Does educational success lead to job success for second-generation immigrants?

By Chris A Garrington, on 11 August 2023

Second-generation immigrants in the United Kingdom now gain better qualifications than those whose parents were born here. So why do they struggle to get into the best jobs, and what role does social class play? In this blog Carolina V.  Zuccotti and Lucinda Platt describe new research which uses census data to shed light on the issue.

A lot has been written about how the children of immigrants fare in education and in work, and the United Kingdom provides an important perspective: in many countries these young people do worse in education than their peers, but in the UK the opposite is the case. White British young people are now outperformed by their ethnic minority peers at every level of the education system.

We set out to ask three key questions, using data from the ONS Longitudinal Study (LS): 

• How do second-generation ethnic minorities gain an educational advantage despite their tendency to come from lower socio-economic backgrounds?
• To what extent does this success carry them through into good jobs?
• What does this case tell us about the interplay between education and social origins, and what are the implications for future research?

There are differences between ethnic groups – for instance, Indians tend to be higher-attaining than Black Caribbeans – but all second-generation ethnic minorities in the UK improve their test scores throughout their schooling faster than the majority population. They are also more likely to stay on in education after the legal school leaving age, and more likely to go to university.

Yet there is a paradox – despite their apparent ability to overcome humble social origins to succeed in education, these well-qualified young people are still at a disadvantage when it comes to entering the labour market, and their access to the top jobs is mixed.

There are some well-documented explanations for this. Migrants, the parents of these children, – by the very fact that they have been prepared to move around the world – are likely to be aspirational, determined, and resilient. Their children may benefit from these qualities and from their parents’ relatively good education.

Yet, migrants tend to end up in jobs for which they are over-qualified, so they take a step down from where they started out in their country of origin, which may negatively affect their children’s job prospects. These  families are also likely to live in poorer neighbourhoods and to lack access to important social networks that could get their children a start in the world of work. 

Unique dataset

Using the unique 40-year dataset provided by the LS, we were able to track individuals well into their working lives and also to look at the relationship between education and career success for men and women in each ethnic group. 

We identified around 175,000 individuals who were aged under 15 in 1971, 1981 or 1991 and for whom we could see which socio-economic groups their parents were in. We then tracked their educational and work records to see how they were doing between the ages of 20 and 45.

We looked at whether they had degree-level qualifications, whether they were employed or unemployed, whether those who were employed had professional or managerial jobs and – for women only – whether they were economically active or inactive. We compared those who were second-generation Indian, Pakistani, Bangladeshi or Caribbean – these being the four biggest distinct ethnic minorities in the UK – with those in the white British majority.

Manual jobs

We found all the ethnic minority groups’ parents were more likely to be in manual jobs than White British parents, but this was especially so for Pakistanis and Bangladeshis. All ethnic minority groups were also more likely to have grown up in overcrowded households and in deprived neighbourhoods. Yet they were still likely to do better in education than their white peers. For example, almost half the second-generation South Asian men had parents with manual jobs, compared to just three in 10 White British men. Yet more than a third of second-generation South Asians had degree-level qualifications, compared with around a quarter of White British men.

When it came to labour market outcomes, results were more mixed. Of all the ethnic groups, only Bangladeshi men were more likely to be employed than white British men, once key predictors of employment such as education and social origins were considered. Among women, Pakistanis and Bangladeshis had higher levels of inactivity than their White British peers, especially those without university education. 

Those who achieved in education managed to translate some of that advantage into the labour market, especially in terms of the type of job they accessed. Indian and Bangladeshi men and women, for example, were more likely to have professional or managerial jobs than White British people from similar social backgrounds. This suggests that unmeasurable background factors such as parental motivation may play only a small part in access to jobs, but a bigger one in the quality of the job and in later promotion. 

