1. Why do we want to know about populations and geography?

2. 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 Inequalities Trends

3. What sort of things do we want to know about a population? Size Age structure Fertility Ethnic mix Inequalities Projected changes You will notice that this is the first stage of a needs assessment

4. 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?

5. Africa 2000

6. China 2000

7. Europe 2000

8. UK population through the decades http://www.ons.gov.uk/ons/interactive/historic-uk-population-pyramid/index.html

9. Total world population Worldmapper is a collection of world maps, where territories are re-sized on each map according to the subject of interest

10. Deaths from HIV/AIDS http://www.worldmapper.org/display.php?selected=2 ‘Worldmapper’ is a collection of world maps, where territories are re-sized on each map according to the subject of interest

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

12. Sources of population data

13. General Practice - Registered population - Exeter registered resident - Strategic Tracing Service Counts, estimates, projections GLA / Other sources - 2013 Projections (up to 2036) - For London but could be a guide Office for National Statistics - 2011 Census - Mid year estimates - Subnational population projections Local Authority -Electoral Roll - School Roll - Local Planning data

14. 2011 Census – primary source Consultation on questions Trial of data collection in 2007 Rehearsal of complete census system 2009 More reliance on postal distribution of forms Option to respond by internet Enumerators concentrated on areas with poor response rate

15. 2011 Census National Population Results The population in England was 53 million: the largest the population had ever been. The largest growth in the population in England and Wales in any 10-year period since census taking began: 3.7 million (7.1%). For men, the median age was 38 and for women it was 40. In 1911, the median age was 25. The percentage of the population aged 65 and over was the highest seen in any census at 16.4 per cent, that is one in six people in the population was 65 and over. There were 430,000 residents aged 90 and over in 2011 compared with 340,000 in 2001 and 13,000 in 1911. In 2011, there were 3.5 million children under five in England and Wales, 406,000 more than in 2001.

16. Issues to be aware of 1.Under-estimation of households and people – urban areas – corrected in subsequent mid year estimates 2.Disclosure control – use least detailed tables 3.Comparison with earlier censuses – definitions, geography, One Number Census 4.Other anomalies – living rent free, working at or from home

17. From Census we subsequently use mid-year estimates Get data from –ONS website (check for rebased populations for historical data) –POPPI Projecting Older People Population Information System www.poppi.org.uk/ –Local Authorities (who have expert local knowledge) –NHS informatics staff (for “Exeter” patient data)

18. 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)

19. 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 Partly depends on decisions about ID cards etc More info: http://www.statistics.gov.uk/downloads/theme_population/i pss.pdf

20. National Projections UK population to rise to 65m by 2015 http://www.ons.gov.uk/ons/interactive/ppu-2012-v2/index.html

21. Components of Population Change: Births, Deaths, In-Out Migration Population Change = Natural Change + Net Migration –Natural Increase = Births – Deaths –Net Migration = In-migrants – Out-migrants Poor measurement of migration

22. Local authority data Local authority planners able to provide detail on proposed developments not included in regional projections Electoral roll can be useful for picking up possible population growth not identified by other sources

23. 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 or migrant workers) “special populations” Does not include persons not registered with GPs –Temporary European migrants –Illegal immigrants –Young men

24. PCT populations Derived from GP registrations Constrained to ONS populations at LA level Still being produced by HSCIC! http://nww.indicators.ic.nhs.uk/webview/ CCG populations Can be added up from LSOAs Available from 2001 to 2012 on ONS website

25. Resident versus registered populations This is what ONS uses for CCGs

26. Which one to use? Resident for attaching to Census data –When discussing with local council Registered for commissioning Needs adjustment for commissioning and finance –Unified weighted –RAWP / Carr-Hill / AREA? Wakefield –325,000 resident –350,000 registered –380,000 weighted

27. Population data: strengths and weaknesses CensusONS Mid year estimate ONS Projecti ons GLA Projecti ons ExeterLocal Authority Resident pop Registered pop Includes ethnicity National comparisons Available at small areas Regularly updated Accounts for housing stock Yes Partly Yes Partly No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No

