1. Census and Health Knowledge and Intelligence Team (West Midlands) Sharon Walton – Senior Public Health Intelligence Analyst sharon.walton@phe.gov.uk

2. Overview How we are using the census to support health intelligence General overview Specific case study 2Census and Health

3. Overview 3Census and Health

4. Health is about people… Use census based population estimates to create directly age sex standardised rates. This method is used for many of the PHOF indicators…. Eg vaccinations data uses LSOA populations to weight data from PCT to LA geographies. 4Census and Health

5. Public Health analysis at local level What do we use census data for? Inform Joint Strategic Needs Assessment to provide information on health and care needs of local populations for commissioning services. Main items used Population count Age profile Household composition Type of accommodation, including whether a mobile or temporary structure Ethnicity Self assessed health Support and care given to others with health needs by number of hours 5Census and Health Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group

6. Social-economic environment e.g. jobs, housing, education, transport Types of Health Inequality Lifestyles/health behaviour e.g. diets, smoking, social networks Access to effective health/social care e.g. services that result in health benefits Health outcomes e.g. increase/reduce mortality, ill health, disability GENDER GEOGRAPHY DISABILITY AGE ETHNICITY SOCIAL CLASS Census and Health 6

7. Housing and households Poor housing is detrimental to health. Owning a house has been related to longer life expectancy, the percentage of owner occupied housing in England and Wales has risen from 58% in 1981 to 69% in 2001 but has dropped to 64% in 2011 Those who own their own homes are exposed to less health hazards, less noise, damp, lower crime. 7Census and Health

8. Households without central heating Cold weather impacts on health 31,100 EWD in England and Wales last winter (2012/13) (ONS) The causes of EWD are complex In 2011, 2.7% of households in England had no central heating The Public Health Outcomes Framework, first published in January 2012, includes indicators to reduce excess winter deaths and address fuel poverty. 8Census and Health

9. Jobs and Lifestyle Education is vital to health. People with low levels of educational achievement are more likely to have poor health as adults. 23% of adults aged over 16 in England have no qualifications 9Census and Health

10. Working hours 35% of residents aged 16-74 in England are not in employment. The UK has the longest working hours in Europe 10% of men and 3% of women work more than 49 hours a week in England 10Census and Health

11. Travel Transport can affect health: Air pollution Accidents and injuries Health and lifestyle Community severance In England: 37% of the working population drive a van or car to work 3% are working at home 7% walk to work. 11Census and Health

12. Morbidities The numbers of people suffering from chronic illnesses has increased over the last 10 years and will increase in the future. This will have far reaching consequences on the health services and the economic welfare of the areas. 5% of people in England in 2011 said their general health was either bad or very bad. 12Census and Health General Health, England 2011 Number % All categories: General health 53,012,456 100% Very good health25,005,712 47% Good health18,141,457 34% Fair health6,954,092 13% Bad health2,250,446 4% Very bad health660,749 1%

13. Small area statistics Some councils keen on the administrative data approach, which would see more regular population estimates at district level at the expense of population characteristics at the very local level. Public health needs small area statistics Individual data items Index of Multiple Deprivation scores Neighbourhood statistics – include administrative data 13Census and Health Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group

14. Census and Health14 Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group Census and Health

15. As hoc analyses using census data Ad hoc queries to Public Health departments informed by Census data… Some can be addressed quite easily: population breakdown and projections, Others are more complex questions where the Census might be the only data source estimates of populations potentially affected by the proposals in the draft Care Bill people who consider their health as ‘not good’, carers providing over 50 hours a week of care estimated prevalence of female genital mutilation 15Census and Health Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group

16. Case Study: Female Genital Mutilation 16Census and Health Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group

17. 17Census and Health Source: UNICEF: Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change. 2013 Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group

18. FGM practising country groups 18Census and Health 1(i)Almost universal FGM, over 30% FGM Type III Sudan (north), Somalia, Eritrea, Djibouti. 1(ii)High national prevalence of FGM WHO Type I and II Egypt, Ethiopia, Mali, Burkina Faso, Gambia, Guinea, Sierra Leone 2Moderate national prevalence of FGM WHO Type I and II Central African Republic, Chad, Cote D’Ivoire, Guinea Bissau, Kenya, Liberia, Mauritania, Senegal, Togo 3Low national prevalence of FGM WHO Type FGM I and II Benin, Cameroon, Ghana, Niger, Nigeria, Democratic Republic of Congo, United Republic of Tanzania, Uganda, Yemen Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group

19. Estimated percentage of maternities to women with FGM in England and Wales, 2001 and 2004 19Census and Health FORWARD (2007) A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales.

20. Use of 2011 census data Previous estimates used just one table of age by country of birth from 2001 census Other relevant data items available: Ethnicity – may be too crude Date of most recent arrival to live in UK Main language / ability to speak English Educational level Address one year ago National identity Passports held 20Census and Health Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group

21. Summary The Census is used locally in Public Health because it provides open, accessible, consistent, standardised data at no additional cost, with no restrictions on availability, all in one place. Valid, robust and measures what it purports to measure Particularly valuable where there may be a lack of alternative local sources of data, such as traveller populations Data available for small areas 21Census and Health Sylvia Godden, London Borough of Sutton Liz Rolfe, Public Health England Alison Macfarlane, City University London on behalf of the Health Statistics User Group