1. South West Public Health Observatory Populations, ethnicity and geography

2. 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

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

4. 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

5. 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

6. 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?

7. Africa 2000

8. Asia 2000

9. China 2000

10. Europe 2000

11. http://www.statistics.gov.uk/downloads/theme_population/Pop-trends-winter09.pdf

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

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

14. 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 http://www.worldmapper.org/display.php?selected=2

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

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

17. 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

18. National Projections UK population to rise to 65m by 2016

19. 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)

20. 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 www.poppi.org.uk www.poppi.org.uk PANSI Projecting Adult Needs Information System www.pansi.org.uk Local Authorities (who have expert local knowledge) NHS informatics staff (for “Exeter” patient data)

21. 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)

22. 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: http://www.statistics.gov.uk/downloads/theme_population/ Population_trends_135.pdf

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

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

25. 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

26. 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

27. Resident versus registered populations

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

29. South West Public Health Observatory Who’s missing?

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

31. Longer term projections depend partly on fertility

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

33. 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 15-17 Fertility - usually women 15-44 – sometimes women 14-46

34. 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

35. Standardised mortality ratios by country of birth, aged 20- 29, all causes, England and Wales 1999-2003 NB England is 100 Source: London Health Observatory

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

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

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

40. 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

41. South West Public Health Observatory Resources ONS www.statistics.gov.uk ONS geography www.statistics.gov.uk/geography/ ONS area classification www.statistics.gov.uk/about/methodology_by_theme/area_classifica tion/ United Nations population division www.un.org/esa/population/unpop.htm Population trends www.statistics.gov.uk/statbase/Product.asp?vlnk=6303 South West Observatory www.swo.org.uk/ http://www.healthknowledge.org.uk/Health%20Information/HK%203 a,b,c.htm