28. Who’s missing? Note down some missing populations before continuing.

29. Who’s missing? Homeless Travellers Illegal immigrants Unregistered migrant workers “Special populations” –Armed forces and dependents –Prisoners

30. Present and future patterns of population change

31. Population change England & Wales 1971-2006 Source: Population Trends Autumn 2008

32. The rectangularisation of the life curve England and Wales 1851 - 2031

33. Births and deaths England and Wales 1901-2051 Source: ONS

34. Population mobility Population mobility may mean that the numbers are the same, but their needs are different (may be 30% in some areas and age groups)

35. Some examples of special rates for denominators (population at risk) Stillbirths – all births Infant mortality (<1 year) – live births Teenage pregnancy - usually girls 15-17 Fertility –usually women 15-44 –sometimes women 14-46

36. 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

37. Ethnicity data Sources of data: –2011 Census –GLA ethnic projections –ONS experimental statistics***** –Exeter for place of birth –GP and special surveys (quality varies) –Hospital and other service data (quality varies)

38. Ethnic breakdown – 2001 Census England White British87.0% White Irish1.3% Other White2.7% Mixed White and Black Caribbean0.5% Mixed White and Black African0.2% Mixed White and Asian0.4% Other Mixed0.3% Indian2.1% Pakistani1.4% Bangladeshi0.6% Other Asian0.5% Black Caribbean1.1% Black African1.0% Other Black0.2% Chinese0.5% Other ethnic group0.4%

39. Ethnic breakdown – 2011 census England White British 79.8% White Irish 1.0% Other White 4.7% Mixed White and Black Caribbean 0.8% Mixed White and Black African 0.3% Mixed White and Asian 0.6% Other Mixed 0.5% Indian 2.6% Pakistani 2.1% Bangladeshi 0.8% Other Asian 1.5% Black Caribbean 1.8% Black African 1.1% Other Black 0.5% Chinese 0.7% Other ethnic group 1.0%

40. Geographical hierarchy and classification

41. Beginner's Guide to UK Geography - Administrative

42. Beginner's Guide to UK Geography - Health PHE Regions PHE Centres Plus!! Commissioning Support Units Strategic Clinical Networks

43. Beginner's Guide to UK Geography – and there’s more Wards: CAS/ST – mostly used for 2001 census, still quite popular with councillors/public. Map to LSOAs and LAs Census: Workplace Zones (New!): Built from OAs, consistent worker populations based on where they work http://www.ons.gov.uk/ons/guide-method/geography/beginner-s- guide/index.html MSOAs LSOAs Output Areas Map into LAs, CCGs and beyond

44. Borough / District

45. Ward

46. LL SOA

47. Output area

49. NS 2001 Area Classification for Health Areas www.statistics.gov.uk/about/methodology_by_theme/area_classification/ha/svg/area classpctdraft2.html

50. CIPF Nearest Neighbour Tool http://www.cipfastats.net/resources/nearestneighbours/profile.asp?view=select&dat aset=england

53. Population segmentation tools (geodemographics ) Commercial organisations also supply population segmentation tools Common examples: –OAC –Mosaic –Acorn

55. Learning outcomes Why do we want to know about populations? Present and future patterns Census Sources of data Migration Ethnicity Geographical hierarchy and classification

56. Resources ONS http://www.ons.gov.uk/ons/index.html http://www.ons.gov.uk/ons/index.html ONS geography http://www.ons.gov.uk/ons/guide-method/geography/beginner-s- guide/index.html http://www.ons.gov.uk/ons/guide-method/geography/beginner-s- guide/index.html ONS area classification http://www.ons.gov.uk/ons/guide- method/geography/products/area-classifications/ns-area-classifications/index.html http://www.ons.gov.uk/ons/guide- method/geography/products/area-classifications/ns-area-classifications/index.html United Nations population division www.un.org/esa/population/unpop.htm www.un.org/esa/population/unpop.htm Population http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Populationhttp://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Population Yorkshire & Humber PH Observatory http://www.yhpho.org.uk / http://www.yhpho.org.uk / http://www.healthknowledge.org.uk/Health%20Information/HK%203a,b,c.htm