by Gypsy, Roma and Traveller communities’, sets out a comprehensive review of the available evidence across a range of areas.

In education, Gypsy and Traveller children leave school at a much earlier age and have lower attainment levels than non-GRT children, and only a handful go on to university each year.  They also experience much higher rates of exclusions and non-attendance.

There are many reasons for this – from discrimination and bullying, to a lack of inclusion of GRT within the educational curriculum. There are also cultural issues to be addressed within the GRT community itself.

Scottish Traveller activist Davie Donaldson has spoken about the discrimination he faced in school where a teacher refused to “waste resources” by marking his homework because he was a Traveller, who she assumed was “not going to do anything with his education anyway”.  He also discusses how many Travellers within his own community felt he was betraying his roots by attending university. This clearly illustrates the multi-faceted nature of the issue of supporting GRT children in education.  The Traveller Movement addresses this and other related issues in their recently published guide to supporting GRT children in education.

Health outcomes for GRT communities are also very poor compared to other ethnic groups.  Their life expectancy is 10 to 12 years less than that of the non-Traveller population.  Maternal health outcomes are even more shocking – with one in five Gypsy Traveller mothers experiencing the loss of a child, compared to one in 100 in the non-Traveller community.

Poor health outcomes can be partially attributed to the difficulties that many experiences when accessing or registering for healthcare services due to discrimination or language and literacy barriers.  There is also a lack of trust among GRT communities which can result in a lack of engagement with public health campaigns.

Historic fear of engagement with public services

Indeed, there is a historic wariness of public services among many in the GRT community.

In the 1800s, many Travellers had a well-placed fear of the ‘burkers’ – body-snatchers looking to provide the medical schools with bodies for dissection.  Travellers felt particularly at risk because they lived on the margins of society.  There are many Traveller stories about burkers that have been passed on from generation to generation.

Similarly, a fear of social services intervention also exists, following the forced removal of children from Traveller families.  Some were taken into care, and others were deported to be servants in Canada or Australia.

Being aware of these cultural issues, along with the historic criminalisation and continued discrimination that GRT communities face, can help health and social services to understand and empathise with the GRT community when reaching out to them.

Poor employment outcomes and a lack of target support

Gypsies and Travellers were an essential part of the economy in the 19th Century and early 20th Century.  Many were skilled tinsmiths, silversmiths, basketmakers or other crafters.  They also played an important role as seasonal agricultural workers – for example, in the berry fields of Blair and farms of the north east of Scotland.  They moved from place to place, and bringing news and selling and trading their wares.  In the days before roads and motor vehicles, they were a lifeline for rural crofting communities who may have been many days travel away from the nearest settlement.

Time has rendered many traditional Traveller occupations redundant, and today employment outcomes for GRT groups are generally poor.

While more likely to be self-employed than the general population, the 2011 England and Wales Census found that Gypsies and Irish Travellers were the ethnic groups with the lowest employment rates, highest levels of economic inactivity, as well as the highest rates of unemployment.

However, unlike other minority groups, there has been no explicit government policies that support Gypsies or Travellers to enter employment or to take up apprenticeships and/or other training opportunities.  Many Gypsies and Travellers have also reported being discriminated against by employers, making it more difficult for them to find and stay in work.

A lack of robust data

There is a lack of robust data about the different GRT groups in the UK – even something as seemingly simple as how many GRT people there are.

This is because most data collection exercises – including the Census and in the NHS – do not include distinct GRT categories.  If an option exists at all, often it conflates the different GRT ethnicities into one generic tickbox, with no way to differentiate between the different ethnic minorities.  This is an issue that is being increasingly addressed and there are plans to include a Roma category in the 2021 census.

However, there are also issues with under-reporting.  Many people from GRT communities are reluctant to disclose their ethnicity, even when that option is available to them.  This stems both from a lack of trust and the fear of discrimination.

So, while the 2011 Census recorded 58,000 people as Gypsy/Traveller in England and Wales, and a further 4,000 in Scotland, it is estimated that there are actually between 100,000 to 300,000 Gypsy/Traveller people and up to 200,000 Roma people living in the UK.