Advantage and disadvantage

So, a mixture of both advantage and disadvantage is an increasingly common feature of the second-generation immigrant experience in the UK. Disadvantaged socio-economic circumstances growing up do not constrain them from high rates of success in education, but the picture is much more mixed once they enter the labour market. Social class clearly does not mean the same thing for ethnic minority groups as it does for the majority, but it still plays a role in their occupational outcomes

What are the implications for future research? We believe the complex interplay between different factors in the lives of second-generation migrants needs further investigation. The fact that this group is bucking the social trend in terms of education provides interesting opportunities to look at what the ‘black box’ of social class really means to different groups of people.

The paradoxical role of social class background in the educational and labour market outcomes of the children of immigrants in the UK is research by Carolina Zuccotti and Lucinda Platt, and is published in The British Journal of Sociology.

Carolina Zuccotti is s a Marie Skłodowska-Curie (MSCA) Global Fellow at the Universidad Carlos III de Madrid, Getafe, Spain, and Lucinda Platt is Professor of Social Policy and Sociology in the Department of Social Policy at the London School of Economics and Political Science.

Do caregivers’ children reach milestones earlier?

By Chris A Garrington, on 15 June 2023

The number of looked-after children in England has risen significantly in the past three decades, and around three quarters are placed with foster families. Many of those families have children of their own: what are the longer-term effects on them? In this blog Amanda Sacker and colleagues describe research which set out to shed light on the issue – and which suggests specific training for social workers could be helpful.

A growing body of research suggests those who grow up alongside foster children are affected in the longer term by the experience – in ways which are both positive and negative. On the plus side, these children can learn to appreciate their families, to empathise with others’ misfortunes and to take responsibility. Challenges can include having to share belongings and parents’ time, dealing with negative behaviours such as stealing or lying, loss of privacy, family tensions and sometimes a loss of innocence.

But how strong are these effects? Although findings from earlier studies are quite consistent, they tend to be from unrepresentative and often small-scale qualitative research. Using a large, representative dataset from the ONS Longitudinal Study (LS), we set out to discover whether foster carers’ children made key transitions to adulthood sooner than other young people. 

This is a subject that should be of interest to policymakers: official statistics from 2022 suggest there were 58,000 caregivers’ children in England, living alongside 82,000 looked-after children – the latter being a rise from 47,590 in 1994. 

The LS enabled us to access information on children who lived with foster-siblings between 1971 and 2001 – we identified 2656 who lived with a foster child and 209,453 who did not. We looked at whether there were differences between the groups in the ‘big five’ transitions to adulthood: finishing school; leaving home; finding work and becoming financially independent; getting married and having children. These were broken down further to give us a total of 11 measurable outcomes.

Different outcomes?

We found there were differences – but they were small. For nine out of the eleven outcomes, caregivers’ children had earlier transitions than non-caregivers’ children but for three of those nine, the effects were not statistically significant. 

There were some significant differences, although small – 83 per cent of caregivers’ children left school with few qualifications compared with 79 per cent of non-caregivers’ children, for instance. Three out of four measures for getting on in work and becoming financially independent showed differences between the two groups of children. Caregivers’ children were less likely to be in work in early adulthood – 69 per cent as opposed to 72 per cent – and more likely to be non-employed long-term. These differences were independent of the household’s socioeconomic environment.

Twenty per cent of caregivers’ children were in managerial or professional jobs compared with 23 per cent of those without a foster child in the family. Those who had left their parents’ homes were less likely to be owner-occupiers and more likely to be renting or in other less secure housing.

Caregivers’ children were a little more likely to be married before they entered their 30s – 16 per cent compared to 14 per cent – and women who grew up with a cared-for child had children younger: six per cent were teenage mothers compared with five per cent of the non-caregiver group, and 1.6 per cent of mothers had three or more children by the age of 30 compared with 1.2 per cent of others.

The only transition for which we did not find any evidence of earlier transitions was leaving home.

We found some limited indications that daughters could be more affected later in life as well as during fostering in childhood. Unfortunately, we only had information on women’s fertility and cannot comment on parenthood for caregivers’ sons.  Evidence supporting the notion that caregivers’ sons and daughters were less affected when the foster children were of the opposite sex was very limited and equivocal at best.

The effects we did find had disappeared by mid-adulthood: by the time they were in their 40s, no differences between carers’ children and non-carers’ children were seen. 

