1. Populations and Geography Andy Muirhead (Derby City PH) Analyst Training Course 2012 Day 2 – Session 1

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

4. Why are we interested in populations? Likely future needs Denominator Population at risk Inequalities Past trends and future projections

5. What specific things do we want to know about a population? Size Age structure Fertility Ethnic mix Residence You will notice that this is the first stage of a needs assessment

6. 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 http://populationpyramid.net/

11. The demographic transition model http://www.bbc.co.uk/programmes/b00wgq0l

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

13. Deaths from HIV/AIDS http://www.worldmapper.org/display.php?selected=2

14. Sources of population data

15. General Practice - Registered population - Exeter registered resident - Strategic Tracing Service Counts, estimates, projections GLA / Other sources - 2009 Low projections - 2009 High projections Office for National Statistics - 2001 / 11 Census - Mid year estimates - Subnational population projections Local Authority - Electoral Roll - School Roll - Local Planning data

16. Population An accurate count of the population in each local area helps Government to calculate the size of grants it allocates each local authority and health authority. In turn, these authorities use census information when planning services within their areas. Health Data on the age and socio-economic make up of the population, and more specifically on general health, long-term illness and carers enables the Government to plan health and social services, and to allocate resources. Housing Information on housing and its occupants measures inadequate accommodation and, with information about the way we live as households, indicates the need for new housing. The Census – a primary information source

17. 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. 2011 Census http://www.ons.gov.uk/ons/guide- method/census/2011/index.html http://www.ons.gov.uk/ons/guide- method/census/2011/index.html

19. 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

20. 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/www.poppi.org.uk/ Local Authorities (who have expert local knowledge) NHS informatics staff (for “Exeter” patient data)

21. 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 (3-12 months)

22. ONS future plans Integrated Population Statistics System 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: www.ons.gov.uk/ons/guide-method/.../ipss/update-of-ipss.pdf

24. 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

25. 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

26. 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

27. PCT populations Derived from GP registrations Constrained to ONS populations at LA level NB: Need both resident and registered (GP relevant) populations https://indicators.ic.nhs.uk/webview/

28. Resident versus registered populations

29. 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

31. 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

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

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

34. Present and future patterns of population change http://www.neighbourhood.statistics.gov.uk/HTMLDocs/dvc1/UKPyramid.html

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

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

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

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

39. 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)

40. 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

41. 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

42. Ethnicity data Sources of data: 2001 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)

43. Ethnic breakdown – 2001 Census Y&HLondonEngland White British88.6%59.8%87.0% White Irish0.6%3.1%1.3% Other White1.8%8.3%2.7% Mixed White and Black Caribbean0.4%1.0%0.5% Mixed White and Black African0.1%0.5%0.2% Mixed White and Asian0.4%0.8%0.4% Other Mixed0.2%0.9%0.3% Indian1.4%6.1%2.1% Pakistani3.3%2.0%1.4% Bangladeshi0.3%2.2%0.6% Other Asian0.4%1.9%0.5% Black Caribbean0.5%4.8%1.1% Black African0.6%5.3%1.0% Other Black0.1%0.8%0.2% Chinese0.6%1.1%0.5% Other ethnic group0.5%1.6%0.4%

44. Geographical differences

45. London projections suggest a much more modest growth in number of older people

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

47. Standardised mortality ratios by country of birth, aged 20-29, circulatory diseases, England and Wales 1999-2003 Source: London Health Observatory

48. Where are? Most ethnic minorities? Most deprived? Most elderly? Most migrants?

49. Geographical hierarchy and classification

50. Beginner's Guide to UK Geography

51. Borough / District

52. Ward

53. LL SOA

54. Output area

56. NS 2001 Area Classification for Health Areas www.statistics.gov.uk/about/methodology_by_theme/area_classification/ha/svg/area classpctdraft2.html http://www.cipfastats.net/resources/nearestneighbours/profile.asp?view=select&dat aset=england

59. Population segmentation tools (Geo/socio-demographics) Commercial organisations also supply population segmentation tools Common examples: OAC Mosaic Acorn

60. Mosaic Public Sector http://guides.business- strategies.co.uk/mosaicpublicsector2009/html /visualisation.htm?010121 http://guides.business- strategies.co.uk/mosaicpublicsector2009/html /visualisation.htm?010121

61. A classification for all households and postcodes in the UK, that comprehensively describes their social, economic and cultural behaviour Approx. 30% of the data is sourced from Census, while the remaining 70% is derived from Experian’s Consumer Segmentation Database: Edited Electoral Role Experian Lifestyle Survey Consumer Credit Activity Post Office Address File Shareholders Register House Price and Council Tax Information Qualitative research also undertaken covering the whole of the UK Leading experts in the fields of consumer psychology, human geography and economics were employed to interpret the classification What is it?

62. BMRB’s Target Group Index (TGI) The British Crime Survey MORI’s Financial Research The Expenditure & Food Survey (EFS) Forrester’s Technographics and Internet Use Monitor English and Welsh Index of Multiple Deprivation National Pupil Database Health Survey for England Hospital Episode Statistics (HES) Etc, etc, etc Where from?

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

64. Resources ONS www.statistics.gov.uk www.statistics.gov.uk ONS geography http://www.ons.gov.uk/ons/guide-method/geography/ons- geography/index.html http://www.ons.gov.uk/ons/guide-method/geography/ons- geography/index.html ONS area classification http://www.ons.gov.uk/ons/guide- method/geography/products/area-classifications/index.html http://www.ons.gov.uk/ons/guide- method/geography/products/area-classifications/index.html United Nations population division www.un.org/esa/population/unpop.htm www.un.org/esa/population/unpop.htm Population trends http://www.ons.gov.uk/ons/rel/population-trends-rd/population- trends/no--145--autumn-2011/index.html http://www.ons.gov.uk/ons/rel/population-trends-rd/population- trends/no--145--autumn-2011/index.html 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