Background

In 2017–2018, Santé publique France Nouvelle Aquitaine investigated two significant public health alerts among the Traveler community: a major measles outbreak that affected the region, with numerous clustered cases among the Traveler community, on the one hand, and the occurrence of lead poisoning cases in children during an organized screening campaign in Charente across various living areas, on the other. In light of these findings, Santé publique France sought to conduct an epidemiological study to better assess the health needs within this population.

Concurrently, the National Federation of Solidarity Associations for Action with Gypsies and Travellers (Fnast-Gens du voyage) launched a region-wide project on the health of travellers, integrated into the Regional Program for Access to Prevention and Care for the Most Disadvantaged (PRAPS) implemented by the Nouvelle-Aquitaine Regional Health Agency for the period 2018–2023. As part of this multi-component project, Santé publique France Nouvelle-Aquitaine carried out the epidemiological component to better quantify the health needs of travelers, estimate vaccination coverage, and study the links between environment and health.

Objectives of the study

• Identify people’s health needs

• Assess vaccination coverage for measles and other vaccine-preventable infectious diseases, primarily among children

• Assess the links between living conditions and housing and the health of Travellers

Ultimately, it will help us understand and improve the location of living spaces, the role of pollution, online access, distance from specialists, stress, respiratory problems, vaccination, etc.

Study Population

The study involved 2,000 participants: adults and children aged 7 to 13 who were randomly selected and reside in four departments in the region. It was conducted by Santé publique France with the support of the National Federation of Associations for Solidarity and Action with the Roma and Travellers (Fnasat – Travellers).

Study Methodology

The surveys were conducted in person by a social worker from a local organization (Fnasat network or community center). Three questionnaires were developed by Santé publique France in collaboration with local organizations and Travellers:

• a questionnaire for adults,

• a questionnaire for children aged 7 to 13,

• a questionnaire to describe the characteristics of the living environment and housing.

Several days of training were organized for the interviewers during October 2019.

Data Confidentiality

The survey was conducted with strict respect for the confidentiality and privacy of the participants.

It was carried out by individuals working with the Traveler community, commissioned by Santé publique France and bound by professional confidentiality, under conditions compliant with the obligations set forth by Law No. 78-17 of January 6, 1978, on information technology, files, and civil liberties—known as the “Data Protection Act”—and the Public Health Code. All data collected, excluding your last name, first name, date of birth, and contact information, has been transmitted and stored in a secure area of Santé publique France accessible only to those in charge of the study. These databases will be destroyed once the study’s analyses are complete.

You may exercise your rights to object, access, rectify, and restrict the processing of your data by contacting the Nouvelle-Aquitaine Unit until Santé publique France begins analyzing this data.

For more information, you may contact the Data Protection Officer at Santé publique France: dpo@santepubliquefrance.fr.

Study Results

The participation rate was 73.6%, including 1,030 adults and 337 children. Among the adults, 36.6% were obese, 14.4% had diabetes, 24.7% had hypertension, and 14.4% had experienced a major depressive episode. Healthcare non-utilization over the past 12 months stood at 48.4%. Among children, 45.3% had completed the measles-mumps-rubella (MMR) vaccination series by age 24 months, and 17.9% were obese. Housing insecurity affected 74.5% of households, and 22.2% lacked access to running water.

The Travellers in this study face living conditions and environmental exposures that may affect their health and access to care. These findings call for targeted “outreach” initiatives, such as health mediation, that take into account their difficult living conditions.

Learn more:

• Epidemiological Study on the Health Status, Access to Healthcare, and Preventive Care Among Travellers in Nouvelle-Aquitaine, 2019–2022. Weekly Epidemiological Bulletin, February 20, 2024, No. 4.

• The Health of Travellers. Living and Housing Conditions, Health Status, Use of Healthcare and Prevention. Results 2019–2022, Study in Nouvelle-Aquitaine (brochure/flyer).

• The Health of Travellers. Living and Housing Conditions, Health Status, Access to Healthcare and Prevention. Results 2019–2022, Study in Nouvelle-Aquitaine (poster).

Fnasat-Gv commissioned Anna Pitoun to produce a short film (13 minutes) to present the study’s results and explore potential next steps. The various stakeholders in the study—travellers who participated in the study, representatives from Santé publique France, the Nouvelle-Aquitaine Regional Health Agency (ARS), and Fnasat-Gv—share their perspectives and call for a continued, action-oriented collaborative approach.

Publications related to this study

Mondeilh A, Spanjers L, Brabant G, Quirino Chaves F, Lévêque S, El Ghozi L, Castor C, Autès-Tréand E, Vandentorren S. Co-designing a study on the health of Travellers: lessons learned. Public Health. 2024;35(HS2):61-66.

Haidar S, Richard E, Vaux S, Allaire C, Castor C, Levy Bruhl D, Mondeilh A, Vandentorren S. Factors associated with vaccine adherence among an underserved population: adult Travellers in Nouvelle-Aquitaine, France. Eur J Public Health. 2024 Feb 5;34(1):163-169. doi: 10.1093/eurpub/ckad203

Mondeilh A, Brabant G, Haidar S, Saboni L, Ruello M, Lesieur S, Castor C, Autes-Treand E, Le Strat Y, Vandentorren S. Health status, healthcare use, and childhood MMR vaccination coverage among Travellers according to their environmental and living conditions in Nouvelle-Aquitaine, France, 2019–2022. Eur J Public Health. 2023 Dec 9;33(6):1194-1199. doi: 10.1093/eurpub/ckad175.

Vandentorren S, Brabant G, Spanjers L, Coudret S, Haidar S, Mondeilh A, Gault G, Comba M, Etchevers A. Activities at risk of lead exposure and lead poisoning in children of Traveller families in Charente, France. Heliyon. 2023 Jan 16;9(1):e13056. doi: 10.1016/j.heliyon.2023.e13056. eCollection Jan 2023.