Raising awareness of GRT culture

While this all may make for some pretty depressing reading, there are some promising signs of progress.

From Corlinda Lee’s Victorian ‘Gypsy Balls’ – where the curious public could pay to come and see how a Gypsy lived and dressed, to Hamish Henderson catalysing the 1950s Scottish Folk Revival with the songs and stories of Scottish Travellers – there have been attempts to promote Gypsy and Traveller culture among the settled population.

Today, organisations and individuals such as The Traveller Movement, Friends, Families and Travellers, and Scottish Traveller activist Davie Donaldson strive to promote awareness of and equality for the GRT community.

The recent Tobar an Keir festival held by the Elphinstone Institute at Aberdeen University sought to illustrate traditional Traveller’s skills such as peg-making, and there is a wonderful Traveller’s exhibition – including two traditional bow tents – at the Highland Folk Museum in Newtonmore.

There are even more events planned for GRTHM – including an exhibition of Travellers’ art and photography at the Scottish Parliament.

The hard work may be beginning to pay off – just last week, the government announced a new national strategy to tackle the inequalities faced by Gypsies, Roma and Travellers.

Using knowledge to fight prejudice

While there is without doubt an urgent need for practical measures to address the inequalities that the GRT community face – such as an increase in the number of authorised sites available – addressing the fundamental lack of awareness and knowledge of GRT culture is a key step towards eradicating prejudice towards GRT communities.

As well as raising awareness among the general public, there is also a need to for people working in public services – from health and social services to education and even politics – to have a better awareness and understanding of Traveller culture and history, and how this affects their present day needs and experiences.

Gypsy, Roma and Traveller History Month is an ideal opportunity to address the huge gap that exists in society’s collective knowledge about the GRT way of life, their history, culture and contribution to society. All of which can help to combat the prejudice and discrimination that they continue to face.


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A road less travelled: celebrating Gypsy, Roma and Traveller History Month – part 1

Traditional Scottish Traveller bow tent at the Highland Folk Museum, Newtonmore

This month is Gypsy, Roma and Traveller History Month (GRTHM).

GRTHM aims to celebrate and promote awareness of Gypsy, Roma and Traveller (GRT) history, culture and heritage, and the positive contribution that GRT groups have made and continue to make to society.  It also seeks to challenge negative stereotypes, prejudices and misconceptions associated with GRT groups.

Over the next two blog posts, we will raise awareness of the many issues faced by GRT communities in the UK today, and highlight some lesser known aspects of GRT culture and heritage.

Gypsies and Travellers are not a homogenous group

One common misconception is that Gypsies, Travellers and Roma are a homogenous group.

In fact, GRT is a term which encompasses many distinct ethnic groups with their own cultures, histories and traditions.

This includes Romany Gypsies, who today are generally of English or Welsh heritage.  Gypsies first arrived in Britain in the 16th Century. The term ‘Gypsy’ was coined due to a common misconception that Gypsies originated from Egypt. However, recent DNA studies suggest that they actually originated from the Indian subcontinent.  Some Gypsies may prefer to be known as either English Gypsies or Welsh Gypsies specifically.

Irish Travellers are Travellers with Irish roots, however, a recent DNA study suggests they have been genetically distinct from the settled Irish community for at least 1000 years. Irish Travellers have their own language – Shelta (also known as Cant).

Scottish Gypsies/Travellers are indigenous to Scotland.  Their exact origins are uncertain, but it is thought that they may be descended from the Picts, and/or the scattering of the clans following the Battle of Culloden in 1746.  Certainly, Scottish Travellers tend to share many of the same Clan surnames – including Stewart, McMillan, McPhee and McGregor.

Scottish Travellers also have their own language – the Gaelic-based Beurla Reagaird.

European Roma are descended from the same people as British Romany Gypsies, and they are Gypsies/Travellers who have moved to the UK from Central and Eastern Europe more recently.  Some have arrived as refugees and asylum seekers. While they face many of the same issues as Gypsies, Irish and Scottish Travellers, they are also subject to a number of additional challenges.

