Populations ethnicity and geography Helen Cooke (SWPHO) adapted by John Langley for the East Midlands 2008 PHI course

Learning objectives  Why do we want to know about populations?  Present and future patterns  Health differences between ethnic groups  Census  Sources of data  Migration  Geographical hierarchy  Similar areas

Why are we interested in populations?

 What sort of population are we dealing with? - health needs assessment  Likely future needs  Denominator  Population at risk  Ethnicity  Cash

What sort of things do we want to know about a population  Size  Age structure  Fertility  Ethnic mix  Projected changes

 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?

Africa 2000

Asia 2000

China 2000

Europe 2000

Interactive population pyramid on ONS website

The rectangularisation of the life curve, England and Wales

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

Some examples of different issues of population and ill health

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

Deaths from HIV/AIDS

Census data  Census contains much, much more than population data, but we will only consider populations here

The Census – a primary information source Name 3 kinds of information collected by the Census Can you remember 3 questions on the 2001 Census? What questions on the Census might be of use in Public Health Information? Name one other major source of population statistics

The Census – a primary information source

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

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 migration (3-12 months)

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

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

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

National Projections UK population to rise to 65m by 2016

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  Local Authorities (who have expert local knowledge)  NHS informatics staff (for “Exeter” patient data)

ONS future plans  Integrated population statistics  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: population/ipss.pdf

Electoral roll  Another cross-check  Used at local level for detailed planning

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 (particularly a problem where many foreign students)- still called “embarkation”  “special populations”

PCT populations  Derived from GP registrations  Constrained to ONS populations at LA level  Need both resident and registered (GP relevant) populations nww.nchod.nhs.uk

Resident versus registered populations

Which one to use?  Registered for commissioning  Resident for attaching to Census data

Who’s missing?  Homeless  Travellers  Illegal immigrants  Armed forces  Prisoners  Unregistered migrant workers

Longer term projections depend partly on fertility

Births and deaths England and Wales Source: ONS

Population change England and Wales Source: Population Trends Spring 2008

Conception patterns at different ages

Some examples of special rates for denominators (population at risk)  Stillbirths – all births  Infant mortality (<1 year) – live births  Teenage pregnancy - usually girls  Fertility  usually women  sometimes women 14-46

Ethnicity and its relevance to health needs assessment  Healthy migrants?  Different patterns of mortality and morbidity  Immigrant groups may have a different age distribution according to migration patterns and ageing  Source LHO report summary

Standardised mortality ratios by country of birth, aged 20-29, England and Wales Source: London Health Observatory

Standardised mortality ratios by country of birth, aged 20-29, England and Wales

NS 2001 Area Classification for Health Areas

Beginner's Guide to UK Geography

Geographic boundaries & units EC geography NUTs 1 (region) NUTs 2 (Counties groups of counties) NUTs 3 (Counties / groups of unitary authorities )

Resources  ONS  ONS geography  ONS area classification eme/area_classification/  United Nations population division  Population trends =6303  East Midlands PH Observatory  mation/HK%203a,b,c.htm