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Geographies and populations Where are the boundaries?

NHS Information Centre, 21st March 2011. Paul Norman School of Geography University of Leeds p.d.norman@leeds.ac.uk. Geographies and populations Where are the boundaries?. Acknowledgements ESRC ONS GROS NISRA OS UKBORDERS CDU ESDS ESRC Research Awards RES-165-25-0032, RES-189-25-0162.

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Geographies and populations Where are the boundaries?

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  1. NHS Information Centre, 21st March 2011 Paul Norman School of Geography University of Leeds p.d.norman@leeds.ac.uk Geographies and populations Where are the boundaries? • Acknowledgements • ESRC ONS GROS NISRA OS UKBORDERS CDU ESDS • ESRC Research Awards RES-165-25-0032, RES-189-25-0162

  2. Geographies and populations What is a ‘geography’? How are geographies defined? What is a population? How are they defined? Health measures by areas and by population subgroups What else do geographers do with health data? Challenges of time-series analysis: changing boundaries and population definitions What geography & which population? Aspects of the DH White Paper

  3. Geographical boundaries Vancouver Island 49th Parallel Some large lakes & a river River Tweed Offa’s Dyke • Natural • Coastline • Rivers • Arbitrary / artificial • Defend • Tradition • Organise • Political • Ownership • Legal Territoriality

  4. Examples of geographies • Traditional geographies • Counties, parishes • Electoral geographies • Constituencies, wards • Administrative geographies • National / local government, census • Functional geographies • Postal • Emergency services: police, fire, ambulance • Health; Education • Utilities: gas, electricity, water, sewerage • Sport • Planning regions • Enterprise zones, regeneration areas • National Parks, nature reserves

  5. What is a population? Area 2 Area 1 Area 3 Area 4 Area 5 • Count of people … in a defined geographical area • Differentiated by • Age & sex; Ethnic group; Social Class (or SEG or NS-SEC) • Educational achievement; Tenure

  6. What do geographers, demographers, social scientists, do? Self-reported health, 1991 Mortality, 1991

  7. What do geographers, etc, do? Self-reported health: limiting long-term illness, 2001 Social Class Ethnicity Tenure

  8. Area distributions of health outcome Area distribution Model residuals

  9. Area profiles: classification Deprivation distribution k-means classification Good health cluster Poor health cluster Student cluster

  10. Analysing point data Point distribution of health outcome? Kernel density map Clusters

  11. What about change over time? Tricky due to boundary change … Peterborough: 1988 - 2005 1997-2003 … 1988-1996 2004-2005 … No ward stays exactly the same during the period (East is almost the same though)

  12. What about change over time? “The redisorganisation of the NHS” Smith J, Walshe K, Hunter D (2001) BMJ: 323: 1262-3 1999 1991 2004 Soon … All change please!

  13. Administrative boundary change: due to Need for good governance (re-organise subnational structure of administrative geography) & Differential population change by small areas & need for equity in electoral representation Census boundary change: due to Many census geographies aligned with administrative geographies (as above) & Need for a local geography which protects confidentiality yet delivers usable statistics, & thus may be time point specific Lead to boundaries being re-drawn But this severely hampers comparison of cross-sections Census & other applications may need consistent geographical areas over time for analysis of change Why do boundaries change?

  14. IMR relative to national rate Time-series: infant mortality rates 1981 1991 2001 2006 1986 1996 Deprivation Supergroups

  15. What about change over time? 1991 Ethnic groups 2001 Ethnic groups Social Class to NS-SEC • Why (not) change? Administrative, census & survey data, etc • Historical record versus contemporary relevance? • Continuity versus current applicability? • Reactive versus proactive?

  16. Detailed demographic data Coarse geographic scale Detailed geographic scale Banded demographic detail • ‘Right’ geographies & ‘right’ populations? • Confidentiality: tension between providing … Nation Region District Ward Synthetic Output Areas Super Output Areas

  17. ‘Healthy Lives, Health People: Our Strategy for public health in England’ • Geographical & population aspects to be resolved • Life expectancy between the richest and poorestneighbourhoods (p.16) • One ward in Kensington and Chelsea … compared with … one of the capital’s poorer wards (p.15) • Neighbourhood income level (p.16) • Data will be published to make it easier for local communities to compare themselves with others across the country (p.26) • Department for Communities and Local Government will support local areas with streamlined planning policy that aligns social, economic, environmental and health priorities into one place (p.40) • GP consortia will have responsibility for the whole population in their area (p.62)

  18. Community? Neighbourhood? Indian, Pakistani, Bangladeshi Students

  19. Community? Neighbourhood?

  20. ‘Healthy Lives, Health People: Our Strategy for public health in England’ • Community? Neighbourhood? • Anne Milton, Under Secretary of State for Public Health 11/01/2011 • “We generally take a lead from the Office for National Statistics and use Super Output areas (lower and/or middle layer) for small area analysis” • “Terms such as, for example, communities or neighbourhoods referred to in publications should be interpreted as plain English terms that in analysis would be represented by an appropriate standard geography”

  21. ‘Healthy Lives, Health People: Our Strategy for public health in England’ • GP consortia? • p.62 GP consortia will have responsibility for the whole population in their area • Anne Milton Under Secretary of State for Public Health 11/01/2011 • “The White Paper makes clear that GP consortia will have to have an area of geographical focus. Work on this is still ongoing but it is likely that this will be based on existing standard geographies”

  22. ‘Healthy Lives, Health People: Our Strategy for public health in England’ • GP consortia? Likely to be within a local authority • but #1 … Edge effects & wider catchment

  23. ‘Healthy Lives, Health People: Our Strategy for public health in England’ • GP consortia? Likely to be within a local authority • but #2 … People are different & from different areas

  24. Geographies and populations • Where are the boundaries? • Need consistency over time: geographies & populations • Need also to have contemporary / ongoing relevance • Good policy decisions & appraisals of success need to be underpinned by good data • “Data will be published to make it easier for local communities to compare themselves with others across the country” • “Local areas with streamlined planning policy that aligns social, economic, environmental and health priorities into one place” • Needs • Global shift by data providers: a ‘can do’ attitude • Georeferencing: e.g. postcode > OA > SOA linkages • Back revisions of existing datasets • 2021 Census & / or a real replacement

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