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					Health Impact Assessment of
     Doneraile Traveller
 accommodation proposal
Health Impact Assessment of Doneraile Traveller accommodation
proposal

Written by Dermot Glackin HIA practitioner;
HIA Ireland

ISBN: 0-95391142/978-0-959142-27

Published by HIA Ireland




Reproduction authorised, for
non-commercial purposes, providing
source is acknowledged

Glackin D (2008) Health Impact Assessment of
Doneraile Traveller accommodation
Proposal; HIA Ireland

For further copies please contact either
Dermot Glackin: HIA Ireland
Tel: N-I 07912054940
ROI 00447912054940
         Or
Deirdre O’Reilly Traveller Health Coordinator
Health Promotion Department
Ear Nose & Throat Hospital
Western Road, Cork

Front cover Art work created by Young Travellers from Doneraile.
Front cover design by Rock Art Conway Mill Falls Road Belfast.



                                     2
Acknowledgments

I would like to thank all those who contributed to this Health Impact Assessment
(HIA) and the production of this report, particularly the members of the HIA
steering group, and all those who participated in the five appraisal workshops.

A special word of thanks to Deirdre O’Reilly & Hilary Fitzgerald for championing
the HIA approach and encouraging attendance at the appraisal workshops; also
Brigid O Brien for sharing her knowledge of Traveller customs and culture and
advising on how best to encourage members of the Traveller community to
engage with this Health Impact Assessment

This HIA was financed by the Traveller Health Unit HSE South as part of a Cork
County Interagency Traveller action plan.

Dermot Glackin HIA practitionaire

February 2008

HIA Ireland




                                       3
                               Contents page


Foreword                                       5



Executive summary                              6



Chapter 1. Background                          7



Chapter 2. The Health Impact Assessment        11



Chapter 3. Monitoring and Evaluation           42



Chapter 4. Other findings from the HIA         44



References                                     45




                                         4
List of Tables


Table 1 Summary of prioritising impacts

Table 2 Recommendations


List of Appendices (available on request)

Appendix 1 Cork City Interagency Traveller Plan

Appendix 2 Screening exercise

Appendix 3 Steering group membership

Appendix 4 The letter of invitation and HIA appraisal tools

Appendix 5   Evaluation and monitoring schedule

Appendix 6   Impacts identified at appraisal workshops

Appendix 7   Full health profile

Appendix 7   Impacts and supporting evidence




                                       5
Foreword

I am very pleased that the Traveller Health Unit, HSE South was able to support
the implementation of this work. The report contains a huge amount of
information about the opportunities and difficulties faced by the Traveller
community and the impact upon their health of the built environment, cultural &
socioeconomic factors. The report makes recommendations that challenge a
range of agencies to consider how best the opportunities presented by this
redevelopment can be harnessed.

This report describes a prospective Health Impact Assessment (HIA) carried out
on a Cork County Council (CCC) proposal to develop permanent and transient
sites at Ballydineen, Doneraile County Cork. HIA facilitates cross-sectoral working
and has a particular focus on Health Inequalities. It requires participating
organisations to consider the impact on health of a particular proposal, in this
case the building of a halting and transient site, and seeks to influence the
proposal so that the health of affected communities is improved as a result.

I would like to thank all the people who have contributed to this HIA, in
particular the steering group which consisted of Travellers, Traveller
Organisation representatives, CCC housing staff, Community work department
HSE South and a range of interested statutory and voluntary groups. I would
also like to thank the Travellers, workers and settled community who attended
the appraisal workshops and provided the evidence that has influenced the
recommendations in this report. Finally a word of thanks to Dermot Glackin, HIA
practitioner, for his understanding and dedication to this HIA process and his
commitment to challenging inequality.

Deirdre O’Reilly

Chair, HIA Steering Group




                                        6
Executive Summary

This report describes a prospective Health Impact Assessment (HIA) carried out
on a Cork County Council (CCC) proposal to develop permanent and transient
halting sites at Ballydineen, Doneraile.

The HIA was overseen by a steering group made up of Travellers, Traveller
representatives, CCC housing managers and a range of interested statutory and
voluntary groups.

Evidence was collected on the potential health impacts of the proposal from:

      •   Five appraisal workshops
      •   A series of art based workshops with young Travellers
      •   A literature review
      •   A health profile

The information collected at the appraisal workshops yielded a total of 150
impacts of which 59 related to Transient site and a further 91 relating to Halting
site. The 150 impacts were prioritized into impact statements based upon
evidence gathered at workshops, the literature review and health profile. The
steering group made recommendations based on the prioritized impacts
statements.

The recommendations relate to;
                • Environments
                • Safer Neighbourhoods
                • Community spirit
                • Service Provision
                • Employment & Local business opportunities
                • Other things that affect our health

The HIA recommendations have been handed over to an Implementation
Group, which includes representatives from CCC, Travellers, Traveller
representatives and a range of interested agencies. The Implementation group
will see through the outworking of the recommendations.




                                         7
Chapter 1 Background


Health Impact Assessment (HIA) has been defined as “a combination of
procedures, methods and tools by which a policy programme or project1 may be
judged as to its potential effects on the health of a population and the
distribution of those effects within the population (1)

HIA represents an innovative approach to the evaluation of social, economic
and environmental policies, programmes and projects. It is recognised by Article
152 of the Amsterdam Treaty which calls for the European Union to examine the
possible impact of major policies on health (2)

HIA in Ireland is endorsed by Investing For Health (Northern Ireland) (3) and
Quality and Fairness (Republic of Ireland) (4) as a means of improving the
health benefits of new proposals at policy, programme or project level.

HIA is concerned with the impact a proposal will have upon a defined population
or sub groups within a population. The purpose of HIA is to increase awareness
of the health implications of new proposals with a view to maximising potential
health gain.

HIA
  • Takes account of the distribution of impacts within a population
  • Promotes sustainable development
  • Recognises the need for differing ‘types’ of evidence including qualitative
    and quantitative evidence
  • Ensures that all evidence is used in an ethical manner
  • Has an explicit focus on equity and social justice
  • Uses multidisciplinary, participatory approaches
  • Is open to public scrutiny

There are five stages in a HIA process.

      1. Screening which determines whether or not to undertake a HIA.

      2. Scoping which sets the boundaries and terms of reference for the HIA.

      3. Appraisal which involves gathering the evidence and identifying the
         positive and negative health impacts associated with the policy
         programme or project.