Taking action

We believe social work education and training could include knowledge and skills development relevant to foster carers’ own children, including the risk of an early transition to adulthood. Social workers both supervise and support foster carers, and they act as intermediaries between the caregiver and the foster child’s own social worker, so with better understanding of the issues they could play a key role. 

For example, supporting foster parents to keep their children in education for longer could become part of the role of supervising social workers. They might explore with foster carers any barriers to their own children staying in school, and what might prompt them to want to leave. They might also take on a wider role in supporting the children of foster parents, especially during their adolescence, though to do this, fostering services would have to ensure there was sufficient extra support time available.  

Our research suggests a broader investigation of foster carers’ households is called for: there are several areas where further study is needed. Are these earlier transitions driven by the benefit of maturity or by the challenge of sharing a home? Do caregivers’ children cope better if they are older than the foster child? Are daughters in fostering households more affected than sons? And although our focus was on the children of caregivers, it would be helpful to know whether children in foster care fare better or worse if placed with a foster parent who has children. 

Our study is the first of its kind to examine the transition to adulthood in relation to caregivers’ children – and although its findings are modest, they do support the suggestion that they make earlier transitions to adulthood. With some tens of thousands of caregivers’ children potentially experiencing these impacts, more work needs to be done on the issue.

Is foster caring associated with an earlier transition to adulthood for caregivers’ own children? ONS Longitudinal Studyis research by Amanda Sacker, Rebecca Lacey, Barbara Maughan and Emily Murray and is published in SocArvXiv Papers, 19 Feb 2023

Is selective education really ‘the great leveller’?

By Chris A Garrington, on 7 June 2023

As recently as 2017 the Conservative government was elected on a manifesto which pledged to promote new grammar schools – with the explicit aim of increasing mobility. But is school selection really a factor in ‘levelling up’? In this blog Franz Buscha describes research which used census data to track the generation which experienced a mass change from grammars to comprehensives in England. Selective education made little difference to their life chances, it found.

For many decades, opponents and proponents of selective education have argued over its possible effects on social mobility. And while the current government has never fulfilled its pledge to remove legal constraints on new grammar schools, the idea that selective education is a route to ‘levelling up’ remains popular with many MPs and social commentators.

Those who support the expansion of grammar schools argue they give children from disadvantaged backgrounds a leg up in life by enabling them to access high-quality teaching and positive peer influence. Those who oppose selection point to the disadvantages suffered by those who find themselves excluded from such education. Non-selective schools can aid social mobility without the psychological scarring that comes from entry failure at an early age, they argue.

Until now, research evidence has tended to focus on individuals who attended grammar schools. How did those who narrowly passed the 11-plus fare when compared to those who narrowly failed it, for example? Broadly, those studies tell us grammar schools have small positive effects on pupils’ test scores and larger ones on their likelihood of staying on for more years in education. 

But such research cannot look at the effect of selection on the whole population because it ignores the possible negative effects on the majority of pupils. For many children in selective school systems, selection means being educated in schools from which the top end of the ability spectrum has been removed. For policy purposes, the key question is how to design systems which work for the whole pupil population, regardless of academic talent, geography or ability to pay.  We were able to address this by using census data which gave us a picture of the system as a whole.

England provides a rare opportunity to look at this issue, because in the space of two decades during the 1960s and 1970s it went from having a predominantly selective education system to a predominantly mixed ability one. For the vast majority of pupils, their secondary school choices went from either grammar or secondary modern to comprehensive only. Using the ONS Longitudinal Study we were able to look at a sample of more than 90,000 pupils who were born between 1953 and 1972, and whose secondary education therefore took place during this period of transition. 

We linked information on the proportion of pupils attending selective schools in each of England’s 145 Local Education Authorities to census data which allowed us to look at social mobility in those areas over time. Using recognised measures of social mobility we could then track pupils through the changing system to see if those in selective areas were more or less likely to end up in a higher social class than their parents.  

