Gypsies & Travellers

1 Introduction


This Needs Assessment describes the Gypsy and Traveller community and culture in the London borough of Richmond upon Thames, explores their healthcare needs, and shares their experiences of healthcare services. It draws on evidence gathered through epidemiological analysis, a literature review and semi-structured interviews with Gypsies and Travellers in Richmond.


In Richmond borough, in 2013 there were 95 Gypsies and Travellers, accounting for 0.06% of the population. Nearly 60% of the local community are women, (compared to 51% in Richmond overall), one in three (33%) are under the age of 18, (compared to 22% in Richmond overall), more than half (56%) are between 18 and 59 years of age (59% in Richmond overall) and about one in ten (11%) are over the age of 59 (19% in Richmond overall)[1] The high proportion of people under 18 and low proportion of people 59  is suggestive of a higher birth rate/larger family size and a shorter life expectancy.


Although Gypsies and Travellers in Richmond borough make up a small proportion of the population the community experiences significant health inequality.

The 2011 Census collected data on the Gypsy and Traveller population and self-reported health. In England and Wales, nearly one in five people (19%) report their health as “not good”. In comparison, nearly one in three (30%) Gypsies and Travellers reported their health in this way. While a similar average for Gypsies and Travellers is seen in London (30%), in Richmond borough, this proportion is higher with 37% of Gypsies and Travellers reporting their health as “not good”. In England and Wales, Gypsy and Irish Travellers had the highest proportion of people with “not good health” compared to all other ethnic groups; this finding is consistent across all regions in England and Wales1.Research carried out by Parry et al reported statistically significant worse health status than their age–sex-matched comparators[2].

2 Background


The All Ireland Traveller Study[3] reported life expectancy of Gypsy and Traveller males as 62 years – this had remained unchanged since 1987 – and life expectancy for females as 70 years – an increase of 5 years since 1987. This is noticeably lower than life expectancy for the general population in England and Wales: 78 years for males and 82 years for females1.

Evidence suggests that where Gypsies and Travellers have access to secure permanent sites and adequate medical care life expectancy may be closer to that of the surrounding sedentary population[4].

Although there is no data available on the prevalence of chronic conditions in the Gypsy and Traveller population, the literature suggests that 42% report having a chronic illness, compared with 18% of the general population and that experiencing more than one chronic condition is common[5].

Disadvantaged minority groups such as Gypsies and Travellers are recognised as having a greater burden of injuries than the general population[6].

Despite depression and anxiety being common among the Traveller population, it has been found that there is stigma associated with being “mentally ill” – seen as something to be ashamed of and to be kept hidden5.

In a study carried out by Parry et al 2 Gypsies and Travellers were almost three times more likely to suffer from anxiety and were more than twice as likely to be depressed when compared with the rest of the population2.

The All Ireland Traveller Study found that premature mortality, especially among younger men, was largely caused by high rates of suicide and accident related mortality[7]. Among Gypsy and Traveller women there are higher rates of maternal deaths compared to the general population, the majority of which are considered to be preventable1.

Children are extremely important to Gypsies and Travellers, and for many represent a “reason to live”[8]. One study reported that Gypsies and Travellers have significantly more children than those in an age-sex matched comparator group4, with families of four or more children not considered unusual2.

The All Ireland Traveller Study found levels of lifestyle health risk factors among the Gypsy and Traveller population such as drinking alcohol, smoking, and consumption of excessive salt and saturated fat were high. It also found a lack of physical activity common among the Gypsy and Traveller population7.

A qualitative piece of research found that many Gypsies and Travellers have low expectations of enjoying good health. Stoicism, along with self-reliance, was seen as underlying a tendency to not seek support, to delay presentation to healthcare services and dismiss health complaints that are deemed minor8.The research indicates that Gypsies and Travellers experience worse health, yet are less likely to receive effective, continuous healthcare.


Gypsy and Traveller accommodation needs may be met in a variety of ways. Gypsies and Travellers will typically form only a very small percentage of the population in any given area. The total population is estimated to be about 0.6% of the total UK population, of which only a proportion are living in, or seeking, caravan site accommodation. This means that a Strategic Housing Market Assessment is unlikely to yield results that are statistically robust for Gypsies and Travellers as a separate group.


