1. The Use of Surveys in Public Health Intelligence Vasant Hirani Senior Research Fellow UCL Contributors: Carole Davis EMPHO, John Hamm RPHG London

2. Learning Objectives To increase awareness of the use of surveys in Public Health Intelligence To increase awareness of large national surveys and mandatory local surveys

3. National surveys most-used surveys recent survey examples accessing the reports accessing and using the raw data

4. Can you think of any national surveys? Icebreaking exercise Get into groups Brainstorm and write down 2 to 3 surveys you know or have heard about Discuss brief purpose

5. Can you think of any national surveys? Health Survey for England General Household Survey Psychiatric Morbidity Surveys ONS Omnibus Survey National Survey of NHS Patients Adult Dental Health Infant Feeding Survey National Food Survey National Diet & Nutrition Survey National Survey of Sexual Attitudes & Lifestyles (NATSAL) Drug use, Smoking and Drinking among Young People in England

6. The Health Survey for England Series of annual health surveys –2009 will be the 19 th Commissioned by Department of Health up to 2004, Information Centre from 2005 Conducted by –1991-1993 Social Surveys Division, ONS –1994 onwards Joint Health Surveys Unit of NatCen and UCL

7. Background to the survey First proposed in 1990 to provide improved information about morbidity Five key areas for action, e.g. coronary heart disease & stroke, cancer ‘The Health of the Nation: A Strategy for the health of England’ Recommendation of a continual survey to monitor trends & targets in public health

8. The Health Surveys for England (HSE) HSE designed to: provide annual data from nationally representative samples to monitor trends in the nation’s health; estimate the proportion of people in England who have specified health conditions; estimate the prevalence of certain risk factors associated with these conditions; examine differences between subgroups of the population (for example by age, sex or income and likelihood of having specified conditions or risk factors;

9. continued…. Assess frequency with which particular combinations of risk factors are found, and in which groups these combinations most commonly occur; monitor progress towards selected health targets; since 1995- measure the height of children at different ages, (replacing the National Study of Health and Growth) since 1995- monitor the prevalence of overweight and obesity in children.

10. HSE timeline 1996Respiratory disease, lung function & health states 1997 2002 Young people 1991-1994CVD 1998 2003 2006 CVD 1995 2001 Respiratory disease, accidents & disability 1999 2004 Minority ethnic groups 2000 2005 Older people

11. Large dataset Large nos. interviewed in ‘standard’ year –16,000 adults –4,000 children Core provides continuity Large number of variables –HSE 2007: 2,173 variables

12. Stage 1 (interviewer): core topics Socio-demographic data Lifestyle factors Health Measurement of height and weight (BMI)

13. Nurses’ data collection: Objective measurements Infant length (6 weeks - 2 years) Blood pressure (5+ years) Waist & hip circumference (11+ years) Demi-span (65+ years) Saliva (4+ years) - for cotinine analysis Urine (16+ years) – for Na / K / creatinine Blood (16+ years) – usually non-fasting Sub-groups included and analytes vary

14. Unique features The HSE is an example of a survey that is both –a Health Interview Survey (HIS) and –a Health Examination Survey (HES) Annual survey since 1991 Trends available –Trend tables published on IC website www.ic.nhs.uk/pubs/hse07trends

15. 2007 report was published in December 2008 Report is available on IC website & hard copies available shortly

16. Healthy lifestyles Key results HSE 2007 Obesity BMI≥ 30 Men: 24% Women: 24% Raised waist circumference Men: 33% Women: 41% Self-reported doctor-diagnosed diabetes Men: 5.6% Women: 4.2%

17. Over two-thirds of men (67 per cent) and over half of all women (56 per cent) in England are overweight or obese, based on body mass index. Just under a quarter of all men and women in the country (24 per cent) are obese – a rise of ten per cent for men and eight per cent for women since 1994. England's obesity levels

18. Chart from The Health Survey for England 2007 report Overweight & obesity prevalence in children aged 2-15

19. General Household Survey - ‘Living in Britain’ multi-purpose continuous survey since 1971 face to face interviews all adults in 13,000 addresses annually (72% response) regular health-related lifestyle topics –smoking – prevalence, consumption, dependency –drinking - amount & frequency occasional lifestyle topics –e.g. sport & leisure extensive socio-economic data –household composition, education, employment, housing tenure

20. “Binge drinking Britain” January 2009 Headline based on GHS 2007 findings that over a third of adults exceed regular daily drinking limit The report also shows that more people in ‘managerial and professional’ households exceeded the daily limits on their heaviest drinking day of the week (43 per cent) than routine and manual’ households (31 per cent)