Evidence

Overall, our results showed little evidence that selective or comprehensive education systems made a difference to overall levels of social mobility. The shift to mixed-ability teaching brought some minor positive changes, but these were insignificant once we adjusted for broader social trends. Based on our evidence, even a change from 100 per cent to 0 per cent selectivity would have led only to small improvements.

Mobility

Although our findings are in some ways modest, our analysis provides an important advance in understanding how school selectivity is related to social mobility. We can now definitively reject the more florid claims made by both sides in the political debate over grammar schools.

Individual tales of ‘long range mobility’ from humble working-class origins to professional and managerial destinations – with the key turning-point being admission to the local grammar school – will continue to be told by those in favour of selection. And our findings do not contradict these anecdotal experiences. There is no doubt that for some people from disadvantaged backgrounds, attending grammar school makes a big difference. 

However, we hear much less often from the corresponding group of people who did less well in a secondary modern than they would otherwise have done in a comprehensive school. And to properly assess the effect of a schooling system on social mobility, it is necessary to consider the outcomes for all affected individuals, not just the beneficiaries. 

Conversely, we can now see that the introduction of comprehensives did not bring its promised increase in social mobility either – though to be fair, the claim has never been as central to the comprehensive ideal as it has been to the selective one. It is also true that the full benefits of a comprehensive system cannot be realised while a significant minority of academically high-achieving pupils are ‘creamed off’ into remaining selective schools. 

In any event, we find no evidence that either type of schooling system has had a notable effect on intergenerational social class mobility. Our conclusion casts doubt on the idea that education policy can be a ‘silver bullet’ solution to the larger problems of widening economic inequality and stagnant social mobility. 

Selective schooling and social mobility in England, is research by Franz Buscha, Emma Gorman and Patrick Sturgis and is published in Labour Economics Volume 81, 2023

Is London becoming a city segregated by privilege?

By Chris A Garrington, on 12 May 2023

Globally, more people live in cities, and while they shape those cities they are also shaped by them. In this blog, Dr Bonnie Buyuklieva describes PhD research in which she used census data on London and elsewhere to develop new ways of modelling the metabolic processes of people and their built environments. The results should inform planning, building use and social sustainability.

What makes healthy cities? I believe these should be places able to sustain their populations and enable people to progress through different phases of their lives. 

An unhealthy city, then, is one where the lives of those who live in it are limited by insecurity and infrastructure. An unhealthy city is often a ’burn-and-churn’ place which draws in the young, the educated and the moneyed, then wears them out by failing to afford the context for smooth transitions across different stages and milestones of the lifecycle. 

My research compared data on London and its hinterland and found significant differences between England’s capital and other areas outside it. Briefly, it found that housing increasingly reflects economic privilege. What this means is that London, a place whose populations have for many centuries been empowered by mobility, may in the future become a place where that logic no longer holds. 

Mobility

London may become a place segregated by economic privilege – a place where no-one can afford not to be rich. And that would create problems for all its citizens because it would make it less attractive as a centre of employment. 

I looked at population density, residential stability and mobility, both within London and between the city and its hinterlands.  Using Census data from 1981 to 2011, it became clear that while some pockets of London are not too different from other places in England and Wales, the capital is generally denser and less residentially stable. 

It is not surprising that the centre of London has low population stability and also low density – it is largely commercial and is also home to several University of London institutions along with other education hubs. As for the rest of London – broadly in the North and West few places have a stable population, while the East and South historically have had both higher stability and lower mobility. 

Both South and East London are comparatively less well connected to the rest of the capital, particularly by tube. However, the East, in contrast to the South, is in some senses a residential area in its adolescence:  until the early 1980s it was home to docklands, but as this industry moved out to Tilbury, the area was redeveloped. More recently, it was developed again to accommodate the 2012 Olympic Games, bringing in new housing trends such as purpose-designed built-to-rent developments.  

Looking at built-to-rent developments, which are the fastest-growing sector of London’s housing market, we observe a trend towards smaller-sized, higher-cost rented housing units. These provide ‘plug-and-play’ or ‘just-in-time’ solutions in a constrained market. But they are also a time-limited home for most residents, so they create migration chains that are likely to lead to local residential instability. 