1
    To avoid repetition the term proposal replaces policy programme or project
                                                         8
    4. Developing recommendations based on the impacts plus evidence
       identified at the appraisal stage.

    5. Monitoring and evaluation involves examining the HIA’s contribution to
       the decision making process and its contribution to improved health and
       equity.

 Background the Doneraile proposal

In July 2005 Cork City Council brought together representatives from key public
agencies and other relevant groups to form an interagency forum. The
interagency forum developed an action plan for the delivery of Traveller specific
services in an integrated way. Within the action plan they prioritised the following
themes:

    • Youth issues
    • Education
    • Accommodation & health
    • Enterprise, employment & training
In 2006 the interagency forum published the Cork City Interagency Traveller Plan.
Contained in this document, under the theme accommodation and health, was the
following action: Conduct Health Impact Assessments on two Cork City halting
sites (Appendix 1).

The responsibility for overseeing and managing the HIAs was delegated to
Traveller Health Unit HSE South with support from the accommodation and health
working group.
HIA Ireland
In July 2007 HIA Ireland was commissioned to undertake this HIA by Traveller
Health Unit HSE South on behalf of the interagency forum.

HIA Ireland is a consultancy agency committed to the development of HIA as an
effective tool in tackling health inequalities.

HIA Ireland aims to build capacity for agencies to undertake HIAs by providing a
highly skilled resource when and where it’s needed.

To date HIA Ireland has specialised in working with marginalised and hard to
reach groups.



                                          9
The Doneraile proposal

Background

In July of 1981 CCC purchased a 79 acres’ site in Doneraile with the intention of
developing a landfill site. However, the site was deemed unsuitable as the land
was of poor quality.

In 2000 CCC, as a result of a court order, developed a temporary halting site at
Doneraile for a family of Travellers who had based themselves in a town car park.
The original family never took up occupation but it was occupied in late 2000 by
another Traveller group of 4 families. There are now three families living in this
location.

In 2001 legal proceedings were initiated, by CCC, to remove the occupants and
repossess this site; this action was not progressed to court.

In 2004 initial plans were put forward to place a permanent halting site at this
location. Application for Housing Accommodation, with preferences for permanent
halting site, was included in the Council’s Traveller Accommodation Programme
2004 - 2008.

From 2004 onward, CCC, in discussion with various groups, amended the initial
proposal to include provision for both permanent and transient sites.

The current proposal:

To provide a three bay permanent halting site and six bay transient site at
Ballydineen, approximately 3 miles from Doneraile, providing suitable water,
sanitary, cooking and heating facilities for the families currently resident on the
site.

The transient site is intended to be used on a pre-booked, intermittent basis and,
therefore, is more basic with a bay, electricity and a toilet that can be accessed.

The current proposal allows the families to remain on the existing site during the
construction period.

Why do a HIA of the Doneraile proposal?

The Doneraile proposal was considered a good candidate for HIA as

    • The Traveller community experiences significant health inequalities.
    • The proposal could be influenced at the planning and development stage.


                                          10
• The decision makers, i.e. Cork County Council, were actively engaged
  with the process as members of the Interagency Traveller accommodation
  and health sub group.
• The use of HIA methodology had been identified as an action in Cork City
  interagency Traveller plan Objective 1 Action 1.
• HIA offered an opportunity to explore the evidence base relating to health
  impacts for Travellers of redevelopment and the built environment.
• HIA provided an opportunity to involve the people and communities most
  directly affected by the proposal, including the settled community who
  neighboured the proposed site of the redevelopment.
• HIA had the potential to enhance the coordination of action to improve
  health across various sectors including: Traveller representative groups,
  Cork County Council and The HSE; also, those who currently provide a
  range of services to the Traveller community and those who could
  potentially develop new services for this community.
• HIA offered an opportunity to maximise benefit from the investment by
  examining the proposal’s potential to influence a range of health
  determinants including: crime and safety, community spirit and educational
  achievements.
• HIA provided a structured framework for the investigation and discussion
  of health impacts, and the identification of many more impacts compared
  to not doing one.
• The Traveller Health Unit had the necessary resources to carry out the
  HIA.




                                   11
Chapter 2.       The Health Impact Assessment

Screening

A screening exercise was completed to determine whether a HIA should be
undertaken.

A screening tool, developed by the Institute of Public Health in Ireland, was used
(7). This tool provided a structured guide to identifying potential positive and
negative health impacts and their distribution within target populations.

Screening Process

Representatives from Traveller community, CCC and a range of interested
voluntary and statutory agencies were invited to attend a screening exercise
facilitated by the HIA practitioner. The detail of the screening exercise is
included in Appendix 2. The outcome of the screening exercise was agreement
to proceed with a HIA of the Doneraile proposal.

A search of completed HIAs showed one example of a similar HIA with the
Traveller community in County Donegal; however, at a structural level these two
pieces of work differed significantly.

Establishment of a Steering Group

A Steering group was established with representation from the three main
stakeholder groups.

  1. Those most affected by the proposal, i.e. Travellers living on the current
     site

  2. Those concerned or interested in the proposal’s impact, i.e. Statutory,
     Voluntary or Community sector representatives working with Traveller
     community.

  3. Those expected to act on the HIA recommendations, i.e. CCC.

The steering group membership is shown in Appendix 3.




                                       12
Building capacity for stakeholders to engage with the HIA

The majority of the stakeholders involved in this HIA had no prior experience of
HIA methodology. To enable stakeholders to engage with the process, the HIA
practitioner provided a series of briefing sessions with interested parties.

Pre & post meeting briefings were provided to those from the Traveller
community who formed part of the steering group.

The local HSE community development team played a key role in encouraging
attendance and participation at appraisal workshops. The team’s local
knowledge of key stakeholders ensured turn out at the workshops.

Making the HIA appraisal process accessible

Steering group members, with knowledge of Traveller issues, advised on best
practice in promoting participation from Traveller community at the appraisal
workshops; including, design of letters of invitation to attend appraisal
workshops and workshop materials.