There are also other groups that are considered ‘cultural’ rather than ‘ethnic’ Travellers.  These include Occupational Travellers such as fairground and circus owners and workers and New Age Travellers – individuals who have chosen a travelling lifestyle for ideological reasons.

Distinct ethnic minorities protected by law

Whilst there are some similarities between GRT groups in terms of lifestyle, economic, family and community norms and values – and certainly in terms of the discrimination and poor outcomes that they experience – there are clear genetic differences between each of the groups.

As such, Gypsies, Irish Travellers and Scottish Travellers are each considered ethnic minorities in their own right and protected as “races” under the Equality Act 2010.  Migrant Roma are protected both by virtue of their ethnicities and their national identities.

However, despite this protection, GRT groups are still subject to high levels of discrimination.

‘The last acceptable form of racism’

Indeed, prejudice and discrimination has affected GRT groups throughout history.

In the 16th century, any person found to be a Gypsy could be subject to imprisonment, execution or banishment.  Even after anti-Gypsy laws were repealed, discrimination continued.  In the 19th and early 20th centuries, it was not uncommon for doctors to refuse to attend to Travellers.  And despite Travellers’ strong Christian beliefs, churches would often refuse to bury their bodies within their grounds.

And today, GRT people have the worst outcomes of any ethnic group across a huge range of areas, including education, health, employment and criminal justice.  They have the poorest health and the lowest life expectancy of any ethnic group in the UK, and are subject to high levels of racism and hate crime.

GRT groups still face barriers to accessing health services.  As part of a mystery shopper exercise by the Friends, Families and Travellers (FFT) charity, 50 GP practices were contacted by an individual posing as a patient wishing to register without a fixed address or proof of identity. They found that almost half would not register them, despite NHS guidance to the contrary.

And while racism towards most ethnic groups is now seen as unacceptable and less frequently expressed in public, racism towards GRT groups is still common and often overt – even among those who would otherwise consider themselves ‘liberal’ or ‘forward thinking’.  This had led it to be termed “the last acceptable form of racism”.

The 2015 Scottish Social Attitudes Survey found that over 30% of people in Scotland would be unhappy with a close relative marrying a Gypsy or Traveller, and 34% felt that Gypsies or Travellers were unsuitable as primary school teachers.

Research by Travellers Movement has found that four out of five (77%) of Gypsies, Roma and Travellers have experienced hate speech or a hate crime – ranging from regularly being subject to racist abuse in public to physical assaults.

Prejudice and discrimination against GRT groups is not limited to the public – there is also evidence of discrimination against GRT individuals by the media, police, teachers, employers and other public services.

Even politicians have openly displayed anti-GRT sentiment.  In 2017, the Conservative MP for Moray Douglas Ross, stated that he would impose “tougher enforcement against Gypsy Travellers” if he were Prime Minster for the day.

His remarks were widely criticised.  Amnesty International’s Scottish director, Naomi McAuliffe, said “When our elected leaders use this sort of blatantly partisan speech, they set a terrible example that only serves to foster further discrimination and prejudice.”.

A lack of sites has led to a ‘housing crisis’

Mr Ross’s remarks reflect another common misconception about GRT communities – that they all live in caravans, purposefully choosing to set up on unauthorised sites.

The truth is that while Gypsies and Travellers have traditionally lived a nomadic life, living in bow tents, wagons – and even caves – over 70% of Gypsies and Travellers no longer live in caravans, having chosen, or being forced for one reason or the other – disability, old age, lack of suitable sites – to move into traditional ‘bricks and mortar’ accommodation.

For those who do still live in caravans, it is widely recognised that they face a ‘housing crisis’ – an urgent shortage of authorised sites to set up on, which threatens their travelling heritage.  It is this shortage that drives much of the use of unauthorised sites.

Of those sites that do exist, quality has been raised as a key issue.  Many sites can lack even the most basic amenities, and some are sited near recycling plants or in other undesirable locations.  Poor conditions and sanitation contributes to poor levels of health, exacerbating existing health inequalities.

Further inequalities

In our next blog post, we will look in more depth at the inequalities that GRT communities face – in health, education and employment.  We also highlight work to address these inequalities and raise awareness of GRT communities’ rich cultural heritage.


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