Young families

This trend, along with the rise of asset-based housing wealth and the gig economy’s trend towards precarious, project-based employment, tends to ‘slow down’ people’s lives. Typically, young professionals may delay child-rearing because it is not suited to mobile, dense urban living. They appreciate the tight and bustling city life, but families with easily tiring young children might struggle with that.

Globally, there is a pattern of young professionals clustering in high-density urban neighbourhoods, but the trend has major downsides. Quick-fix policies such as built-to-rent in isolation will impact negatively on London if increasing numbers of people find the financial gains from being in London can only be realised by leaving. 

When compared to the rest of England and Wales, London has few places with high stability and many with low stability. It hosts the densest places in England and Wales. My research has been able to map the small areas which have unusually high levels of density and transience and where we expect to find the churning populations on the edge of belonging in London.

All this impacts people’s lives: social renters and owner-occupiers tend to have children in their late twenties; private renters do not do so until they are over 30, possibly reflecting a sense of housing insecurity. Couples in particular may be treating private rent as a sort of ‘waiting room’ whilst accumulating the financial or social confidence to take on the responsibility of children.

There is an even greater contrast between privately renting households within and outside the capital. Outside London, the majority of private renters over 30 have children; in London, that proportion is only reached after the age of 34. 

As my research took shape, I became increasingly conscious that we needed to look at these issues over time – as people move and their lives change, so do cities. People are the fundamental urban resource, and to maintain healthy cities, planners need to think not just about what is needed now but also in future. By considering how and where populations can move on through their lifecourse, we can plan for the future needs of cities themselves.

Buyana Buyuklieva’s PhD thesis is available to download: London’s Demographic Metabolism: Using Computational Social Science Methods to Map Mobility in Populations and Places

Have school league tables led to more socially segregated neighbourhoods?

By Chris A Garrington, on 24 January 2023

In the early 1990s, parents in England were given access to league tables based on school performance which gave them more information when deciding where their kids would go to school. In this blog Dan McArthur and Aaron Reeves share findings of research which used the ONS Longitudinal Study and which found quantifying school quality had the unintended consequence of increasing the geographical concentration of advantage, potentially entrenching inequalities. 

Where we grow up matters: a childhood in a neighbourhood where the majority of people are materially deprived can lead to lower earnings, a less prestigious occupation and even a lower life expectancy. Neighbourhoods matter because they contain important local services such as hospitals that can have a profound impact on what happens in our lives. Parents sense that neighbourhoods (and the local services available within them) matter and so areas perceived to have high quality services typically have higher house prices, and this can to segregation because less affluent families find it harder to stay in or move to neighbourhoods where the quality of these local services is perceived to be good.

Education is particularly important because school quality can have a major influence on adult life chances, and British parents pay a substantial house price premium to gain access to good schools. This can be self-perpetuating. School league tables at least in part reflect the social composition of the pupils: middle class children tend to perform well, and this pushes their schools up the rankings. Better-off parents move to be near successful schools, and in doing so help those schools to become even more successful. Conversely, the process leads to less successful schools facing a downward spiral as parents who are able to move away from them choose to do so.

The very act of measuring school quality, then, has the potential to deepen divisions between advantaged and disadvantaged residential areas. To explore this possibility, we carried out two studies to explore what happened after the introduction of GCSE league tables in England, which provide a clear and simple (albeit controversial) measure of school quality. 

Our first study compared census data from 1981 to 2011 on the social class composition of neighbourhoods with school performance data, and showed that areas with better-performing schools saw greater increases in the proportion of professional and managerial people among their populations.

Our second study used the ONS Longitudinal Study, a one per cent sample of English and Welsh census records and life-events data, to study individual-level patterns of residential mobility. We found people with professional or managerial occupations became more likely to move to areas with better schools after the introduction of school league tables. However, this only occurred if those people had school-age children: this provides us with strong evidence that those who were most able and most incentivised to benefit from the introduction of league tables did indeed alter their patterns of residential mobility in response to their introduction.