The letter of invitation to attend a workshop and the HIA appraisal tools were
modified to ensure they contained:
  • Clear and simple text (plain English) with short sentences, simple
      punctuation and no jargon.
  • Large print and a clear typeface with plenty of spacing
  • Bullet points to make the main points clear
  • Symbols to support text where possible

The workshop facilitators were further instructed by members of the steering
group on cultural issues relating to Traveller customs. This support was
essential in ensuring that questions were framed within Travellers’ lived
experience and that facilitators had prior knowledge of issues such as
relationship between Travellers and a range of agencies, such as Garda
Siochana, Social services & CCC.

Facilitators were also fully briefed by CCC housing managers on the context and
background to the proposal’s development.




                                       13
Scoping

The Health Impact Assessment steering group held a scoping exercise to
identify the work programme, timetable and terms of reference for the HIA. The
following scoping checklist was used (5):

                    Donaraile HIA scoping checklist

  1. Objectives of the HIA

    I. To influence the design for the redevelopment of Dunaraile halting and
       transit sites, with the express purpose of ensuring that positive health
       impacts can be enhanced and negative impacts reduced or eliminated.

   II. To promote Traveller participation in the Dunaraile redevelopment
       decision making process as it impacts upon their community.

   III. To develop a shared understanding, among all those involved in the HIA,
        of the links between the proposed redevelopment and health.

  2. Elements of the proposal to be appraised

  I. Proposed redevelopment of Halting and Transit site, including:
    • Construction phase
    • Design of new dwellings and area lay out
    • Environmental, social & health Impacts upon surrounding area

  3. Output of HIA

  I. A series of recommendations based on best available evidence that
     maximise the positive impacts and minimise the negative impacts of the
     proposed redevelopment of Dunaraile Traveller sites.

  4. Non-negotiable aspects of the HIA

  I. Traveller involvement in all stages and at all levels of HIA process

  II. HIA should not delay the redevelopment

 III. Units to be built according to plans and within Building and planning
      regulations
                                         14
  5. Target groups for the appraisal workshops

  I. Travellers from current Doneraile site and Traveller representatives with
     knowledge of issues affecting those using Transit sites (all must be
     members of Traveller community)
 II. Workers with knowledge of Traveller issues
III. Those from surrounding area
IV. Traveller children via art project
 V. Small scale interviews with Traveller men

  6. Geographical area affected by the proposal

     I. Doneraile Halting site and surrounding areas

  7. Communities & Vulnerable Groups directly affected by the proposal

     I.   Single mothers
    II.   Traveller men
   III.   Children
   IV.    Families using the transit site (particularly children of school age)

  8. Local conditions & circumstances relevant to the HIA

     I. Engaging with Traveller men will be difficult
    II. Breaking down barriers between agencies and encouraging joint
        working could prove difficult.
   III. Constraints of design might limit possible changes
   IV. Completing HIA work within timescale to effect maximum change
    V. Traveller wedding planned for September – this will take up residents’
        time and might make it hard to get people engaged with process.

  9. Health Impacts of Concern - Direct and Indirect
  I. Safety during construction phase

  10.      Stakeholders
Cork County Council Housing Department
Travellers of North Cork (TNC)
Southern Traveller Health network
HSE Community work Dept , North Cork
                                   15
Ballyhoura Development Association
Irish Traveller Movement
Traveller Health Unit, HSE South

  11.      Methodology for the HIA

   I. Appraisal workshops with Travellers and workers & those from
      surrounding area
  II. Literature review to be commissioned from an academic with specialist
      knowledge of Traveller issues
 III. A series of small scale interviews with Traveller men
IV. Undertake an art project with children and young Travellers.
  V. Health profile using local information
VI. Steering group to consider all of above and develop recommendations
VII. Steering group to consider how best to monitor and evaluate the HIA

  12.      Management Arrangements for the HIA

   I. The overall direction of the Health Impact Assessment would be set by
      Steering group
  II. HIA practitioner is responsible for gathering the evidence at appraisal
      stage.
 III. The Steering group would agree the recommendations and ensure, where
      possible, they are evidence based.

  13.      Sources of Funding

Traveller Health Unit will provide funding for this project. Members of Steering
Group to contribute staff time and commitment to process


  14.      Major items of Expenditure

   I.HIA practitioner’s time and costs
  II.Art project with Traveller children
 III.Publishing final report
 IV. Launch of report
  V. Resources to enable participation at appraisal workshops and steering
     group
 VI. Venue hire and hospitality
                                         16
   15.      Decision-making Forums for the HIA (including points of
      influence)
   I. The steering group is the decision making forum for the HIA
  II. The Cork County Council planning process is key point of influence

   16.       Work program for HIA

   I.   Steering group meetings
  II.   Gather evidence at appraisal stage
 III.    Literature review
 IV.    Complete health profile
  V.      Develop recommendations
 VI.    Agree monitoring and evaluation
VII.    Complete Health Impact Assessment
VIII.   Launch report

   17.       Dissemination of the results of the HIA

   I. Media strategy to be developed by relevant PR personnel from the
      range of agencies involved; dissemination of results to comply with this
      strategy
  II. Recommendations to be in place before end of October
 III. Summary of finding and recommendations to be distributed to all
      Travellers from Doneraile and settled community from surrounding area

Monitoring and evaluation

The evaluation and monitoring schedule agreed for use is contained in
Appendix 4.




                                      17
Appraisal

The appraisal stage of a HIA involves collecting the evidence and assessing the
health impacts. This is done by analysing the proposal, profiling the affected
population and identifying and characterizing the potential health impacts on the
population.

The following approaches were used to gathering evidence for appraisal:

    •   Five appraisal workshops
    •   A series of art based workshops with young Travellers
    •   A literature review
    •   A health profile

Appraisal workshops

Selection of the appraisal Tool

An appraisal tool, used in a previously completed HIA of Dove Gardens
redevelopment (2006), was selected as a template for this HIA and modified to
remove bias toward settled community (6).
The appraisal tool took account of:
  • Disadvantage and social exclusion (poverty, unemployment, crime, low
    educational achievement and poor social & community environment)
  • Living conditions
  • Working conditions
  • The wider environment
  • Individual’s behaviour and way of life
The appraisal tool was made accessible to members of Traveller community by
removing references to settled community experience, such as replacing the
appraisal heading house with trailer. The appraisal tool is shown in Appendix 5

Appraisal Workshops:

   A total of 63 people attended the five appraisal workshops
      • 34 attended the workshops from Traveller community
      • 29 attended the workshops from Settled community and workers
In addition 4 young people from the Traveller community attended 3, art based,
appraisal workshops. The sample of art work from workshops, shown below,

                                       18
was produced by Noreen. Additional art work was used to illustrate the front
cover of this report.




