Frequently Asked Questions (FAQs) about the Health Profiles 2006

This webpage provides information on Frequently Asked Questions for the Health Profiles 2006. See the Current FAQ for information on Frequently Asked Questions for the current Health Profiles.

The following FAQs are available:

Added Value
Feedback
Indicators
1. Choice
2. Gaps
3. Data
4. Interpretation
Labelling
Making appropriate comparisons by person, time and place
1. Place
2. Time
3. Person
Maps
1. Concerns
Other publications
1. In HP family
2. Other public health intelligence
Using profiles
1. Inappropriate use
2. Intended uses
3. Policy relevance
4. Copying into other documents

1 Added value

What is special about the Health Profiles?
This is the first time that Health Profiles have been produced for local authority areas across England. There is a profile for 386 of the 388 local authorities in England: County Councils, District Councils, Unitary Authorities and London Boroughs. (There is no profile for the City of London and the Isles of Scilly. Due to their small populations, the number of people represented in many of the health profile indicators is small and not statistically robust.)

Why do the profiles have “prototype” written across the bottom of the page? Are they not correct?
The final format for the profiles has not yet been decided on with the Department of Health and so we are calling these “prototypes”. However, it is important that the information within the profiles can be used as soon as possible so that plans can be made locally to further improve health and reduce health inequalities. We don’t expect that the data will change between the prototype and the final version. All the information has been through rigorous checking and we are as confident as we can be that the information is accurate.

2 Feedback

What sort of feedback are you looking for?
We would be delighted to get feedback on the content and format of the profiles as well as how they have been used to support local action. Feedback can be submitted via the website.

3 Indicators

(a) Choice

How did you choose the indicators?
We included an indicator if it met the following criteria:

It has an important effect on the health of the local population
It can support local government and NHS management processes
It is valid. This means that it measures what it tries to measure
It is primarily based on existing indicators which are consistently available for every council in England
It is primarily available at Local Authority level. These include County Councils, District Councils, Unitary authorities and London Boroughs
It is possible to make meaningful comparisons over time and between places or people
It can be communicated easily to a wide audience.

(b) Gaps

Why are there gaps?
Where there are gaps, that is because the indicator is important to describing the health of the population but the data are currently not available for all local authority areas in England.

(c) Data

Will we be able to look at the data behind these indicators and profiles?
At present only the completed profiles are available. It is planned that data and further information will be available for local use before the end of 2006.

(d) Interpretation

Q7 To follow.

4 Labelling

Why do the profiles have “prototype” written across the bottom of the page?
The final format for the profiles has not yet been decided on with the Department of Health and so we are calling these “prototypes”. However, it is important that the information within the profiles can be used as soon as possible so that plans can be made locally to further improve health and reduce health inequalities. We don’t expect that the data will change between the prototype and the final version. All the information has been through rigorous checking and we are confident as we can be that the information is accurate.

5 Making appropriate comparisons by person, time and place

(a) Place

What geographical options were considered for the Health Profiles?
Wards, Local Authorities, Counties, Super Output Areas, PCTs.

Why use local authority geography?
Local Authority is a generic term for any level of local government in the UK. In geographic terms LAs therefore include English counties, non-metropolitan districts, metropolitan districts, unitary authorities and London boroughs; Welsh unitary authorities; Scottish council areas; and Northern Irish district council areas.
Historically many health-related datasets are available at local authority level. LAs are important institutions for delivering interventions to improve health and reduce inequalities. Local authorities have a statutory duty to improve the wellbeing of local people and scrutinise local health services. All local authorities have a community plan which outlines the action that they intend to take to improve conditions in their local area. Health Profiles aim to inform local community plans.
Local Area Agreements (LAAs) are currently being put in place across local authorities in England and the profiles should help to develop and monitor these agreements.

Why not use Primary Care Trust geography?
The geography of Primary Care organisations has been unstable over the last decade. The number of PCTs in England was reduced from 303 to 152 in autumn 2006. The new configurations improve the co-terminosity of PCTs with local authorities. Only certain health-related datasets are currently available at PCT level.

Why use electoral ward geography?
Wards are the key building blocks of UK administrative geography, being the spatial units used to elect local government councillors. They are also used to constitute administrative and political geographies e.g. local authorities and parliamentary constituencies. Wards are familiar and meaningful to both local politicians and the general public.

Why not use Super Output Areas?
Super Output Areas (SOAs) were developed to overcome some of the drawbacks of presenting data for electoral wards. They are a range of areas of consistent size and their boundaries do not change. They are built from groups of the Output Areas (OAs) used for the 2001 Census. There are 3 layers of SOA: the Lower Layer SOA has a minimum population of 1000, is built from groups of OAs (typically 4 to 6) and is constrained by the boundaries of the Standard Table (ST) wards used for 2001 Census outputs.
Unfortunately SOAs can look strange on the ground. They are intended as a purely statistical geography and, although they allow for detailed small area data, they are not intended to represent communities. SOAs do not have names that relate them to specific towns, villages or other subsections of a local authority. They are designated through a numbering system, which is meaningless to most people.
In order for the Health Profiles to present data for SOAs we would need to have accurate, detailed population denominator data for SOAs. Data for Lower SOAs are currently not detailed enough for the Health Profiles, although data for Middle Layer SOAs could be used.