Indirect links

We could not directly ask parents why they moved to a particular area, and we could not see which schools their children subsequently attended, but our study does provide substantial indirect evidence that league tables drove a change in class-specific patterns of residential mobility. We do, however, consider alternative explanations for the changes we see over time. For example, it might be the case that middle class parents became more concerned about their children’s educational prospects during this period; but we find no evidence of a change in this direction. By ruling out these alternative explanations, we can be more confident that the change was driven by the change of policy rather than by other factors.

Would these findings be replicated elsewhere? We believe they would: England’s schools are funded via a centralised system which also redistributes funding to areas where there is educational disadvantage, and in places where this is not the case, such as the United States, the effect may in fact be more pronounced.

We believe the alluring simplicity of league tables based on exam performance may reduce the importance of more informal sources of information for parents. Before the league tables were published, families gleaned background on schools through local networks, as well as ad hoc publicity around the particular successes of individual schools. League tables changed their perspective – what may previously have seemed a good local school may have suffered in comparison with a more successful school further away, and in fact the average distance children travel to school has almost doubled since the 1980s.

We know from other research that there are class differences in how families respond to league tables. Those in less advantaged homes may put more weight on proximity, for instance, and may give their children more say. Those with professional and managerial jobs are more likely to take the lead in the decision, and also to be focused on entry to an elite university. But there are also financial reasons why a middle-class family is more likely to move into the catchment of a good school: those on lower incomes are often unable to afford to do so.

Wider implications

Our research showed that the share of professional and managerial residents increased fastest in local authorities with high-performing schools. It also found those in advantaged social classes became more likely to move to areas with high-performing schools after the introduction of league tables, but only if they had school-aged children. 

This does not necessarily mean that league tables will always lead to a greater geographical concentration of advantage – other background factors such as school funding policies and the level of house price inequality will also play a part. But we can say that quantifying quality in this way reveals inequalities in performance which were previously opaque. It also increases the likelihood that good schools will do even better as successful families move into new catchment areas.

This matters because the measurement of school quality is a political choice, albeit one which – as we have shown – has unintended consequences. League tables enable parents to make informed choices, and may even improve teaching quality, according to some research. But in doing so they deepen the geographical concentration of disadvantage, and they potentially affect the life chances of children whose parents are unable to move into the catchment of successful schools.

‘The Unintended Consequences of Quantifying Quality: Does Ranking School Performance Shape the Geographical Concentration of Advantage?’ by Daniel McArthur and Aaron Reeves, was published in The American journal of sociology: https://www.journals.uchicago.edu/doi/10.1086/722470

Health and place: How levelling up health can keep older workers working

By Chris A Garrington, on 21 November 2022

As part of its levelling up agenda, the UK Government has set itself an ambitious target to add five additional healthy years to the average UK lifespan by 2035. In this blog Dr Emily Murray highlights lessons from the Health in Older People in Places project (HOPE), which she leads. HOPE uses data from the ONS Longitudinal Study to showing the link between levels of employment and health in a place.

We know place matters when working to extend healthy life expectancy (HLE) – there are large inequalities in older people’s health, depending on where they live. The Government recognises this and has set target of narrowing the gap between those living in the ‘healthiest’ and ‘unhealthiest’ local authority areas by 2030.

There are strong links, too, between the health of the population in a local area and levels of employment. So if we want people to be able to stay healthy and to work for longer, narrowing these gaps can make a real difference.

Staying in work

If the UK had achieved the current levelling up agenda goal of reducing the HLE gap by five years between 2001 and 2011, older people’s participation in the labour market would have increased by 3.7 per cent between 2001 and 2011. That would have meant 250,000 additional older people in paid employment. The HOPE project used Disability-Free Life Expectancy (DFLE) g as a proxy for HLE, as HLE data for local authorities was not available in 2001.

While disability-free life expectancy (DFLE) improved overall in the UK from 1991 to 2011, there was still a significant gap between the local authority areas considered the ‘healthiest’ and the ‘unhealthiest’. In 2011, DFLE at age 50 varied from 13.8 to 25.0 years – that’s a gap of 11.3 years between the healthiest and unhealthiest areas, which widened during the study period.