At the scoping stage it was decided to hold separate appraisal workshops
focusing on either the halting or transient site.

Comments made at five appraisal workshops were recorded using standard
note taking format and fully transcribed within 24 hours of workshop finishing. At
the Transient workshop the workers and settled community groups were split.
Settled community comments on transient site are shown in appendix 6

This was done to enable the thoughts of the settled community to be
distinguished from those of the workers.

Each workshop lasted on average 2 hours.




                                        19
The workshop facilitators reviewed all workshop comment and related it to a
specific heading in the appraisal tool. This was done by:

  Step 1 Facilitators agreeing the comments.

  Step 2 Facilitators’ agreement on the determinant of health underlying the
  workshop comment using the categories set out in the appraisal tool.

  Step 3 Facilitators agreeing the impact upon the particular determinant of
  health. This included classifying the impact as negative or positive,
  documenting any particular groups mentioned, e.g. men or women, young or
  old, those from particular communities.

  Step 4 Recording the impacts under a particular determinant of health
  heading and labelling it as coming from a defined group, such as Travellers,
  settled community or workers.

  Step 5 Each impact was assigned a unique reference number making it
  possible to track the impact’s progress through to forming recommendations
  stage.

As aforementioned, a total of 150 impacts were identified across the 6 major
impact categories, 59 relating to Transient site and 91 relating to Halting site:

           1.   Environments
           2.   Safer Neighbourhoods
           3.   Community Spirit
           4.   Service Provision
           5.   Employment & Local business opportunities
           6.   Other things that affect our health

The impacts are shown in Appendix 7.

Literature Review

The literature review used by the HIA project was based on a paper
commissioned from Dr Robbie McVeigh. Dr McVeigh reviewed all impacts and
where possible linked these to available published research on Traveller
experience. A second literature review was completed which related to generic
public health studies on the health impacts of redevelopment on a
neighbourhood.




                                       20
Dr McVeigh’s paper is included in appendix 8, however, the section on
Literature and Policy on Travellers and Health in Ireland warrants inclusion in
main body of this report.

There is a paucity of academic and other research literature on Travellers
health. The key text remains The Travellers Health Status Study: Vital Statistics
of Travelling People (Barry et al. 1987). But this is now twenty years out of date
and there have unquestionably been many changes in the health status of
Travellers – as well as in related policies – in the interim. Pauline Ginnety’s The
Health of Travellers (1993) is the equivalent text in the north. The Task Force
on the Travelling People report has a section on health and commissioned some
health-specific research in support of its work (Task Force 1995: 132-153;
McCarthy et al. 1995.). In the north the PSI Working Group Report on
Travellers also has a detailed section on health (Office of the First Minister and
Deputy First Minister 2004: 36-41). In total, however, the area of Traveller
health remains profoundly under-researched. The Pavee Point Primary Health
Care for Travellers Programme provides an important analytical and practical
intervention recording different aspects of Traveller health care. But this
grounded, primary health intervention does not generate substantial new
research data. At present, therefore, there is a dearth of contemporary analysis
and data on Traveller health in Ireland. Little has changed since the THS
suggested:

      There is currently no systematic or regular gathering of data relating to the
      health status of Travellers. The major barrier to achieving this is the
      absence of any specific identifier of Travellers within the existing health
      data-gathering systems in use in hospitals or the community. (2002: 32)

This situation should be corrected by the recently launched All-Ireland Traveller
Health Study (UCD School of Public Health and Population Science 2007) but
this has not generated any new data to date and will not report for some years.
In the interim the key policy and strategy document remains the Traveller Health
Strategy (THS) and associated policy and practice.

Thus the publication Traveller Health: A National Strategy 2002-2005
(Department of Health 2002) remains the key analytical and policy tool for
addressing the impact of different policies and practices in terms of Traveller
health. The THS makes clear the absolute centrality of Traveller
accommodation issues to Traveller Health:

      There is little doubt that the living conditions of Travellers are probably the
      single greatest influence on health status. Stress, infectious disease
      including respiratory disease and accidents are all closely related to the
      Traveller living environment. It is clear that an immediate improvement to
                                           21
      the living environment of Travellers is a prerequisite to the general
      improvement in health status. (2002: 28)

The THS provides baseline data on Traveller health status as well as a policy
context for work in support of Traveller health. Its analytical approach is put in
context by its ‘reasons for a Traveller Health Strategy’:

      Travellers are a distinct minority group of Irish people. They differ from the
      general population in many respects including their life-style, their culture
      and their treatment by society. In the Ireland of today, the Traveller
      community continues to experience high levels of social exclusion and
      disadvantage – a situation which requires an urgent, planned response.
      (Section 1.1)

This echoes the approach of Pavee Point Primary Health Care for Travellers
Programme:

      Traveller health is significantly worse than the health of those in the settled
      community. As Travellers are a distinct cultural group Travellers have
      distinctive health needs and require special consideration in the health
      service. (Pavee Point 2007)

Thus the approach is firmly rooted in recognition of Travellers as an ethnic
group and in the implications that this has in terms of the delivery of health care.

As we have seen, the THS also has some specific reference to Traveller
accommodation. Most importantly, it recognises that accommodation is one of
the ‘key determinants’ of Traveller health outside the formal health care sector:

      Some of the key determinants of health exist outside the formal health
      care sector. This Strategy includes proposals which will ensure that full
      account is taken of these factors, in the course of future planning and
      delivery of health services…. One important area is that of Traveller
      accommodation and the conditions in which many Travellers live from the
      perspective of health and safety. (26-7)

This analysis has key implications in terms of policy on accommodation:

      While neither the Department of Health and Children nor the Health
      Boards have a major direct role or responsibility in relation to the living
      environment of the Traveller Community (and /or accommodation
      provisions), it is important that close links be established between the
      health sector and the environmental authorities and that there should be
      maximum co-operation in addressing the environmental factors which
      have such a significant influence on the health status of Travellers. 28
                                         22
Thus an ‘intersectoral approach’ including specific attention to Traveller
accommodation is central to improving the health status of Travellers:

