Jo Watson sepho South East Public Health Observatory Solutions for Public Health Day 2: Session 2 Populations and geography

2 South East Public Health Observatory Learning outcomes Why do we want to know about populations? Present and future patterns of demographic change Sources of population data and their strengths and weaknesses The impact of migration Ethnic groups and ethnicity data Geographical hierarchy and classification

3 South East Public Health Observatory Discussion What demographic or health data has been collected about you or your family in the last few months?

4 South East Public Health Observatory Data through our lives Environment and lifestyle Death Birth Healthcare Childhood

5 South East Public Health Observatory Why do we want to know about populations and geography?

6 South East Public Health Observatory Why are we interested? Anticipating future needs Denominator Population at risk Cash

7 South East Public Health Observatory What sort of things do we want to know about a population?

8 South East Public Health Observatory What sort of things do we want to know about a population? Size Age structure Fertility Ethnic mix Projected changes – fertility, mortality, mobility You will notice that this is the first stage of a needs assessment

9 South East Public Health Observatory The next few slides are population pyramids for different areas They are all to the same scale What could you guess about the health needs of these populations? Population pyramids (or trees)

10 South East Public Health Observatory Size? Age structure? Fertility?

11 South East Public Health Observatory Size? Age structure? Fertility?

12 South East Public Health Observatory Size? Age structure? Fertility?

13 South East Public Health Observatory Size? Age structure? Fertility?

14 South East Public Health Observatory Present and future patterns of population change

15 South East Public Health Observatory The rectangularisation of the life curve England and Wales

16 South East Public Health Observatory Births and deaths England and Wales Source: ONS

17 South East Public Health Observatory What does population growth depend on?

18 South East Public Health Observatory Population change (Mid-year to Mid-year) England and Wales Source: Population Trends Autumn 2009, ONS

19 South East Public Health Observatory National Projections UK population to rise to 65m by 2018 Source: Estimated and projected UK population mid-2008 and mid-2033

20 South East Public Health Observatory What is the fastest growing age group in the UK population?

21 South East Public Health Observatory Estimated & projected population aged 85 +, UK 2008 & 2033

22 South East Public Health Observatory Change in fertility patterns (Age-groups at which fertility is highest) 1986 & Source: Population trends Autumn 2008

23 South East Public Health Observatory Longer term projections depend partly on fertility

24 South East Public Health Observatory The same principles apply at local planning level what sort of services might we need to provide for these wards?

25 South East Public Health Observatory Sources of population data

26 South East Public Health Observatory Sources of population data General Practice - Registered population - Exeter registered resident - Strategic Tracing Service Counts, estimates, projections Office for National Statistics Census - Mid year estimates - Sub-national population projections Local Authority -Electoral Roll - School Roll - Local Planning data

27 South East Public Health Observatory National Statistics – Census and Mid Year Estimates Subsequent estimates Mid Year Estimates 2001 Add births Subtract deaths Adjust for migration 2001 Census Adjust for under- enumeration Adjust April to June Migration: 1. Internal (GP registrations) 2. International (long term – 12+ months; short term 6-12 months)

28 South East Public Health Observatory Local Authority Estimates / Projections Local authority planners are able to provide detail on proposed developments Electoral roll can be useful for picking up possible population growth not identified by other sources Generally considered more accurate than ONS for planning purposes

29 South East Public Health Observatory PCT data Resident ONS mid year estimate Registered –Attribution dataset GP registered populations (ADS). The data were collected in April of a particular year for GP relevant populations. They have been constrained to the ONS pop estimate of the previous year excluding some special populations –Based on practice list size which are unconstrained e.g. QOF practice list size

30 South East Public Health Observatory GP registration (“Exeter system”) Used to provide internal migration estimates Useful for producing patient distribution maps, working out distance between patient and health centre etc Problems with: –Delay in re-registering on re-location (particularly a problem in university towns) –Failure to de-register on leaving the country - still called “embarkation” (particularly a problem where many foreign students or migrant workers) –Results in ‘list inflation’

31 South East Public Health Observatory Resident versus registered populations

32 South East Public Health Observatory Catchment Populations The number of people resident in the catchment area who are (or who are at risk of being) clients of a health facility or service. Thus the catchment population is also known as the ‘effective population’ or ‘population at risk’.

33 South East Public Health Observatory A catchment population of a GP practice

34 South East Public Health Observatory Population sources: strengths & weaknesses CensusONS Mid year estimate ONS Projecti ons ExeterLocal Authority Resident pop Yes Registered pop NoNoNo YesNo Includes ethnicity Yes Partly National comparisons Yes No Available at small areas YesNo Yes Regularly updated NoYes Accounts for housing stock YesNo Yes

35 South East Public Health Observatory Who’s missing?

36 South East Public Health Observatory Who’s missing? Homeless Less than 6 months? Travellers Illegal immigrants Unregistered migrant workers “Special populations” –Armed forces and dependents –Prisoners

37 South East Public Health Observatory Ethnic groups and ethnicity data

38 South East Public Health Observatory Ethnicity and its relevance to health needs assessment Healthy migrants? – how does this change over time? Different patterns of mortality and morbidity Immigrant groups may have a different age distribution according to migration patterns and ageing

39 South East Public Health Observatory Ethnic breakdown – 2001 Census South EastEngland White British91.3%87.0% White Irish1.0%1.3% Other White2.8%2.7% Mixed White and Black Caribbean0.3%0.5% Mixed White and Black African0.1%0.2% Mixed White and Asian0.4% Other Mixed0.3% Indian1.1%2.1% Pakistani0.7%1.4% Bangladeshi0.2%0.6% Other Asian0.3%0.5% Black Caribbean0.3%1.1% Black African0.3%1.0% Other Black0.1%0.2% Chinese0.4%0.5% Other ethnic group0.4%

40 South East Public Health Observatory Standardised mortality ratios by country of birth, aged 20-29, circulatory diseases, England and Wales Source: London Health Observatory

41 South East Public Health Observatory Self-reported bad or very bad general health by minority ethnic group HSE 2004

42 South East Public Health Observatory Ethnicity data Sources of data: –2001 Census –GLA ethnic projections (London only) –ONS experimental statistics –Exeter for place of birth –GP and special surveys (quality varies) –Hospital and other service data (quality varies)

43 South East Public Health Observatory Geographical hierarchy and classification

44 South East Public Health Observatory Geographic boundaries

45 South East Public Health Observatory District/ Borough

46 South East Public Health Observatory Ward

47 South East Public Health Observatory LL SOA

48 South East Public Health Observatory Output area

49 South East Public Health Observatory NS 2001 Area Classification for Health Areas

50 South East Public Health Observatory Learning outcomes Why do we want to know about populations? Present and future patterns of demographic change Sources of population data and their strengths and weaknesses The impact of migration Ethnic groups and ethnicity data Geographical hierarchy and classification