Ethnicity data collection was also initiated in other areas besides the census. It became a requirement to collect ethnicity data as part of the Hospital Episode Statistics (HES) data in 1995 but was poorly implemented. The levels of missing data and invalid codes rendered the data unusable (Aspinall, 2000). However, some improvement has been reported in Finished Consultant Episodes with a reduction in ‘not known’ and ‘not stated’ codes from 23.9% in 2004/05 to 8.6% in 2009/10
6 (HES online, 2011). In 2004, a single Quality and Outcomes Framework (QOF) point out of a possible thousand was offered for collection of ethnicity data for all new registrations in primary care, and again this was a weak incentive which did not have much impact. The system could also be cheated by selecting ‘other’, or ‘not known’ which would mean the field was complete but did not provide any useful information, the incentive was recognised to be ineffective and abandoned (Johnson, 2012).
1.4
Ethnicity
The term ‘ethnicity’ is derived from the Greek word ‘Ethnos’ meaning ‘tribe of people’. Ethnicity is a multi-dimensional and subjective concept, which means that self-reporting is the most accurate method of capturing this information. Ethnic groups can be broadly defined as people from the same geographical location or those who have a common language, religion or culture. There is no hard or fast definition of ethnicity and the area is subject to great debate with researchers using a diverse range of terminology, which has meant that publications relating to ethnic minorities are not easy to find. Bhopal (2004) attempted to define the concept and measures of ethnicity in the form of a glossary style article with the hope that it might lead to an internationally applicable glossary and provide a basis for indexing terms. The essential components of ethnicity can be said to comprise of the following items but this list is by no means exhaustive:
7 Country of origin
Parents country of origin Religion Language Diet Nationality Race Culture Dress
Race is an out of date term and is considered unacceptable in the UK (Gill et al, 2007). Historically, race was used prior to ethnicity and is still collected in some countries such as the USA today. Race refers to physical attributes such as, skin colour, facial features, hair colour and texture. Skin colour is an inaccurate indicator of ethnicity, it is not possible to distinguish between white groups such as English, Scottish, Welsh or other Europeans nor between some non-whites, e.g. Indian, Pakistani or Bangladeshi. The items considered to be of national importance can first and foremost be found in the census.
1.4.1
Ethnicity indicators
1.4.1.1Ethnic group
Prior to 1991, country of birth was the only indicator of ethnicity collected. Ethnicity was first incorporated in the 1991 census as a ten category item (Table 1.1). The categories followed immigration roots and combined geographical origin with skin colour. The intention was to increase the accuracy of ethnic group classification
8 where subjects originated from a multi-cultural continent, e.g. Black African, Black Caribbean. In 2001, the census categories were supplemented with the addition of a new ‘Mixed’ categories, expansion of the ‘White’ category and the introduction of an ‘Other’ category, with space for free text in each category. The categories were arranged into five broad groups: White, Black, Mixed, Asian, Chinese and Other.
The 2011 census saw the introduction of two further classifications, ‘Gypsy or Irish traveller’ and ‘Arab’ accumulating in 18 categories. Other changes included relocating the Chinese category from ‘Other ethnic group’ in 2001 to the ‘Asian/Asian British’ category. A ‘not stated’ code exists for coding purposes to be used by those collecting the data but not offered on forms or verbally in order to minimise missing data (Table 1.1). No subsequent changes have been made to ethnic minority categorisation in the UK census.
9 Table 1.1 Ethnicity categories in thirty years of the England and Wales census 1991-2011
1991 2001 2011
0 White A White A White
1 Black Caribbean 1 British 1 English/Welsh/Scottish/Northern Irish/British
2 Black African 2 Irish 2 Irish
3 Black other 3 Any other white background 3 Gypsy or Irish Traveller
4 Indian B Mixed 4 Any other White background
5 Pakistani 4 White and Black Caribbean B Mixed/multiple ethnic groups
6 Bangladeshi 5 White and Black African 5 White and Black Caribbean
7 Chinese 6 White and Asian 6 White and Black African
8 Other Asian 7 Any other mixed background 7 White and Asian
9 Any other ethnic group
C Asian or British Asian 8 Any other Mixed/multiple ethnic background
Not stated 8 Indian C Asian/British Asian
9 Pakistani 9 Indian
10 Bangladeshi 10 Pakistani
11 Any other Asian background 11 Bangladeshi D Black or Black British 12 Chinese
12 Caribbean 13 Any other Asian background
13 African D Black/African/Caribbean/Black British
14 Any other Black background 14 African E Other Ethnic Groups 15 Caribbean
15 Chinese 16 Any other Black/African/Caribbean background
16 Any other ethnic group E Other ethnic group
Not stated 17 Arab
18 Any other ethnic group Not stated
10
1.4.1.2Religion
Religion was first introduced as a census question in 2001 and remained unchanged for the 2011 round, it continues to be optional. The question comprises of seven responses: 1) Christian, 2) Buddhist, 3) Hindu, 4) Jewish, 5) Muslim, 6) Sikh, and 7) any other religion. The Office of National Statistics also distinguished between degree of religious practice (active faith and participation in religious activity and worship) and religious identity (belonging to a religious community even if the religion is not practiced). As previously, the ‘not stated’ option was not offered either verbally or as a category on a form.
1.4.1.3Language
Language was collected as part of the 2011 census in two parts. The first asked for language to be specified if it was not English, with the second part asking respondents to indicate their level of proficiency in English using a Likert scale.
1.4.1.4Country of birth
Country of birth is routinely recorded on UK birth and death certificates and has been collected in the census since 1841 this has often been used as a proxy for ethnicity mainly because of its availability. However, it has two main weaknesses. Firstly, it is not possible to distinguish immigrants from the children of British residents born overseas, even though these individuals would identify themselves as White. Secondly, it is unable to identify the British born offspring of immigrants
11 and with over 50% of ethnic minorities in 2001 born in the UK, country of birth is no longer a reliable indicator of ethnicity.
1.4.1.5Nationality
Nationality was collected as part of the census between 1841 and 1961 before being abandoned. It was first collected in order to identify those of Scottish and Irish origin. However, following the mass inward migration of the 1960s the question caused confusion and data were difficult to collect. However, nationality and feeling like a member of the society in which you live are important parts of identity and have been recognised by the Office of National Statistics. The 2011 census once again included a question about national identity, allowing individuals to choose from six categories: English, Welsh, Scottish, Northern Irish, British or Other, with space provided to capture free text.