      As indicated in Chapter 4, it is now widely acknowledged that many of the
      major determinants of health such as social, environmental and economic
      factors are beyond the direct remit of the health sector. The Health
      Promotion Strategy 2000-2005 acknowledges this and calls for the
      development of intersectoral collaboration through the establishment of a
      National Health Promotion Forum. The new Forum will be widely
      representative and its membership will include representatives of those
      Departments and agencies whose policies/actions have a direct or indirect
      impact on health determinants. If the inequalities which exist in Travellers
      health, particularly those relating to income, education, discrimination and
      accommodation, are to be addressed at a macro level, it is imperative that
      Travellers and Traveller organisations are included in the membership of
      the Forum. (2002: 46)

In other words, therefore, the connection between Traveller health and Traveller
accommodation is explicitly recognised by Government in the THS:


The THS also provides some baseline data but confirms that there should be a
strong caveat with this data:

      This document does however make some references to the 1996 Census
      data. It should be borne in mind that because the data was skewed, in that
      it counted only Travellers in halting sites, the data may be biased in terms
      of the age profile of Travellers (since younger Traveller families tend to be
      more mobile because their accommodation options are more limited).

Despite this caveat, there is a clear and unambiguous identification in the THS
of Traveller-specific health disadvantage. The Traveller Health Strategy
identified several indicators of profound inequality in Travellers health –
including life expectancy, infant mortality and Sudden Infant Death Syndrome
(2002 19-36). Again this underlines the conceptual link between
accommodation issues and other Traveller health indicator data.

The THS also recognises specific issues in terms of Travellers with disabilities
and accommodation:

      It has been suggested that Travellers with disabilities may suffer from
      being an almost invisible sub-group within the Traveller community,
      lacking in community support services such as home help, occupational
      therapy and physiotherapy. Because of difficulties of accessibility of
                                       23
      Travellers accommodation, those with disabilities may become
      institutionalised inappropriately at an early age, with little account being
      taken of their particular cultural identity as Travellers. (2002: 86)

The THS envisages this issue as being addressed by new liaison structures:

      The liaison mechanism with the Department of the Environment and Local
      Government proposed in Chapter 4 will address and monitor the issue of
      appropriate accommodation for Travellers with disabilities. (2002: 87)

The THS also confirms the ongoing reality of ‘on the roadside’ accommodation
for nearly one quarter of the whole Traveller population with all the health
implications of this accommodation status. While the proportion of Traveller
families ‘on the roadside’ has reduced, the actual number has remained fairly
constant.
Source THS 2007: 27

In short, therefore, the THS identifies a strong positive correlation between
improvements in Traveller accommodation and improvements in Traveller
health.

Conclusions
All the research suggests that there is a clear correlation between appropriate
accommodation provision for Travellers and improvements in health care. This
analysis was central to the Task Force Report and has informed all interventions
in support of Traveller health since. In this instance, this means that both
permanent and transient accommodation provision is required for Travellers.




                                         24
Prioritising Impacts.

The HIA steering group prioritised impacts by matching the workshop impacts to
evidence from the literature review and health profile. Impacts that were not
coded as likely (L; supported by evidence) were not considered in developing
recommendations. The full Health profile is shown in Appendix 9.

This approach was explained and agreed by the steering group. This enabled all
the recommendations to be linked back to the original impact statements which
are included in Appendix 5. This was done in three stages.

Stage 1

Matching impacts to available evidence

The Appraisal Workshops identified 150 impacts. Dr Robbie McVeigh was
commissioned to review the 150 impacts and identify published evidence from
Traveller specific research to support, or not, the impacts identified at the five
appraisal workshops. Also included was the report from the young Travellers
workshops shown in appendix 10.

Along with this strand of evidence, a literature review of the impact of
redevelopment upon health was matched to impacts. This review was not
confined to Traveller specific research.

As a result of the matching process, impacts, for which there was no evidence,
were removed.

Stage 2

The HIA steering group coded all remaining impacts for which there was
supporting evidence using the coding schedule developed by the Institute of
Public Health Ireland (7).

   •   L=health impact is Likely and is supported by evidence
   •   I=heath impact will have an affect on health Inequalities
   •   C= health impact is considered as a cause for concern by the Community
   •   S=health impact is Speculative
   •   U=health impact is Unlikely in this case
   •   O=Other give detail

                                        25
Stage 3.

The steering group prioritised those impacts which had been coded as likely and
supported by evidence. Some impact statements had more than one coding e.g.
Likely and Community, these were also included.

The prioritising was done on the strength of the evidence and how well this
matched the impact and health profile findings.

Table 1.   Summary of Prioritising Impacts

                                     Stage 1

5 appraisal workshops identified 150 impacts. Evidence from research and
impacts were matched.
                                  Stage 2

Impacts not supported by evidence were removed

Steering group assigned a code to each of the impacts based upon evidence
from literature review and health profile.

                                     Stage 3

Steering group prioritised those impacts with a primarily coded as Likely (L).



Recommendations of HIA

The purpose of a HIA is to develop evidence based recommendations which
influence the decision making process. The recommendations inform decision
makers of the ways in which their proposal needs to be amended to enhance
the positive impacts and reduce or eliminate the negative impacts. The steering
group had representation from the decision makers, CCC, those interested in
the proposals impact and those most affected by the proposal, i.e. the Traveller
community who would be living in the redeveloped area. This support was
essential in forming recommendations that were both relevant to the experience
of the Traveller community, and based within the constraints under which
proposal was bound, such as available funding, planning process etc.

The appraisal process generated 140 coded health impacts statements from
which the 70 recommendations, 42 for Halting site and 28 for Transient site,
were formed. Recommendations were developed across the six major impact

                                        26
categories used at the appraisal stage. All of the recommendations can be
linked with one or more prioritised impact statement.

The recommendations are described in Table 2.




