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Dr David Chappel Assistant Director, NEPHO

Dr David Chappel Assistant Director, NEPHO. Ethnic Monitoring in Health in areas with small ethnic populations Wolfson Research Institute Monday 26 th March 2006. Some issues to consider. Why do it? Ethnic Populations in the NE (denominator)

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Dr David Chappel Assistant Director, NEPHO

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  1. Dr David ChappelAssistant Director, NEPHO Ethnic Monitoring in Healthin areas with small ethnic populations Wolfson Research InstituteMonday 26th March 2006

  2. Some issues to consider • Why do it? • Ethnic Populations in the NE (denominator) • Quality of Ethnic Monitoring Data in the NE (numerator) • Examples of usage and problems

  3. WHY MONITOR ETHNICITY?

  4. Why monitor ethnicity? • Race Relations Act, 2000 • Reduce health inequalities • Fair provision of services • Patient experience • Prevent ill health

  5. What is ethnic monitoring & why is it important to health services? ‘Ethnic monitoring is a process you use to collect, store and analyse data about people ethnic backgrounds. You use ethnic monitoring to: • Highlight possible inequalities • Investigate their underlying causes; and • Remove any unfairness or disadvantage’. Commission for Racial Equality, www.cre.gov.uk

  6. White British Irish Other Mixed White & Black Caribbean White & Black African White & Asian Other Mixed Asian or Asian British Indian  Pakistani Bangladeshi Other Asian Black or Black BritishCaribbean African Other Black Chineseor other ethnic group Chinese Other ethnic group Office for National Statistics Ethnic Categories, Census 2001

  7. ETHNIC POPULATIONS IN THE NORTH EAST

  8. Population of the North East • 2001 Census • Total Population 2,515,442 (100%) • White British • 2,425,592 (96.43%) • BME (other than White British) • 89,850 (3.57%) • White • 2,455,416 (97.61%) • BME (other than White) • 60,026 (2.39%)

  9. NE Ethnic population(largest ethnic groups) • White British 2,426,000 (96.4%) • Other White 21,000 (0.8%) • Pakistani 14,000 (0.6%) • Indian 10,000 (0.4%) • White Irish 9,000 (0.4%) • Bangladeshi 6,000 (0.25%) • Chinese 6,000 (0.25%)

  10. LA/ PCT populations

  11. LA/ PCT populations

  12. Issues • Denominators are very small • Outside of Newcastle there are only two non-white populations more than 1000 and there are 39 with less than 100 people • Denominators may be inaccurate • Some questions over census • They have changed dramatically in the last 6 years – particularly with dispersal of asylum seekers (one estimate 18,000) many in Black ethnic groups

  13. ETHNIC MONITORING DATA

  14. Quality of Ethnic Monitoring • Completion rate as measure of quality • Comparison of NE to other regions • Completion rates across the region

  15. Table 3.1 Ethnicity data completeness (% incomplete) by region

  16. Ethnicity data quality in the North East • Hospital Episode Statistics (HES) 2003/4 • One of the best NHS data sources • Ethnicity field ‘mandated’ since 1995 • All admissions to NE trusts (892,111 records) • No ethnicity data in 17.3% • All admissions to NHS Trusts for NE residents (756,556 records) • No ethnicity data in 13.0%

  17. Acute Trust Ethnic MonitoringCompleteness of HES 03/04

  18. Mental Health TrustsCompleteness of HES

  19. HES completeness by PCT

  20. HES completeness by PCT

  21. SMALL NUMBERS IN THE NUMERATOR

  22. PROBLEMS WITH THE DENOMINATOR

  23. EXAMPLE OF STOP SMOKING SERVICES

  24. Stop Smoking Services (SSS) • Reviewed equity of Stop Smoking Services • N = 28,203 • missing data on ethnic group 252 • missing data on PCT of residence 2692

  25. % White attending SSS

  26. % White attending SSS

  27. SSS – success rates (4 week quitters)

  28. Bhopal et al. Newcastle Heart Project: Smoking prevalence (%)

  29. Conclusion • Ethnic Monitoring is an important tool in reducing inequalities • It is feasible to collect data. However, • There are major problems with the data on populations (denominator) in the North East • Where populations are very small the numerator can also be unstable There are other qualitative mechanisms of finding out if groups are accessing services

  30. Further Information • www.cre.org.uk • Ethnic Monitoring: A Guide for Public Authorities’, CRE, 2002. • Analysing Ethnic Differentials in Health Services and the Workforce: A Tool Kit for Local Agencies’, London Health Observatory. • ‘A Practical Guide to Ethnic Monitoring in the NHS and Social Care’, DH, 2005

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