1. Using the HSfE to estimate small area indicators of health need Graham Moon, Steve Barnard, Gemma Holt and Liz Twigg Institute for the Geography of Health, University of Portsmouth Bill Blyth TNS (Taylor Nelson Sofres)

2. Aim To provide an oversight of the outcomes of a programme of integrated projects focussed on the derivation of small area indicators of health need using synthetic estimation. To outline key issues arising in this research

3. Objectives Citizen-based public heath –NSF drivers –Identifying the local geography of risk –Facilitating resource allocation and monitoring at a local scale –Flexible, consistent, bottom-up, robust (Wanless agenda) Academic –Substantive advance in modelling methodology –Determinants of health geographies

4. Data and Methods Consolidated 1998-2003 –HSfE, –census –TNS data –+ rest of UK) Multilevel modelling

5. The Indicators to Date I Known Heart Disease Known Heart Disease Risk Undiagnosed Heart Disease Risk Hypertension Obesity + Known Type II Diabetes Undiagnosed Type II Diabetes NB population health measures not service users

6. The Indicators to Date II Flexible Organisational Geographies: –PCTs, –Wards, –General Practices –Other

7. The Indicators to Date III Robust high quality indicators IndicatorVar Exp %Match % IHD8991 Undiag IHD5488 Ttwo diag7295 Obesity6272

8. Linkage Issues Question comparability Changing geographies over time –The disappearance of DHAs Geographical comparability of spatial levels – PSU = ward Spatial identifiers –Not disclosed for general use

9. Scale issues Variation is scale dependent L1L2L3L4 CHD U-CHD TTWO OBE

10. PCT Scale Diagnosed CHD Undiagnosed Risk of CHD

11. Ward Scale Diagnosed CHD Undiagnosed Risk of CHD

12. Scale GP Surgeries

13. Alternatives HES QoF IMD Area typologies

14. Alternatives - HES

15. Alternatives QoF

16. Alternatives – IMD

17. Alternatives - Mosiac

18. What next Extend into other disease/health domains Extend into non-health areas Extend internationally Link to health service inputs

19. What next

20. Conclusions Healthy England –University environs –Army camps –New developments –Bristol Unhealthy England –Tyne-Tees –Lincolnshire resorts –Black Country

21. Conclusions Major utility in health profiling Clear advantages in methodological terms and through linkage with other sources