                                    27
Recommendations from Health Impact Assessment Halting site

Table 2                                  1 Environments
1.1 Home
                                         Recommendations
  a) We recommend installing a stove/range to provide for cooking and heating. This system should be
     linked to existing home to ensure one source of heat throughout. (1.1b)

  b) We recommend provision be made for internet access in homes to encourage education and home
     study for both children and adults. (1.1c)

  c) We recommend installing the highest standard of ventilation to reduce indoor vapours and keep homes
     free from damp and mould. (1.1d)


  d) We recommend all parties explore the possibility of demountable accommodation to reduce the
     problems associated with traditional mobile homes such as damp/hard to heat & leaking roofs (1.1d)

  e) We recommend that the good relationships developed through the HIA process are maintained and
     developed to foster partnership working. Key to this is the development of an implementation group to
     see through the outworking of the recommendations. (1.1e)

  f) We recommend that the opportunities presented by this development be used to develop greater linkage
     with existing community development activity to promote Traveller involvement in homework support and
                                                   28

Dermot Glackin; HIA practitioner
      after schools clubs. This should be informed by the educational support identified in previous
      consultation. (1.1f)

1.2 Traffic
                                            Recommendations
   a) We recommend that the following points are incorporated into a traffic management plan for the halting
      site

          • Accommodation of parking for extended family
          • Provision for service vehicles such as bin lorry & fuel deliveries, particularly if they need space to
            turn.
          • Balance between need to accommodate vehicles associated with Traveller work practices and
            home life requirements
          • Signage to alert drivers that children are at play and/or emerging from site (1.2a)

1.3 Natural environment & land use
                                            Recommendations
   a) We recommend that Traveller community are supported to take part in cultural activities such as CCC
      tidy towns’ initiatives. This support should include help seeking funding for environmental improvements
      such as flower baskets and planting and practical support with up keep of communal areas such as loan
      of grass cutting equipment. (1.3a, 3.1b)

   b) We recommend introducing regular planned neighbourhood clean ups as part of an overall estate
      management plan. In support of this, Steven O’Sullivan should act to encourage residents to report fly
      tipping (1.3b)

                                                        29

 Dermot Glackin; HIA practitioner
  c) We recommend that the existing site be used for future horse project when it becomes vacant. (1.3c)

  d) We recommend that Traveller families are supported to take part in refuse collection scheme and
     recycling initiatives (1.3d)

  e) We recommend using the surrounding out door space to its fullest potential. Enabling opportunities,
     such as forest walks, to take place for both children and adults (1.3e)

                                       2 Safer Neighbourhood
2.1 Crime & Anti-Social Behaviour
                                          Recommendations
  a) We recommend that both Travellers and settled community develop a joint neighbourhood watch
     scheme supported by Garda. (2.1a,b,e,h 4.1;g)

  b) We recommend that plans for the area are subject to scrutiny by Garda Environmental Design Officer
     for comment on issues such as estate layout and locks on doors and windows. (2.1b)

  • We recommend that all agencies involved seek funding to develop a safe play area for children (2.1c
    3.1;f/g 3.3;e 5.4;a)

2.2 Fear of Crime
                                          Recommendations

  a) We recommend that street lighting be included in development (must avoid shining directly into
     bedrooms) (2.2g)
  b) We recommend that no barrier is used on halting site development and that the reasons behind this
                                                     30

Dermot Glackin; HIA practitioner
      decision are communicated to settled neighbours possibly via proposed neighbourhood watch group.
      (2.2i)


                                         3 Community Spirit
3.1 Image of the area
                                           Recommendations

   a) We recommend that the predicted lift in community sprits associated with this development is harnessed
      to form a residents’ association. (3.1a,b 4.1;g 5.5;a)

   b) We recommend that Traveller children are encouraged and supported to take part in existing youth clubs
      and that the possibility of using the redevelopment as a opportunity to raise settled children’s
      understanding of life for Traveller children and customs be explored. This might also involve the use of
      children’s art in built environment. (3/1f)




                                                    31

 Dermot Glackin; HIA practitioner
3.2 Sense of Community
                                         Recommendations
  a) We recommend the following be incorporated into redevelopment
       • Traveller community renaming their neighbourhood (suggest name from Traveller language that
          relates to local area)
       • A welcome sign in Irish, Cant and English be erected at entrance to area
       • Traveller residents are given opportunity to pick name for their home (suggest name from Traveller
          language) (3.2;a,c,d)

  b) We recommend that space for a grotto to Our Lady be included in redevelopment and this be used for
     an annual outdoor mass on feast of Padre Peo (16th June) to which settled neighbours are invited,
     possibly followed by community barbeque. (3.2;b 3.3d)

  c) We recommend that interim measures be put in place to address current conditions on the halting site,
     focusing on refuse collection Inspection and cleaning of water supply connection to mains electric and
     toilet provision. (3.2;f)
3.3 Social contact
                                         Recommendations
  a) We recommend that opportunities presented by the redevelopment to design layout are used to
     encourage contact between neighbours. Discussed: footpaths, green spaces & communal areas a
     bench to sit on. This should be done in partnership with Traveller community, all plans should permit
     access for those with disability (3.3;a/b 5.4;b)

  b) We recommend that Traveller community are involved in discussion and planning of future
     developments that surround their neighbourhood. (3.3;c)
                                                    32

Dermot Glackin; HIA practitioner
  c) We recommend that the size of bays should permit families space to live in privacy (3.3;g)

3.4 Family cohesion
                                          Recommendations
  a) We recommend acting upon the opportunities to make the redevelopment sustainable; this should
     include laying the ground work for future generations (3.4;b,c,d)



                                         4 Service Provision
4.1 Access to Services
                                         Recommendations
  a) We recommend inclusion of piped fresh water, electricity and connection to sewage system. (4.1;a 4.2a
     5.2;d)

  b)   We recommend circulating new address details to relevant agencies including
  •    Fire
  •    Ambulance
  •    Welfare
  •    Post office
  •    Primary care GPs. (4.1;b)

  c) We recommend Travellers are given training in fire safety both indoor and outdoors. Also how to
     develop an exit plan in event of fire and servicing your smoke alarms. (4.1;d)

                                                    33

Dermot Glackin; HIA practitioner
   d) We recommend that advice is provided on CWO grants associated with moving home along with advice
      on budgeting for refuse collection and electric. This could be linked with a group scheme to bulk buy
      white good such as fridge, carpets etc in partnership with credit union (4.1;e 4.2b)

   e) We recommend council establish a Liaison Officer to act as one point of contact for speedy resolution of
      issues and quality repairs (suggested Muriel Mahony). (4.1;f, h 4.2;d)