A common feature of the Gypsy and Traveller community are the low levels of literacy and education. Evidence suggests that educational underperformance may be due to a combination of factors including a nomadic lifestyle, financial deprivation, low levels of parental literacy and aspiration for their children’s academic achievement, poor attendance, and bullying[9]. A recent systematic review indicates poor literacy is associated with poorer overall health[10]

At present Gypsies and Travellers are amongst the lowest-achieving groups at every Key Stage of education. In 2011, only 25% of Gypsies and Travellers achieved national expectations in English and Mathematics at the end of their primary education, compared with 74% of all students9. At the end of secondary education, only 12% of Gypsies and Traveller students achieved five or more good GCSEs, including English and Mathematics, compared with 58.2% of all students3.


Evidence from Gypsy Traveller Accommodation Assessments indicates that both age and locality of residence have an impact on employment rates[11]: Gypsies and Travellers in Surrey for example, are more likely to be working in a range of non-traditional work and with a relatively high rate of employment.   Low levels of formal qualifications coupled with the surrounding culture of employment (for example, community preferences for family based self-employment or waged, ‘individualistic’ labour) has an impact on economic activity11. The limited evidence on Gypsy and Traveller employment practices and preferences indicates a strong preference for male self-employment.

The references at the end of this needs assessment provide a wealth of information about the Gypsy and Traveller community. These can be used to understand the health issues that are found in the Gypsy and Traveller community as a whole. The extent to which health issues seen in general population are reflected in the local population will depend upon how similar the local population is to the community as a whole.

3 Local picture

Information about Gypsies and Travellers in Richmond upon Thames was gained by desktop research and a piece of local qualitative research. Semi-structured interviews were conducted during June 2013 with six matriarchs from the authorised social rented site in Hampton North: Chapter Way. Travelling was reported to be a crucial part of the identity of this community and is strongly driven by family ties. The family is highly valued and provides an essential social support mechanism, particularly during negative life events.


The qualitative research found that locally many Gypsies and Travellers have low expectations of good health.

The health status of Gypsies and Travellers is affected by a wide range of factors. In Richmond borough, common factors are:

  • Low expectation and priority given to good health, and a fatalistic attitude towards potentially treatable conditions.
  • Poor uptake of preventative health services.
  • A reluctance to engage with health services where there is a lack of continuity in the professional seen or the anticipation that the professional will be of the opposite gender.
  • The stigma attached to some health conditions e.g. ill health and the cultural taboo around discussing some health topics e.g. alcohol, drugs etc.
  • The reliance on younger generations to explain health letters, and confirm when appointments are due and the frequency with which medication should be taken.
  • The reliance on the television and word of mouth for health information.
  • Separation from immediate family members.

Local evidence indicates that when travelling, families use a walk in or A&E if they need health care. There was a lack of knowledge around registering as a temporary patient and using national services such as NHS Direct or 111.

Local Gypsy and Travellers were aware of NHS stop smoking services but had little knowledge of other preventative health services such as LiveWell Richmond or NHS Health Checks. There was some general awareness of screening programmes such as smears and mammograms but, in general, it was recognised that the older generation were not very good at accessing preventative health services. They also recognised that there was a high level of smoking among travellers and that drinking was common among the men. However, there was reluctance to report on these and other topics such as drugs, family planning and sexually transmitted infections. Local Gypsy and Traveller women valued the health visiting service which provided a reliable source of health information.

The local research suggests that significant improvements could be made by overcoming barriers to accessing health services and raising awareness of the benefits of health screening, healthy diet, stopping smoking, and exercise.


In Richmond, there is one authorised socially-rented site in Hampton North. The site is managed by Richmond Housing Partnership (RHP) and has 12 pitches for chalets/temporary homes. This site houses 51 of the 95 Gypsies and Travellers living in Richmond borough[12]. The community living on the site is a relatively stable and settled one with many of the families having held licenses for the pitches for over 10 years.

Of the remaining 33 Gypsy and Travellers living in Richmond borough 18% own their house, 60% live in socially rented accommodation, and 22% live in private rented accommodation1.


Locally there are approximately 31 school aged children in Richmond Borough. Eight of these are registered as Elective Home Education. Attendance and attainment is monitored throughout the year by the Education Welfare Service. Most are on track to achieve the target set at the start of the school year. Some of these targets are meeting age- related expectations particularly year 6, whilst others are either just below age related or significantly lower. Those that are significantly lower are new to Richmond and have not had regular school attendance. 


In Richmond borough, 37% of Gypsies and Travellers have never worked, this compares to 37% in London and 31% nationally1. The majority of Gypsies and Travellers, who do work, undertake routine, semi routine or low supervisory occupations.