Why do the Health Profiles use Standard Table wards?
A number of different types of ward have been created by ONS: Statistical wards, Census Area Statistics (CAS) wards and Standard Table (ST) wards. In 2003 a new policy was introduced across National Statistics to minimise the statistical impact of frequent electoral ward boundary changes. Under this policy any changes to English or Welsh ward boundaries laid down in statute by the end of a calendar year will be implemented for statistical purposes on 1 April of the following year, irrespective of the year the actual change comes into operation. The wards resulting from this policy are known as ‘statistical wards’.
Due to varying time lags between promulgation and operation dates of boundary changes, for some local authorities the statistical ward list for any given year will be different to the normal electoral ward list.
Unfortunately, detailed national denominator data are not available for statistical ward boundaries and therefore it was not possible to use these boundaries in the Health Profiles.
Census Area Statistics (CAS) wards are used for 2001 Census outputs. In England and Wales they are identical to the 2003 statistical wards except that 18 of the smallest wards (all in England) were merged into other wards to avoid the confidentiality risks of releasing data for very small areas. This occurred to those wards with fewer than 100 residents or 40 households (as at the 2001 Census). There are a total of 7969 CAS wards in England and 881 in Wales.
Standard Table (ST) wards are those for which the 2001 Census Standard Tables are available. They are a further subset of the statistical wards such that those with fewer than 1000 residents or 400 households have been merged. This was required to ensure the confidentiality of data in the Standard Tables. In England and Wales a total of 113 statistical wards have been merged to create the ST ward set. There are a total of 7932 ST wards in England and 868 in Wales.
Health Profiles use ST wards and therefore for some local authorities the HP ward boundaries and/or population figures may be different to maps and/or local population estimates based on the most recent statistical wards. Local authorities (LAs) experiencing electoral ward boundary changes in June 2004 can be found at (Is there anything more recent?) http://www.statistics.gov.uk/geography/downloads/LA2004.xls
Note that whilst new sets of statistical wards will come into effect each April, the CAS wards and ST wards were one-off sets specifically defined for 2001 Census outputs.

Were all the numerator and denominator datasets derived from data appropriate to local authority boundaries?
Some indicator datasets are not necessarily derived from data collection based on local authority boundaries.
The GCSE achievement indicator is based on Local Education Authorities which are not necessarily coterminous with all the 386 health profile local authorities. For example in the ‘Health Profile for Warwick 2006’ the GCSE attainment chart does not describe data for Warwick DC but for Warwickshire County Council (the LEA) which is the aggregated educational attainment data from schools in 5 district councils – Warwick, Stratford upon Avon, Rugby, Nuneaton and Bedworth, North Warwickshire.
Another important issue concerns the potential for numerator and denominator error – the dataset is based on state schools within a LEA area and does not include private schools; and is based on pupils attending LEA schools and not pupils living in that area. Therefore caution is advised in interpreting this indicator in areas where a significant proportion of the resident school population are privately educated and/ or where significant numbers of pupils are resident outside the LEA boundary or where resident pupils attend schools outside that particular LEA.
There is also the potential for error when considering the datasets (mental health treatment, people with diabetes) generated by the primary care Quality and Outcomes Framework (QoF), which is collected at practice level and aggregated to PCT level. Practices were apportioned to LAs in order to give an LA figure to produce a national LA-General practice table with the proportions of LA populations in each practice. Therefore caution is advised in interpreting these indicators in areas where there is significant utilisation of primary care services outside the PCT boundary.
We would therefore recommend that when interpreting and drawing conclusions from the information presented in the HPs, the metadata document is consulted. This can be found at: https://www.communityhealthprofiles.info/docs/CHP%20Metadata_08June2006_v1.1.pdf

(b) Time

If each local authority health profile is titled ‘Health Profile for (name of LA) 2006’ why do the maps, charts and indicators, featured in the spine charts, not feature 2005/06 data?
Health Profiles use the most recently published datasets for numerator data and latest available actual or modelled estimates for denominator population data synchronous with the numerator time period. Because of variation in the publication dates of the datasets used, some indicators may appear old or out of date. For example deprivation, air quality, children in poverty indicators are derived from the 2004 IMD, but the data within IMD 2004 is predominantly 2001 derived from the 2001 census. Similarly, the ‘feeling in poor health’ indicator is derived from the 2001 census; and the ward life expectancy and deprivation maps are based on the 2001 Census Standard Tables, as these were the only and latest ward population estimates available. By contrast GCSE achievement by LEA is more up to date, as the data is published annually with HP figures based on 2005 returns. However, GCSE achievement by ethnicity was only available for the 2004 dataset.