                                    5 Other things that affect health
5.1 Income and poverty
                                          Recommendations
Traveller community
   a) We recommend that Traveller families are encouraged to save money to provide for following
   • Fridge
   • Washing machine (see Rec 4.1;d) (5.1;a 5.2;a)

   b) We recommend that homes are built to highest insulation standards and that provision is made in the
      design specifications for inclusion of renewable energies (5.1;b,c)

   c) We recommend that all parties seek out funding to explore use of innovative renewable energies such
      as solar panels and harnessing wind power. (5.1;c)




                                                     34

 Dermot Glackin; HIA practitioner
5.2 Diet
Recommendations

  a) We recommend that Traveller families are encouraged to think about home safety particularly if they are
     living and cooking in two separate dwellings. Recommend fitting safety rails to cooker to prevent
     children pulling pots over and provision of thermostatic valves to prevent scalds. (5.2; b)

  b) We recommend that the anticipated reduction in reliance upon carry out fast foods be backed up by
     provision of healthy cooking skills sessions. (5.2;c)

5.4 Exercise
                                        Recommendations
  a) We recommend that future residents’ group develop links with organisations such as GAA to explore
     opportunities for involvement in traditional Traveller games such as hand ball (5.4;c)


                          6 Employment & Local Business Opportunities
6.1 Access to jobs
                                        Recommendations
  a) We recommend developing links with FAS & Interagency Sub Group on employment and Training to
     explore how opportunities to increase educational achievement and job prospects can be progressed
  (6.1 a,b,d & e 6.2 a)

  b) We recommend developing links with RAPID and HSE community work dept. to explore opportunities in
     adult education and homework clubs (6.1c)
                                                   35

Dermot Glackin; HIA practitioner
  c) We recommend that Travellers are supported and encouraged to take up possible jobs in site security
     and maintenance (Limerick Model suggested) (6.1f 6.2c)

  d) We recommend that training opportunities for young people be developed, including possible week’s
     work experience with CCC planning dept. (6.1 f)

6.2 Creating local jobs
Recommendations
  a) We recommend inclusion of well managed horse project supported by training provided by Vets office.
     The site should be used to its maximum potential including acknowledging the history of the area as the
     place were the first ever steeple chase in Ireland was held. The purpose of this is both to create jobs
     and promote a sense of pride in the area. Any development should look at other examples of
     successful horse project and should involve RAPID(6.2 b)

  Additional recommendation
  We recommend developing a role for Traveller young people in grass cutting and disinfecting bays




                                                   36

Dermot Glackin; HIA practitioner
Table 8 Transient site recommendations 1 Environment
1.1 Home
                                            Recommendation
Traveller community

  a)   We recommend the provision of the following on site:
  •    Fresh piped mains water supply for each bay
  •    Shower facilities
  •    Toilets for each bay
  •    Electric connection for each bay(1.1a)
1.2 Traffic
                                            Recommendation
  a) We recommend traffic management plan is put in place which deals with the anticipated increased traffic
     and makes provision for Traveller families pulling in and out of Transient site. (1.2 a, b)

1.3 Natural environment & land use
                                            Recommendation
  a) We recommend Transient site management plan includes the following:
  • Provision for refuse collection, recommend large bin and cost is part of overall charge for stay
  • Defined caretaker responsibility for maintaince of communal areas (1.3a 3.1b,c)

  b) We recommend that the greatest possible space is placed between Transient site & Halting site. In the
     event that this requires amendment of existing planning permission the Halting site should be progressed
     under current agreed planning permission it is essential that this does not delay the re-development of the
     Halting site. (1.3 b)

  c) We recommend that the Transient site is introduced in a phased implementation as a pilot subject to review


                                                         37
    of its success or otherwise (4.2 e).

  d) We recommend that an environmental report, on the quality of the ground, be undertaken and results made
    available to all concerned. (1.3 d)

  e) We recommend that, as part of phased implementation of Transient site, demand for places is profiled
    using National sources such as All Ireland Traveller Health Strategy and local sources of information held
    by CCC. This work should involve the ITM. Feed back should be gathered from the families using the site
    possibly by way of questionnaire interview or comment book. This should feed into review of site. (1.3 c 2.2
    b 3.2 b)

                                           2 Safer Neighbourhood
2.1 Crime & Anti-Social Behaviour

                                             Recommendation
  a) We recommend CCC develop, in partnership with concerned agencies, a code of conduct and rules for
     those using the transient site. Such a code of conduct should contain contingency plans to deal with ASB
     and be in a format that is accessible for those with poor reading skills (2.1 a)

  b) We recommend that a refundable deposit system is put in place requiring departing Traveller family to
     leave transient bay in good order ( in exceptional circumstances this deposit could be set aside) (2.1b)

  c) We recommend that a maximum of 2 bays are used at any one time for placing families currently on the
     road side. The remaining 4 bays should be available for Travellers from any part of Ireland and Britain. (2.1
     e 4.3 b)

  d) We recommend that, in the event that Transient site is to be used as a place to remove Travellers currently
     on the road side, the CCC is mindful to avoid placing families who are in opposition to each other on the
     site at the same time (2.1 e)

                                                         38
   e) We recommend that any adverse incidences are reported to current interagency partnership which includes
      Garda at Chief Superintendent level (2.1 d)

   f) We recommend that, in the event that Transient site is used as a place to remove Travellers currently on
      the road side, the CCC has a robust process for ensuring the support services remain available e.g. Public
      Health Nurse

   g) We recommend that the booking form for place on Transient site includes the question have you or a
      member of your family been charged with a sexual offence.
2.2 Fear of Crime
                                             Recommendation

   a) We recommend that a range of agencies are approached to support and fund on the Transient site, a small
      play area (2.2c)

   b) We recommend that, as part of phased introduction of Transient site, a watching brief is kept on families
      pulling up outside the Transient site and camping. This should be taken into consideration in the review of
      Transient site (2.2 e)
                                            3 Community Spirit
3.1 Image of the area
                                            Recommendation




                                                          39
a) We recommend that CCC employ a caretaker for the up keep of site and communal areas. (3.1 a, b & c & e
   3.2 d)

b) We recommend that proposed Transient site is linked to other existing and proposed Transient sites.
   Agencies such as ITM should be encouraged to develop a national network of Transient sites. Both helping
   to identify and distribute good practice and early identification of areas of concern e.g. Limerick model. (3.1
   d 3.2 a, b 4.1 d)

c) We recommend that Transient site takes part in Traveller Week activities. This would include block booking
   bays for various artist and performers who could run workshops. A particular focus should be on Young
   Travellers and the transmission of Traveller culture across generations. (3.4 b)