Unfortunately, over a decade later, the conversation hasn’t moved on much further. Health Equity in England: The Marmot Review 10 Years On, the 2020 follow-up to Sir Michael Marmot’s landmark study, found that the health gap between wealthy and deprived areas had continued to grow.

The HOPE project has built on this research by using Census data for England and Wales to show the link between levels of employment and health in a place.

It finds:

• The higher the proportion of older people with poor health in a place, the less likely it is that any adults in that place will be in paid work. For example:
  • • Older workers from the unhealthiest areas were 60 per cent more likely to be out of work than those who live in the ‘healthiest’ areas
    • Women aged 50-74 living in the ‘healthiest’ areas re 5.6 per cent more likely to be in paid work than those living in the ‘unhealthiest’ areas.
    • Men aged 50-74 living in the ‘healthiest’ areas were 7.1 per cent more likely to be in paid work than those living in the ‘unhealthiest’.

• How we measure health in a place matters: links between health in a place and employment are stronger for self-rated health measures, compared with life expectancy figures or mortality indicators.
• Historically disadvantaged areas continue to struggle: areas where people left paid work at a younger age due to poor health in 1991 were much more likely to experience this trend in 2011 as well.
• This disproportionately affects people in manual occupations: they’re much more likely to experience ill health, and they can expect four fewer years of healthy life beyond age 50, compared with workers in administrative or professional roles.
• There’s a correlation between health in a place and younger people being in paid employment: for example, the probability of a woman aged 16 to 49 not being in paid work was 33.7 per cent in the ‘unhealthiest’ areas compared with 26.3 per cent in the ‘healthiest’ areas.
• Those working in professional occupations were more likely to be in work 10 years later than those working in elementary occupations or doing repetitive manual labour: this gap in employment outcomes was most marked for people living in ‘unhealthy’ areas.

The fallout from the COVID-19 pandemic and the current cost of living crisis are likely to widen existing inequalities. So it’s unclear how the Government intends to achieve its ambitious goals to increase healthy life expectancy and to narrow the gap between those in the ‘healthiest’ and ‘unhealthiest’ areas, especially given its recent decision to abandon the promised white paper on health disparities. 

We recommend that The Government should: 

• Increase spending on preventative health programmes to at least 6 per cent of the national health budget. This is in line with Canada, who currently invest the most in prevention across the G20 and continue to raise this proportion in accordance with the rise in preventable diseases. 

• Earmark part of the £4.8 billion levelling up infrastructure fund for projects that will create jobs suitable for older workers in the ‘unhealthiest’ local authority areas, especially in those where a high proportion of employment is in manual work. 

• Collect, monitor and publish data every year on health in a place, in particular self-rated health measures and labour market participation for people over the age of 50. 

• Confirm that there will be another census in 2031 and add detailed questions about health and labour market participation for people aged over 50. 

• Improve access to medical services to allow older people in poor health to remain in work. This includes reducing wait times to see a GP and for referrals, treatments and A&E. 

• Provide support, including career training and advice, to help older workers transition to less physically demanding roles, especially those in manual roles. 

Local authorities should: 

• Develop a five-year strategy to increase employment rates for people aged over 50 in the ‘unhealthiest’ communities, in partnership with business. This strategy should recognise that older women often face additional barriers to employment apart from health barriers. 

• Include local targets to improve population health in line with the national average for people aged 50 to 74 as part of their annual planning exercise. 

• Increase support for older workers in manual occupations to stay in employment. For example, training and financial support, either through the benefits system or apprenticeship schemes, can help older workers transition to less physically demanding jobs as they age. 

• Strengthen local tailoring of prevention programmes to ensure that services fully cater to local population health requirements. 

• Address ageism at a local level, by educating and informing people on how to receive the best care to prevent or manage health conditions, regardless of age. The aim is to challenge the perception that long-term conditions are an inevitable consequence of old age when many are preventable. Local authorities should also work with businesses to challenge employer perceptions that older people’s health is a barrier to their participation in the labour market.