(c) Person

Why use ONS groups as comparators?
Areas differ in demographic structure, household composition, housing, socioeconomic character, employment patterns and type of local industry. These differences make comparing areas problematic. It may be unreasonable to compare mortality rates without taking relevant population characteristics into account. Therefore the health profiles also enable local areas to compare themselves with other similar authorities.
The ONS has produced a classification of local authorities – National Statistics 2001 area classification – which involves a hierarchy of three levels of: ‘supergroups’, ‘groups’ and ‘subgroups’. The classification can be used to make fairer comparisons. Comparisons within groups (e.g. between Swansea and Falkirk) may be more meaningful than comparisons of areas, which are in the same region but in different groups (e.g. between Swansea and Guildford; between Portsmouth and Test Valley).

6 Maps

(a) Concerns

Why might the Health Profile maps differ from local maps?
For a minority of HP maps which feature coastline, the profile maps may look unfamiliar. This is because the boundaries used were ‘Extent of the Realm’ and not ‘Mean High Water Mark’.

‘Extent of the Realm’, is the statutory extent of the administrative areas on which wards are based. Usually the Extent of the Realm (EOR) extends as far as the Mean Low Water mark, but in some instances it extends out to sea and includes offshore islands.

Maps based on ‘Mean High Water Mark’ are simplified and may give a more orthodox appearance to the coastline.

The next set of health profiles maps will better reflect local geography and not administrative boundaries.
Similarly there may be occasional instances where towns are not featured on HP maps. This is because the towns included in the maps were taken from a standard table obtained from Ordnance Survey and this standard table may not feature all locally significant settlements.

Why may the ward level deprivation maps in the Health Profiles differ from those produced locally which are based on the same source? i.e. indices of Derivation 2004
The Health Profile ward maps show the deprivation data split into quartiles which are population based i.e. “Most deprived 25%” refers to the most deprived wards containing 25% of England’s population. Wards may, therefore, appear in a different quartile to that derived by simply splitting the data range into four groups. The ward level deprivation scores were calculated from the SOA level scores and are population weighted. They may not be directly comparable to any locally derived ward level scores.

7 Other publications

(a) In HP family

What about the picture nationally?
The Health Profile of England was published in October 2006, as part of Health Challenge England.

(b) Other public health intelligence

How do these Profiles compare with similar reports produced by other organisations such as the Audit Commission?
The Health Profiles were commissioned by the Department of Health and are a valuable tool for planning action to improve health and reduce health inequalities. They can be used together with local information and other indicator sets and reports to identify where action needs to be taken to improve health and where improvement is already happening.

8 Using profiles

(a) Inappropriate use

What is the point of highlighting a local problem? Will this not just create concern among the public locally rather than actually solving it?
It is only by identifying areas of concern that action can be taken. Local authorities and primary care trusts have a statutory duty to improve the health and wellbeing of the local population. With information like that in the profiles we can all see where there are areas of concern and then take action to improve the health of local communities.

Will these lead to the publication of league tables showing how each area compares with others and year on year changes?
Profiles will be updated every year and will be able to show changes in the local position. They have not been designed to produce league tables.

Is the complete set of Profiles available on a website for comparison purposes?
Yes, www.communityhealthprofiles.info

(b) Intended uses

What action do you expect local authorities to take to deal with any problems highlighted by the profiles?
Local authorities have a statutory duty to improve the wellbeing of local people and scrutinise local health services.
All local authorities have a community plan which outlines the action that they are taking to improve conditions in their local area. Health Profiles will inform local community plans. Local Area Agreements (LAAs) are currently being put in place across local authorities in England and the profiles should help to develop and monitor these agreements. (LAAs are voluntary, three-year agreements between central government, local authorities and their partners. They aim to deliver national outcomes in a way that reflects local priorities.)

(c) Policy relevance

What support is available from the Government to help us take action?
As part of delivering the Department of Health’s White Paper ‘Choosing Health’, monies were made available to improve health and reduce health inequalities. The profiles can help prioritise the best use of those resources.

What is “small change: Big Difference”?
The “small change: Big Difference” (sc:BD) initiative encourages people to make small changes in their lifestyles to give them a better chance of living longer, healthier lives. The objective of the initiative is to encourage people to take a step towards achieving the recommended healthy eating and physical activity targets, by highlighting the fact that a small but sustained change in lifestyle – taking moderate exercise and eating one extra portion of fruit or serving of vegetables every day – can make a significant difference to life expectancy. Lifestyle change does not have to be an all or nothing exercise. Every step towards achieving the recommended targets counts. The initiative was launched on the 25 April 2006 by the Prime Minister Tony Blair with Secretary of State Patricia Hewitt. For more information visit www.dh.gov.uk/smallchange.

(d) Copying into other documents

Can part /all of a Health Profile be reproduced / cut and pasted into other documents?
Yes providing the document is for non commercial purposes and that there is explicit acknowledgement / referencing of the Health Profiles source material. Health profiles material may be referenced as follows: