Myles Gould

ANALYZING PERCEIVED LIMITING LONG-TERM ILLNESS USING U.K. CENSUS MICRODATA

The 1991 Census of England, Wales and Scotland is an improvement on previous censuses in providing fine-grained detail on the geography of limiting long-term illness. Another innovation of the 1991 Census is the release of a Sample of Anonymized Records (SARs). These provide a considerable sample of detailed data on individuals at the sub-regional level. This paper explores individual and geographical variations in morbidity through a multilevel analysis of the SARs. Geographical differences in morbidity are found even after allowing for age, sex, ethnicity, housing tenure, social class and car ownership.

Is there a role for GIS in the 'new NHS'?

In this paper we draw on the existing literature to highlight the gap between academic health-based applications of Geographical Information Systems (GIS) and their everyday use within the UK National Health Service (NHS). We provide examples of the operational benefits accruing from using GIS in a range of health care applications whilst acknowledging the limited use of such technologies in strategic health tasks. The implications of recent policy changes for future projected use of such systems are discussed before presenting a research agenda for realising GIS potential within the NHS. The paper concludes by re-emphasising the importance of using GIS in strategic health planning contexts in the light of both recent health-care restructuring and new technological developments in the health service.

Death and deprivation: an exploratory analysis of deaths in the Health and Lifestyle survey

An analysis is undertaken of deaths of respondents in the UK- representative Health and Lifestyle Survey. The sample was originally interviewed in 1984/5 and followed initially until May 1997. Using multilevel logistic and Cox-proportional hazards models, the relationships between death and a wide range of social circumstances and behaviours is explored. It is found that place deprivation interacts with individual social class in accounting for variations in mortality. This is the case even when account is taken of personal health-related behaviour. There appears to be some evidence of a threshold relationship such that the differential effects of social class are only found at high-levels of deprivation. No statistically significant interactions are found for social and behavioural variables, for behavioural and place deprivation variables, and for social and place deprivation variables with the exception of social class. The study is deliberately exploratory and a wide range of models have been fitted which will be subject to more rigorous evaluation as the HALS death study proceeds.

Ethnic minority unemployment and local labour market conditions in Great Britain

British ethnic minority unemployment rates are considerably higher than those of the white population. In 1991 the ethnic minority unemployment rate was more than double that of the white majority. One possible explanation is that Britains ethnic minorities are concentrated in areas of economic disadvantage. The authors use the 2% Individual Sample of Anonymised Records (SAR) in conjunction with area-based census data for pseudo travel-to-work areas, to explore the relative importance of individual characteristics and area characteristics on ethnic minority unemployment rates. Multilevel modelling techniques are employed to estimate simultaneously variations between individuals and between areas after allowing for variables measured at both levels of analysis. The most important differences in the propensity to unemployment are shown to be between individuals, and, compared with whites, ethnic minority groups are shown to be disadvantaged wherever they live. In general, there is also evidence of greater variation in ethnic minority unemployment between areas than there is for whites. However, there is the same underlying geography of unemployment for the black and white populations, but a slightly different pattern for Asian ethnic groups. These differences can be explained only partially by area-level characteristics. In all, it is argued that at the spatial scale which is identifiable in the Individual SAR, ethnic minority unemployment cannot be attributed to geographical distribution, though data at a finer geographical scale are needed to test this hypothesis more fully.

Using the 1991 Census SAR in a multilevel analysis of male unemployment

The risk of unemployment varies between individuals, between occupations and industries, and between places. The Sample of Anonymised Records drawn from the 1991 Census is used to model geographical, demographic, and socioeconomic variations in male unemployment by means of multilevel logit models. The underlying structure of the problem is such that cells in a multiway cross-tabulation of individual characteristics (level 1) are nested within places (level 2). Geographical variations in male unemployment are found even after allowing for age, marital status, ethnicity, higher education qualifications, social class, and industry.

