Why the next census needs to ask about language.
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Censuses↗
Biomedical subjects
Peter J Aspinall
Publications and source records attributed to Peter J Aspinall.
Managing health inequalities locally: a baseline survey of primary care trusts' experience with health equity audit in the implementation year.
Health equity audit (HEA), a pragmatic policy tool to ensure that services and resources are focused on issues that have the highest impact on health inequalities, has now become embedded in the national strategy to tackle these inequalities through a new mandatory requirement that primary care trusts (PCTs) conduct one such audit annually. This study aimed to assess their experience through a national baseline survey in 2004, all PCTs (n = 303) being electronically mailed a questionnaire with non-respondent follow-up. Replies were received from 132 PCTs (44%), a representative sample of PCT diversity, most of whom had completed only a few steps in the audit cycle. Audit topics (most frequently coronary heart disease, smoking cessation, and access issues) and dimensions of inequity (mainly area and deprivation) were agreed through only limited engagement with local strategic partnerships. Local public health networks and multiagency teams were infrequent partners in undertaking the HEA. Most PCTs wanted comparator data, good practice examples, and specific methodological expertise. While significant progress has been made, this survey shows only limited use of HEA as a tool for multisectoral use by PCTs in partnership with others and a focus on intra-PCT comparisons at the expense of those with a wider pool of 'look-a-likes'.
Data Collection↗
The feasibility of using ethnicity as a primary tool for antenatal selective screening for sickle cell disorders: pointers from the research evidence.
The Department of Health has announced a linked antenatal and neonatal screening programme for haemoglobinopathies by 2004 in a comprehensive national plan for the National Health Service in Britain. In response the National Screening Committee has commenced development work on how such a programme can best be implemented, including investigation of the effectiveness of a question about ethnic origin as a basis for selection. In addition, two recent health technology assessment reports have assessed alternative options for antenatal and neonatal haemoglobinopathy screening programmes in the United Kingdom. Both reports and commentators have emphasised the importance of developing a standardised instrument for collecting ethnicity data and recommended early development of such work. An examination of the evidence base on the use of ethnicity as a primary screening tool reveals substantial variability in practice and in the quality of data collected, with risk group misclassification as high as 20% against a recommended target of under 5.5%. The literature on the conceptual basis and structure of ethnicity questions, method of assignment in data collection, and level of resolution on categorisation is reviewed to identify the most appropriate content and format of a screening question for the haemoglobinopathies. Question options are evaluated, including the use of an extended 2001 Census classification and a 'non-North European' identifier and a candidate question based on 'family origins' is offered for debate. Finally, issues relating to the testing of the efficiency of an ethnicity question and the operationalising of its use for antenatal sickle cell screening are discussed.
Ethnicity↗
Who is Asian? A category that remains contested in population and health research.
Continuing inconsistent use of the term 'Asian' and its appearance for the first time in the 2001 Census justifies an examination of its utility in population and health research. Given the potential for 'Asian' to describe either persons with origins in the Indian subcontinent or those originating from continental Asia, there is a strong argument in studies employing ethnicity as a measure of broad historical processes of colonialism, migration, and discrimination for privileging 'South Asian' over this contested term. Where the focus is on ethnicity as personal identity, there is some evidence of the emergence of bicultural terms such as 'Asian British' and 'Scottish Asian' and of more limited use regionally of 'Asian' and qualified terms such as 'Hindu Asian'. However, such usage cannot be generalized to the acceptance of a pan-Asian identity. Further, the different meanings that attach to terms such as 'Asian' and 'Indian' in the USA and Canada in terms of the specificity of each country's historical process of ethnogenesis mean that, where international comparisons are being made, accurate description of the population is needed to explain the terminology.
Asia, Western↗
Suicide amongst Irish migrants in Britain: a review of the identity and integration hypothesis.
BACKGROUND: Studies have consistently reported higher rates of suicide amongst Irish migrants in Britain than in the population as a whole. Leavey offers a hypothetical model to explain such rates that incorporates lack of social cohesion and integration meshed with the inability to establish an authentic identity and other contributory factors. MATERIAL: Systematic review methodologies are used to examine the central tenets of this explanatory framework. Some of the macro-level ecological associations in the model are critically evaluated in the context of findings from the 1991 Census and government social and household panel surveys. DISCUSSION: The evidence base suggests that statements on social isolation and reluctance to use health care services are questionable and Irish migration is shown to be much more heterogeneous than the model suggests. Only small positive, and as yet unreplicated, associations have been established between identity and health behaviour in a non-representative sample and evidence is lacking of Irish stoicism and anti-Irish racism as putative risk factors. Epidemiological studies show that adjusting suicide rates for social class explains virtually none of the excess in Irish migrants, although higher risks for unmarried persons are reported. Explanations in the literature for higher rates of migrant suicide are discussed. CONCLUSIONS: Studies based on individual-level analysis and record linkage are urgently needed to explain the high rates.
Adolescent↗