4 Service Provision

Primary care

Gypsies and Travellers in the borough are able to access primary care by either registering as a permanent patient with a local practice or a temporary patient if they are visiting the area. The majority of primary care provision is provided by Hampton Medical centre. Health Visitors undertake home visits to new mothers on the site; in addition, they deliver educational sessions.

Community care 

There are two Richmond Housing Partnership (RHP) family outreach workers who provide support with benefits, appointments, correspondence, and help Gypsies and Travellers link to other services including healthcare.

There are a series of specialist services offered, by the family outreach worker, urban academy, a community police officer and a specialist teacher visits the site. 


  • The Richmond Wellbeing Service is part of the national Improving Access to Psychological Therapies (IAPT) scheme. This scheme aims to provide therapies to people with common mental health problems. The Richmond Wellbeing Service work from GP surgeries and community venues.

NHS Choices offers information on living well, services near you, health news and an A-Z of health issues.

People can also call 111 when you need medical help fast but it’s not a 999 emergency.

5 Conclusions

The evidence and qualitative research provides us with an insight to understanding the health needs of the local gypsy traveller population. Based on the findings of this needs assessment there is a need to encourage and help the community to increase their use of available NHS health services and improve its own health through behavioural changes such as reducing smoking and improving diet.  Positive actions to consider to improve health and wellbeing include:

  • Ensuring information about health services such as Improving Access to Psychological Therapies and dental services is available in primary care. For more information go to or call 020 8548 5550.
  • Health visitors to share tools and resources for self care with the community.
  • Community providers such as NHS stop smoking, LiveWell Richmond, Richmond Wellbeing and NHS Health Checks should ensure that their services are known about and accessible to Gypsies and Travellers on the Hampton North site.
  • Trying different approaches to promoting screening and prevention services possibly through a community champion approach.
  • Use the local GP practice to promote NHS smoking cessation services and alcohol support services.
  • Encouraging healthcare professionals to use any Gypsy or Traveller engagement with a service as an opportunity to promote /complete appropriate screening services and health checks for that individual.
  • Supporting ways to improve continuity of care to enable professionals to develop long-standing relationships with Gypsies and Travellers.

Prepared by

Jane Bailey

Anthony Threlfall

Acknowledgements to

Zainab Shather

Katherine Thompson

Lizzy Lenferna de la Motte

6 References and signposting

[1] Source: 2011 Census data, ONS

[2] Parry G, Van Cleemput P, Peters J, Moore J, Walters S, Thomas K, Cooper C (2004): Health status of Gypsies and Travellers in England – Summary of a report to the Department of Health. University of Sheffield

[3] All Ireland Traveller Health Study Team (2010): All Ireland Traveller Health Study

[4] Cemlyn S, Greenfields M, Burnett S, Matthews Z, Whitwell C (2009): Inequalities experienced by Gypsy and Traveller communities – a review. Equality and Human Rights Commission

[5] Parry G, Van Cleemput P, Peters J, Walters S, Thomas K, Cooper C (2007): Health status of gypsies and travellers in England. J Epidemiol Community Health 2007; 61: 198-204 doi: 10.1136/jech.2006.045997

[6] Abdalla S, Kelleher C, Quirke B, Daly L (2013): Disparities in fatal and non-fatal injuries between Irish travellers and the Irish general population are similar to those of other indigenous minorities: a cross-sectional population-based comparative study. BMJ Open DOI: 10.1136/bmjopen-2012-002296

[7] All Ireland Traveller Health Study Team (2010): All Ireland Traveller Health Study – Summary of findings

[8] Parry G, Van Cleemput P, Peters J, Moore J, Walters S, Thomas K, Cooper C (2004): Health status of Gypsies and Travellers in England – Summary of a report to the Department of Health. University of Sheffield

[9] Communities and Local Government (2012): Progress report by the ministerial working group on tackling inequalities experienced by Gypsies and Travellers.

[10] Berkman N, Sheridan S, Donahue K, et al (2011): Health Literacy Interventions and Outcomes: An Updated Systematic Review. Rockville (MD): Agency for Healthcare Research and Quality (US). 

[11] Inequalities experienced by Gypsy and Traveller communities: A review Sarah Cemlyn, Margaret Greenfields, Sally Burnett, Zoe Matthews and Chris Whitwell(2009)

[12] Department for Communities and Local Government (2013): Count of Gypsy and Traveller Caravans – January 2013

Document information

Published: May2014
For review: May 2017 
Topic lead:
 Anna Raleigh, Consultant in Public Health