Distance between home and work: a multilevel analysis of individual workers, neighbourhoods, and employment sites in Northern Ireland

We explore the distances between home and work for employees at twenty-eight different employment sites across Northern Ireland. Substantively, this is important for better understanding the geography of labour catchments. Methodologically, with data on the distances between place of residence (566 wards) and place of work for some 15 000 workers, and the use of multilevel modelling (MLM), the analysis adds to the evidence derived from other census-based and survey-based studies. Descriptive analysis is supplemented with MLM that simultaneously explores individual, neighbourhood, and site variations in travel-to-work patterns using hierarchical and cross-classified model specifications, including individual and ecological predictor variables (and their cross-level interactions). In doing so we apportion variability to different levels and spatial contexts, and also outline the factors that shape spatial mobility. We find, as expected, that factors such as gender and occupation influence the distance between home and work, and also confirm the importance of neighbourhood characteristics (such as population density observed in ecological analyses at ward level) in shaping individual outcomes, with major differences found between urban and rural locations. Beyond this, the analysis of variability also points to the relative significance of residential location, with less individual variability in travel-to-work distance between workers within wards than within employment sites. We conclude by suggesting that, whilst some general ‘rules’ about the factors that shape labour catchments are possible (eg workers in rural areas and in higher occupations travel further than others), the complex variability between places highlighted by the MLM analysis illustrates the salience of place-specific uniqueness.

Family life and alcohol consumption: The transmission of ‘public’ and ‘private’ drinking cultures

This article considers the transmission of drinking cultures within families. In particular, we highlight the differential and discursive construction of the home as a space where parents/carers are happy to introduce children to alcohol in a ‘safe’ environment in opposition to public spaces which they consider to be locations where alcohol consumption is associated with violence and disorder. Presenting empirical research undertaken in the UK, we argue that parents/carers miss the opportunity to teach children about the range of drinking practices and spaces they may experience throughout their lives and fail to engage with their children about wider social responsibilities as potential drinkers in the future. We conclude with theoretical- and policy-relevant insights.

Realising 'joined-up' geography in the National Health Service: the role of geographical information systems?

This paper focuses on the use of geographical information systems (GIS) within primary and secondary health care sectors in the United Kingdom in relation to wider notions of ‘joined-up’ government—a key tenet of central government initiatives aimed at addressing problems such as social exclusion and polarisation. Drawing on findings from a national-level questionnaire survey, and follow-up semi-structured interviews with key respondents from the National Health Service (NHS), we have found that there has been an increase in GIS uptake within health organisations in the last decade. However, there has been limited collaboration between NHS organisations and local authorities on projects that utilise GIS. This lack of interorganisational activity is underpinned by the lack of a service-level agreement for digital data provision within NHS organisations, ambiguous understandings of data confidentiality requirements, and a limited awareness of the benefits of joined-up working arrangements. The paper concludes with a suggestion that significant organisational and cultural changes are required to facilitate enabling contexts for enhanced collaborative use of GIS between NHS organisations and local authorities, in order to support the wider joined-up government agenda currently being promoted in the United Kingdom.

The proximity effect: The role of the affective space of family life in shaping children’s knowledge about alcohol and its social and health implications

Pre-teen children’s knowledge and experience of alcohol has been the subject of relatively little research despite the fact that this is a critical time given that the average age for the onset of drinking in Europe is now 12. Indeed, children are commonly only addressed in national alcohol strategies as the responsibility of parents/families, rather than as an audience for such messages in their own right. Yet, it is important to take a cross-generational perspective by exploring pre-teen children’s understandings of alcohol, as well as that of their parents, because adults and children may experience familial socialisation practices around alcohol differently. Too often adults’ views about what is in the best interests of children are read through the lens of age-appropriate behaviours which are predicated on deterministic theories of child development in which pre-teens are presumed to be too emotionally or physically immature to express their opinions, rather than on children’s own experiences of their life-worlds. This article draws on empirical research from a study of the role of alcohol in UK family life. It comprised a telephone survey of a nationally representative sample of 2089 parents with at least one child aged 5–12, and multi-stage case study research (including child-centred research) with 10 families who were purposively sampled from the survey. The findings presented in this article are primarily drawn from the child-centred element of the research supplemented by some data from the survey and interviews with parents. The article explores children’s knowledge of alcohol, their understanding of the health risks and social harms associated with drinking and the implications for national alcohol strategies. The conclusion highlights the significance of children’s experiential learning about alcohol through a proximity effect which occurs within the affective space of the familial home.

Problems of providing health care in British island communities

Issues and problems relating to the funding and provision of health services to islands are examined with particular reference to the island communities of Britain. The results of a telephone survey of key representatives of relevant health authorities in the British Isles indicate the general problems faced by health care providers in island localities. The Isle of Wight is used as a case study and exemplar of the specific difficulties faced in island settings. The paper concludes by examining the relevance of current resource allocation policy to island contexts.