Populationsethnicity and geographyHelen 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?

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?

-200,000 -150,000 -100,000 -50,000 0 50,000 100,000 150,000 200,000

0-4

04-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100+

males females

Africa 2000

-200,000 -150,000 -100,000 -50,000 0 50,000 100,000 150,000 200,000

0-4

04-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100+

males females

Asia 2000

-200,000 -150,000 -100,000 -50,000 0 50,000 100,000 150,000 200,000

0-4

04-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100+

males females

China 2000

-200,000 -150,000 -100,000 -50,000 0 50,000 100,000 150,000 200,000

0-4

04-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100+

males females

Europe 2000

Interactive population pyramid on ONS website

http://www.statistics.gov.uk/populationestimates/svg_pyramid/default.htm

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

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

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0 1-4 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

% o

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46UBHL Tidworth, Perham Down and Ludgershall South % 40UFGF Minehead North %

Some examples of different issues of population and ill health

Total world populationWorldmapper 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 CensusNational 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 tables3. Comparison with earlier censuses –

definitions, geography, One Number Census4. Other anomalies – living rent free, working

at or from home

National ProjectionsUK 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 www.poppi.org.uk/

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:

http://www.statistics.gov.uk/downloads/theme_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

Resident populations GP 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

Cohorts of childless women 1923 - 1973Source: ONS

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Age 25 Age 35 Age 45

% c

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1923

1973 (projected)

Longer term projections depend partly on fertility

Births and deaths England and Wales 1901-2051

Source: ONS

Population change England and Wales1971-2007

Source: Population Trends Spring 2008

Conception patterns at different ages 1992-7

20-24 35-39

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

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 1999-2003

Source: London Health Observatory

Standardised mortality ratios by country of birth, aged 20-29, England and Wales 1999-2003

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 www.statistics.gov.uk ONS geography

www.statistics.gov.uk/geography/ ONS area classification

www.statistics.gov.uk/about/methodology_by_theme/area_classification/

United Nations population division www.un.org/esa/population/unpop.htm

Population trends www.statistics.gov.uk/statbase/Product.asp?vlnk=6303

East Midlands PH Observatory http://www.empho.org.uk/

http://www.healthknowledge.org.uk/Health%20Information/HK%203a,b,c.htm