1. Geographies and populations Where are the boundaries? Paul Norman School of Geography University of Leeds p.d.norman@leeds.ac.uk Acknowledgements ESRC ONS GROS NISRA OS UKBORDERS CDU ESDS ESRC Research Awards RES-165-25-0032, RES-189-25-0162 NHS Information Centre, 21st March 2011

2. Geographies and populations What is a geography? How are geographies defined? What is a population? How are they defined? Health measures by areas and by population subgroups What else do geographers do with health data? Challenges of time-series analysis: changing boundaries and population definitions What geography & which population? Aspects of the DH White Paper

3. Geographical boundaries Territoriality River Tweed Offas Dyke 49th Parallel Some large lakes & a river Vancouver Island Natural Coastline Rivers Arbitrary / artificial Defend Tradition Organise Political Ownership Legal

4. Examples of geographies Traditional geographies –Counties, parishes Electoral geographies –Constituencies, wards Administrative geographies –National / local government, census Functional geographies –Postal –Emergency services: police, fire, ambulance –Health; Education –Utilities: gas, electricity, water, sewerage –Sport Planning regions –Enterprise zones, regeneration areas –National Parks, nature reserves

5. What is a population? Count of people … in a defined geographical area Differentiated by –Age & sex; Ethnic group; Social Class (or SEG or NS-SEC) –Educational achievement; Tenure Area 1 Area 2 Area 3Area 5Area 4

6. What do geographers, demographers, social scientists, do? Self-reported health, 1991 Mortality, 1991

7. What do geographers, etc, do? Tenure Social ClassEthnicity Self-reported health: limiting long-term illness, 2001

8. Area distribution Area distributions of health outcome Model residuals

9. Area profiles: classification Deprivation distribution k-means classification Poor health cluster Good health cluster Student cluster

10. Point distribution of health outcome? Analysing point data Kernel density map Clusters

11. What about change over time? … 1988-1996 1997-2003 2004-2005 … No ward stays exactly the same during the period (East is almost the same though) Tricky due to boundary change … Peterborough: 1988 - 2005

12. What about change over time? 1991 1999 2004 Soon … All change please! The redisorganisation of the NHS Smith J, Walshe K, Hunter D (2001) BMJ: 323: 1262-3

13. Administrative boundary change: due to –Need for good governance (re-organise subnational structure of administrative geography) & –Differential population change by small areas & need for equity in electoral representation Census boundary change: due to –Many census geographies aligned with administrative geographies (as above) & –Need for a local geography which protects confidentiality yet delivers usable statistics, & thus may be time point specific Lead to boundaries being re-drawn –But this severely hampers comparison of cross-sections –Census & other applications may need consistent geographical areas over time for analysis of change Why do boundaries change?

14. Time-series: infant mortality rates 1981 1986 1991 1996 20012006 IMR relative to national rate DeprivationSupergroups

15. What about change over time? 1991 Ethnic groups 2001 Ethnic groups Social Class to NS-SEC Why (not) change? Administrative, census & survey data, etc Historical record versus contemporary relevance? Continuity versus current applicability? Reactive versus proactive?

16. Right geographies & right populations? Confidentiality: tension between providing … Detailed demographic data Coarse geographic scale Detailed geographic scale Banded demographic detail NationRegionDistrictSyntheticWard Output Areas Super Output Areas

17. Healthy Lives, Health People: Our Strategy for public health in England Geographical & population aspects to be resolved Life expectancy between the richest and poorest neighbourhoods (p.16) One ward in Kensington and Chelsea … compared with … one of the capitals poorer wards (p.15) Neighbourhood income level (p.16) Data will be published to make it easier for local communities to compare themselves with others across the country (p.26) Department for Communities and Local Government will support local areas with streamlined planning policy that aligns social, economic, environmental and health priorities into one place (p.40) GP consortia will have responsibility for the whole population in their area (p.62)

18. Community? Neighbourhood? Indian, Pakistani, Bangladeshi Students

19. Community? Neighbourhood?

20. Healthy Lives, Health People: Our Strategy for public health in England Community? Neighbourhood? Anne Milton, Under Secretary of State for Public Health 11/01/2011 We generally take a lead from the Office for National Statistics and use Super Output areas (lower and/or middle layer) for small area analysis Terms such as, for example, communities or neighbourhoods referred to in publications should be interpreted as plain English terms that in analysis would be represented by an appropriate standard geography

21. Healthy Lives, Health People: Our Strategy for public health in England GP consortia? p.62 GP consortia will have responsibility for the whole population in their area Anne Milton Under Secretary of State for Public Health 11/01/2011 The White Paper makes clear that GP consortia will have to have an area of geographical focus. Work on this is still ongoing but it is likely that this will be based on existing standard geographies

22. Healthy Lives, Health People: Our Strategy for public health in England GP consortia? Likely to be within a local authority but #1 … Edge effects & wider catchment

23. Healthy Lives, Health People: Our Strategy for public health in England GP consortia? Likely to be within a local authority but #2 … People are different & from different areas

24. Geographies and populations Where are the boundaries? Need consistency over time: geographies & populations Need also to have contemporary / ongoing relevance Good policy decisions & appraisals of success need to be underpinned by good data Data will be published to make it easier for local communities to compare themselves with others across the country Local areas with streamlined planning policy that aligns social, economic, environmental and health priorities into one place Needs Global shift by data providers: a can do attitude Georeferencing: e.g. postcode > OA > SOA linkages Back revisions of existing datasets 2021 Census & / or a real replacement