                                                        40
3.2 Sense of Community
Recommendation
  a) We recommend that, in so far as is possible, Traveller cultural practices are accommodated in Transient
     site. The horse is part of Traveller economy and enabling those who travel with horses to pull in and use
     site would help sustain this way of life. Also, assisting those who travel with Trading vehicles (3.2 a 5.1
     a, b)

  b) We recommend that development work takes place between Traveller community and settled
     community with a focus upon developing a shared understanding of needs of both groups. (3.2 e)

  c) We recommend engaging community arts organisations to promote use of art in built environment. Also
     exploring opportunities for cultural exchange programmes between Traveller community and other
     indigenous ethic groups such a native American & Aborigine. (3.2 c)


3.3 Social contact
Recommendation
Traveller community
   a) We recommend that established families living by the road side should not be forced to move to
      Transient site unless there is written guarantee that suitable accommodation can be found within the 2
      week maximum stay period.(3.3 a)

  b) We recommend that, under normal circumstances, a two week period is maximum stay for any family
     using Transient site. However there should be contingency plans for unforeseen circumstances such as
     illness (3.3 a 4.1 f)




                                                      41
                                         4 Service Provision
4.1 Access to Services
Recommendation
 Traveller community
  a) We recommend producing an information sheet with contact details of local services this should be in a
     format which is accessible for those with literacy problems. (4.1 a)

  b) We recommend that the Travellers of North Cork initiative builds good working relations with both sites.
     There could be a possibility of improved access to services for both groups. (4.1 b)

  c) We recommend that children using the transient site are encouraged to use mobile teacher facilities.
     The booking form should identify children of school age this would enable teachers to plan for arrivals.
     (4.1 c)




                                                      42
                                5 Other things that affect health
5.4 Exercise
Recommendations
  a) We recommend that, as far as is possible within design constraints, the built environment should enable
     and encourage those using the site to get out for a walk/exercise. (5.4 a)




                                                     43
Chapter 3.       Monitoring and evaluation

Monitoring and evaluation is the last stage in a HIA process. The steering group
approved the use of the monitoring and evaluation template shown in Appendix
4.

Implementation of the recommendations will be the responsibility of the
implementation Group. This group needs to consider evaluation under three
areas:

  1. Accuracy of impact prediction
  2. How the HIA influenced Decision Makers
  3. Involvement of stakeholders

This needs to be reviewed at one, two and three year intervals following
completion of the HIA.

Accuracy of impact prediction:

The 145 prioritised impacts’ statements forecast the positive and negative health
impacts most likely to occur as a result of this proposal.

Evaluating the process of developing impacts is carried out by review of the
methods used to gather and analyse information. This relates to the three key
areas:

        • How was the evidence gathered?
        • What methods were used to prioritising evidence?
        • How did the evidence link to impacts?

All of the above have been described in detail in this document and
accompanying appendix document.

How the HIA influenced Decision Makers:

All HIA recommendations have been handed over to the Implementation group
which includes representatives from CCC.

The Implementation Group will be working closely with a range of agencies and
stakeholders to plan for the implementation of the recommendations.



                                        44
CCC (the decision makers) was involved at all stages of the HIA process
including:

  • Attending briefing sessions
  • Attending the screening exercise
  • As members of steering group.

Involvement of stakeholders

A review of minutes and record of attendance at meetings showed that
representatives from all stakeholder groups, Travellers, Travellers
representatives and decision makers were present throughout the stages of this
process and at all levels.

Also evaluation questionnaires were used at the end of steering group meetings
a sample is shown in appendix 11




                                       45
Chapter 4 Other findings from the HIA

The steering group noted additional issues from the HIA which were not
identified at the scoping stage:

  • HIA raised awareness of the links between living conditions and health
    outcomes for men and women from the Traveller community. At the most
    basic level it demonstrated the lack of research in this area

  • The modification of existing HIA tools, in order to make them accessible to
    men and women from the Traveller community, sets a template for others
    who may wish to engage in similar work.

  • This HIA contributes to the growing number of completed HIAs in Ireland.

  • Raised the profile of HIA as an effective tool in planning and demonstrates
    a model practice in addressing health inequalities as they impact on
    Traveller community.

  • Debate is ongoing within the HIA community surrounding the prioritisation
    of impacts. Some HIA practitioners argue that all impacts should be
    considered in the final recommendations and that the absence of evidence
    to support an impact statement should not exclude it from consideration in
    forming the final recommendations. In this HIA the steering group chose to
    prioritise impacts based on an assessment of all available evidence from
    literature review, appraisal workshops & health profile.




                                       46
References

1.World Health Organisation Regional Office for Europe Gothenburg Consensus
paper Health Impact Assessment: main concepts and suggested approach.
Brussels: European Centre for Health Policy; 1999.

2.European union. Treaty of Amsterdam amending the Treaty on European
Union, the Treaties established the European Communities and certain related
acts. Luxemburg: Official Journal no C 340, 10.11.1997.

3. Department of Health and Social Services and Public Safety. Investing For
Health. Belfast: Department of Health Social Services and Public Safety; 2002.
www.dhsspsni.gov.uk Accessed on 12/Oct/06

4. Department of Health and Children 2001b, Quality and Fairness: A Health
System for You, Department of Health and Children, Dublin

5. Ison, E. Rapid Tool for Health Impact Assessment in the context of
participatory stakeholder workshops- a task-based approach. Commissioned by
the Director of Public Health in Berkshire, Buckinghamshire, Northamptonshire
and Oxfordshire. Supported by the Faculty of Public Health Medicine. London:
NHS Public Health Resource Unit; 2002

6. Farrell B, Glackin D (2006) Health Impact Assessment; Dove Gardens CAWT
Health Impact Assessment a cross border approach project.

7. C Doyle, O Metcalfe, J Devlin. Health Impact Assessment: a practical
guidance manual        June 2003; The Institute of Public Health Ireland;
http://www.publichealth.ie/index.asp?locID=106&docID=173  Accessed    on
 th
8 /Sep/05



11




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