21. GHS 2007 Tobacco use Smoking prevalence was highest in households classified as ‘routine and manual’, where 27 per cent of adults smoked. Prevalence was lowest among those in ‘managerial and professional’ households at 15 per cent

22. ONS Omnibus Survey (Opinions survey) Multi-purpose survey for non-profit organisations 3000 private households per month in GB Adults >16 interviewed

23. Accessing the reports Health Survey for England http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related- surveys/health-survey-for-england Health Survey for England 2007: Healthy lifestyles: knowledge, attitudes and behaviour Health Survey for England 2006: CVD and risk factors adults, obesity and risk factors children Health Survey for England 2006 Latest Trends General Household Survey http://www.statistics.gov.uk/ssd/surveys/general_household_survey.asp GHS 2007 Overview Report Smoking and drinking among adults, 2007 Ominbus Survey http://www.ons.gov.uk/about/who-we-are/our-services/omnibus-survey/index.html

24. Economic and Social Data Service ESDS Services specialist support for key economic and social data for teaching and research ESDS Government large-scale government surveys, such as the Labour Force Survey and the General Household Survey - ESDS International multi-nation aggregate databanks, such as World Bank, and survey data including Eurobarometers ESDS Longitudinal - major UK surveys following individuals over time, such as the British Household Panel Survey - ESDS Qualidata - a range of multimedia qualitative data sources

25. Accessing data and other national surveys ESDS Government Surveys http: //www.esds.ac.uk/government/surveys/ The surveys that ESDS Government supports are:  Annual Population Survey  British Crime Survey  British Social Attitudes  Continuous Household Survey (Northern Ireland)  Expenditure and Food Survey  Family Expenditure Survey  Family Resources Survey  General Household Survey  Health Survey for England  Integrated Household Survey (Continuous Population Survey)  Labour Force Surveys  National Food Survey  National Travel Survey  Northern Ireland Family Expenditure Survey  Northern Ireland Labour Force Survey  Northern Ireland Life and Times Survey (and the former Northern Ireland Social Attitudes)  ONS Omnibus Survey  Scottish Crime and Victimisation Survey (and the former Scottish Crime Survey)  Scottish Health Survey (SHeS)  Scottish Social Attitudes  Survey of English Housing  Time Use Survey  Vital Statistics  Welsh Health Survey  Young People's Social Attitudes (periodic offshoot of the BSA)

26. ESDS – Health as a Theme

27. The UK Data Archive: Accessing and using the raw data UK Data Archive –http://www.data-archive.ac.uk holds all of: –Health Survey for England, General Household Survey, Psychiatric Morbidity Surveys, ONS Omnibus Survey, National Survey of NHS Patients, Adult Dental Health, Infant Feeding Survey, National Food Survey, National Diet & Nutrition Survey, National Survey of Sexual Attitudes & Lifestyles (NATSAL), Drug use, Smoking and Drinking among Young People in England, Active People Survey... and more! time lag between survey and access

28. The Health Survey for England 5 th most frequently used dataset in UK data archive ‘very widely used by government, academics and researchers’ Provides benchmark statistics on key health measures

31. Mandatory Local Surveys Place Surveys NHS Patient Surveys TellUs

32. NHS Patient Surveys purpose the in-house option the standard methodology core and optional questions

33. Place Surveys National Indicator Set contains 25 indicators which are informed by citizens' views and perspectives. 18 of these are collected by a single Place Survey administered by each local authority These used to set trajectories in 2008/09 LAAs etc Website jointly run by CLG and Audit Commission Further information http://www.communities.gov.uk/publications/localgovernment/placesurveymanual0809 https://place-survey.audit-commission.gov.uk/ http://www.audit-commission.gov.uk/performance/ni-placesurvey.asp

34. Place Surveys – Examples of National Indicators 1% of people who believe people from different backgrounds get on well together in their local area 2% of people who feel that they belong to their neighbourhood 3Civic participation in the local area 4% of people who feel they can influence decisions in their locality 5Overall/general satisfaction with local area 6Participation in regular volunteering

35. TellUs2 (2007) Online survey to gather views of children and young people n = 111,325 (across 141 LAs) School years 6, 8 and 10 (ages 10-15) Every Child Matters outcomes: Be healthy, Stay safe, Enjoy and achieve, Make positive contribution, Achieve economic well-being Evidence for National Indicator set www.ofsted.gov.uk