South West Public Health Observatory Migration in England and the South West Presentation to Better Health for Better Integration Julia Verne 28 November 2011

South West Public Health Observatory The history of migration in the UK Before 1066 – BC Celts –43 – 410 AD Romans –80001,000 AD Danes –1066 Normans – Slaves from West Africa – Irish migration – Refugees from the Third Reich – Caribbean – West Africa, Hong Kong, ISC – East African Asians –1990 – Eastern Europeans, refugees & asylum seekers

South West Public Health Observatory Population by ethnic group, April 2001 Numbers Total population (%) Non-White population (%) White54,153, Mixed677, Indian1,053, Pakistani747, Other Asian247, All Asian or Asian British2,331, Black Caribbean565, Black African485, Black Other97, All Black or Black British1,148, Chinese247, Other ethnic groups230, All minority ethnic population4,635, All population58,789, Source: ONS – 2001 Census

South West Public Health Observatory Source: ONS – 2001 Census

South West Public Health Observatory ONS: Census

South West Public Health Observatory

Non White population by area, April 2001 April 2001 ONS: Census

South West Public Health Observatory

Source: Office for National Statistics, Control of Immigration Statistics UK, Q Table 3.3, 2009 Table 3.1, 2007 Table 6.1

South West Public Health Observatory

Source: National Insurance Number Registrations

South West Public Health Observatory Top 20 South West Local Authorities by NINO registrations to overseas nationals in 2010/11 with 209/10 comparison Source: National Insurance Number Registrations

South West Public Health Observatory South West Flag 4 general practice registrations: Mid 2000 to Mid 2010 Source: Patient Registration Data System: New Registrations – Flag 4

South West Public Health Observatory

Economic activity of women by nationality (per cent), 2006 Source: LFS 2006 (annual average of four quarters)

South West Public Health Observatory

Average hourly wage (£) by country of birth, 2009 Men (£)Women (£) A EU America India Pakistan Bangladesh Other Asia Africa Australia UK Source: The Labour Force Survey, 2009

South West Public Health Observatory Top 10 occupations of foreign-born workers, 2010 Source: Labour Force Survey 1010, Q1-Q4

South West Public Health Observatory School performance, by ethnic group and nationality, England. Ethnic groupMean percentage difference from England mean Chinese+11.0 Sri Lanken+8.0 Indian+7.0 Irish+4.5 Filipino+4.5 French+3.0 Nigerian+1.5 White British+1.0 Ghanaian-0.8 Italian Cypriot-5.5 Bangladeshi-9.3 Pakistani-11.3 Jamaican-15.3 Somali-22.3 Turkish-23.6 Portuguese-32.3 Source: DfES & IPPR, 2007

South West Public Health Observatory Percentage of women with each level of education, employed only, 2009 AgeUK bornAll foreign bornRecent foreign born 16 or under or older Source: The Labour Force Survey, 2009

South West Public Health Observatory Proportion of people living in social housing in UK, by country of birth, 2005/6 RankCountry of birth% in social housing 1=Australia5 1=France5 1=USA5 4=Poland8 4=India8 4=South Africa8 4=Canada8 8China9 9Italy10 Kenya12 11Sri Lanka14 12=Pakistan15 12=Philippines15 14Cyprus16 15UK17 16Zimbabwe20 17Republic of Ireland21 17=Uganda21 19Nigeria29 20Iran33 21Jamaica35 22Ghana39 23Portugal40 24Bangladesh41 25Turkey49 26Somalia80 Source: IPPR

South West Public Health Observatory

Healthcare principles NHS established 1948: –Preventative medicine –Primary care –Hospital services Free at point of use Approximately 12% covered by private medical insurance

South West Public Health Observatory Health inequalities policy: Key Reports 1980The Black Report 1998Acheson Report 2010Marmot Review

South West Public Health Observatory Gender Policy Equality Act 2006 –Services should not discriminate –Services should promote equality –Gender Equality Duty (GED) All NHS Trusts and contractors must publish their gender equality schemes Gender impact assessment of new policies and programmes

South West Public Health Observatory Policy relating to ethnic minorities Many NHS policy documents produced. More recent examples: –Delivering Race Equality in Mental Health (DoH, 2005) –No patient left behind policy (Lakhani, 2008) Also policy addressing specific populations –National Service Framework for health disease (DoH, 2004) –CEMACH (2007) –Race for Health (DoH, 2009) However, not mainstreamed yet !

South West Public Health Observatory Ethnic Minority Health Needs: Introduction Relationship between ethnicity & health complex (Karlsen & Nazroo, 2002) Unconscious & structural racism in service delivery (Chiu, 2004) Many migrants arrive healthy (Johnson, 2006) –Variations across migrant groups Many factors (Kings Fund, 2000) –Migration and settlement –Isolation –Loss of social status –Poverty –Insecure legal status –Government policies (for example detention & dispersal)

South West Public Health Observatory Life expectancy at birth by ethnic group, England 2001, estimated by the GWM method Ethnic groupMalesFemales All White British Indian Pakistani Bangladeshi Black Caribbean Black African Chinese Source: Rees and Wohland, 2008

South West Public Health Observatory Proportions and age standardised risk ratios for self reported bad or very bad health for women by ethnic group, England, 2004 EthnicityPercentageRR Black Caribbean Black African71.68 Indian81.39 Pakistani Bangledeshi Chinese34.02 Irish50.74 General population71 Source: The HSE, 2004