South West Public Health Observatory Populations, ethnicity and geography

South West Public Health Observatory Learning objectives Why do we want to know about populations? Present and future patterns Census Sources of data Migration Health differences between ethnic groups Geographical hierarchy and classification

South West Public Health Observatory Why are we interested in populations?

South West Public Health Observatory Why are we interested in populations? What sort of population are we dealing with? - health needs assessment Likely future needs Denominator Population at risk Ethnicity Cash

South West Public Health Observatory What sort of things do we want to know about a population? Size Age structure Fertility Ethnic mix Projected changes You will see that this is the first stage of a needs assessment

South West Public Health Observatory The next few slides are population trees of different areas. They are all to the same scale What could you guess about the health needs of these different populations?

Africa 2000

Asia 2000

China 2000

Europe 2000

The rectangularisation of the life curve, England and Wales

The same principles apply at local planning level what sort of services might we need to provide for these wards?

Deaths from HIV/AIDS Worldmapper is a collection of world maps, where territories are re-sized on each map according to the subject of interest

South West Public Health Observatory Sources of population data 1.Census 2.Electoral Roll 3.GP “Exeter” data

South West Public Health Observatory Census data Census contains much, much more than population data, but we will only consider populations here

South West Public Health Observatory 2001 Census National Population Results Population growth slowed in the 1990s Fewer men than women – all ages over 21 First time people 60 and over exceeded children under 16 Big growth in numbers of people aged 85 and over, five times more than in 1951 Population is ageing faster than expected Significant shift of population North>South

National Projections UK population to rise to 65m by 2016

South West Public Health Observatory ONS population model Census population in 1-year cohorts – adjusted for under-enumeration – adjusted from April to June for mid-year estimates In subsequent years – Add births – Subtract deaths – Adjust for migration Internal (GP registrations) International (International Passenger Survey) – Long term (12 months +) – Short term migration (3-12 months)

South West Public Health Observatory Sources of population data If you are deriving a rate using data for more than one year, use the middle year for the denominator ONS website (check for rebased populations for historical data) POPPI Projecting Older People Population Information System PANSI Projecting Adult Needs Information System Local Authorities (who have expert local knowledge) NHS informatics staff (for “Exeter” patient data)

South West Public Health Observatory Strengths and weaknesses of Census data and issues to be aware of 1.The biggest cross-sectional survey in England 2.Best-checked Census ever 3.Under-estimation of households and people – urban areas – corrected in subsequent mid year estimates 4.Other anomalies – living rent free, working at or from home 5.Disclosure control – use least detailed tables 6.Population mobility may mean that the numbers are the same, but their needs are different (may be 30% in some areas and age groups)

South West Public Health Observatory ONS future plans Integrated population statistics More mobile population and family structures moving areas, countries – daytime, weekday, monthly populations – Better ascertainment of international migration Address register Population register 2011 Census Partly depends on decisions about ID cards etc More info: Population_trends_135.pdf

Cumulative percentage revision to mid-2008 population estimates as a result of improvements to migration estimates ONS Consultation soon

South West Public Health Observatory Electoral roll Another cross-check Used at local level for detailed planning

South West Public Health Observatory GP registration “Exeter system” Used to provide internal migration estimates 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) “special populations” - see later

South West Public Health Observatory PCT populations Derived from GP registrations Constrained to ONS populations at LA level NB Need both resident and registered (GP relevant) populations nww.nchod.nhs.uk

Resident versus registered populations

South West Public Health Observatory Which one to use? Registered for commissioning Resident for attaching to Census data

South West Public Health Observatory Who’s missing?

South West Public Health Observatory Who’s missing? Homeless Travellers Illegal immigrants Unregistered migrant workers “Special populations” – Armed forces and dependents – Prisoners

Longer term projections depend partly on fertility

Births and deaths England and Wales Source: ONS

South West Public Health Observatory Some examples of special rates for denominators (population at risk) Stillbirths – all births Perinatal mortality - stillbirths + deaths <7 days Infant mortality (<1 year) – live births Teenage pregnancy - usually girls Fertility - usually women – sometimes women 14-46

South West 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 Source: LHO report summary

Standardised mortality ratios by country of birth, aged , all causes, England and Wales NB England is 100 Source: London Health Observatory

Self-reported bad or very bad general health by minority ethnic group HSE 2004

NS 2001 Area Classification for Health Areas statistics.gov.uk/about/methodology_by_theme/area_classification/ha/svg/areaclasspctdraft2.html

Geographic boundaries EC geography NUTs 1 (region) NUTs 2 (Counties groups of counties) NUTs 3 (Counties / groups of unitary authorities )

South West Public Health Observatory Learning outcomes Why do we want to know about populations? Present and future patterns Census Sources of data Migration Health differences between ethnic groups Geographical hierarchy and classification

South West Public Health Observatory Resources ONS ONS geography ONS area classification tion/ United Nations population division Population trends South West Observatory a,b,c.htm