Social inequalities in health expectancy and the contribution of mortality and morbidity: the case of Irish Travellers

The health expectancy of Irish Travellers, a disadvantaged indigenous minority group in Ireland has not been previously estimated. This study aimed to examine health expectancy inequalities between Irish Travellers and the general population. We used Sullivans life table method to construct healthy life expectancy (HLE) and disability-free life expectancy (DFLE). The All-Ireland Traveller Health Study provided Irish Traveller populations mortality and health data. Vital registration, census and comparable national survey health data were used for the general population. We calculated the absolute and relative life expectancy, HLE and DFLE gaps between Irish Travellers and the general population and decomposed the HLE and DFLE gaps into mortality and morbidity contributions. Irish Travellers had consistently lower HLE and DFLE than the general population. The health expectancy gap displayed notable age and gender variations and was wider than the life expectancy gap. Mortality contributed more than morbidity to the health expectancy gap in men but not in women. This study illustrated the true extent of health inequalities experienced by an indigenous minority in Europe, clarifying the importance of reducing the burden of non-fatal disabling conditions for addressing these inequalities. The health expectancy measure used has application for other similar indigenous minorities elsewhere.