Although the prevalent narrative is often that individual health is an individual problem rather than a societal one, the whole community is affected by poor health. It’s not just about helping people live longer, healthier lives but supporting local economies and economic growth.

The levelling up agenda is more important now than ever, and it’s vital it is not sidelined. 

The Health of Older People in Places (HOPE) project is a multidisciplinary research project funded by the Health Foundation under the Social and Economic Value of Health in a Place (SEVHP) programme. The research team includes scientists from the Department of Epidemiology and Public Health at University College London (UCL) and the School of Geography at the University of Leeds. The full report, Health and place: How levelling up health can keep older workers working,

 is available here. The report was written and published by the International Longevity Centre, UK.

The work was launched on October 19, 2022, at an event whose keynote speakers included Lord James Bethell, Parliamentary Under Secretary of State at the Department of Health and Social Care. Slides from the event are available here: https://ilcuk.org.uk/hope-project-report/

Dr Murray discuss the work further along with Dr Brian Beach in this Linking our Lives podcast.

Mental health service use and local crime – how are they associated?

By Chris A Garrington, on 26 September 2022

Living in neighbourhoods with higher crime rates is linked with a higher prevalence of mental health problems – but what is the relationship with mental health service use, especially with psychotropic medications? Also, are there any groups of people more vulnerable to the impact of crime, and how do changing crime levels help to understand this association? In this blog, Gergő Baranyi discusses new insights using data from the Scottish Longitudinal Study.

In the United Kingdom one adult in six is affected by common mental health disorders at any given time, and the cost associated with mental illnesses adds up to four per cent of the national gross domestic product. We know the physical and social environment plays a part: Residential areas with high levels of deprivation and social disorganisation tend to have more crime and violence, and that might impact the mental health of residents. Personal experience of being a victim or witness of crime and violence is more common in high-crime neighbourhoods. However, people in these areas might experience more stress, avoid public areas and reduce social interaction with others, even if they are not affected directly by crime – and that can influence their mental health.

We were able to use the Scottish Longitudinal Study (SLS), a five per cent sample of the Scottish population which enabled us to link participants’ census responses with levels of crime in their neighbourhood and with psychotropic medications prescribed through their GP. Our study captured people who responded to both the 2001 and 2011 censuses and who were aged 16 and over in 2001. Based on addresses available in the census and in other administrative records we linked information on neighbourhood crime to these participants. This included police-reported crimes and offences such as assaults, crimes of violence, domestic break-ins, drug offences and vandalism, which were aggregated across 6,500 small areas in Scotland with a population of 500-1000 individuals. Although the 2011 census in Scotland included a question on self-reported mental illness, the SLS enabled us to link NHS Scotland records on prescribed antidepressants and antipsychotics to our participants.

The findings showed that living in a higher crime area was linked to reporting mental illness in the census and receiving antidepressants or antipsychotic medication, and also extended our understanding of crime and mental health.

Psychotropic medication as a proxy for mental health problems

After excluding from the sample those with pre-existing mental health conditions – identified as receiving any psychotropic medications in the first six months of the study period – we had a sample of almost 130,000 adults with an average age of 51 in 2009.

During the follow-up period between 2009 and 2014, 22 per cent of our sample received at least one new prescription for antidepressant and two per cent at least one new prescription for antipsychotic medications.

After taking into account key personal characteristics, we found these proportions differed significantly according to crime levels in residential neighbourhoods. Those living in areas with high crime were at a significantly higher risk of having a new prescription for antidepressants. The odds were higher for people in young and middle adulthood, especially women. These associations were present even after we controlled for area disadvantage.

When we looked at antipsychotic medications we found a similar association, though the risk was higher among men and in middle adulthood. Area deprivation was not associated with antipsychotic prescription.

While we used antidepressants and antipsychotics as a proxy for mental health problems, they are often prescribed for other health problems and not all individuals with mental illnesses receive pharmacological treatment. Still, findings with self-reported mental illness led to similar conclusions.

Utilising changing crime levels to understand underlying mechanisms

Scotland experienced a significant drop in crime during the study period, but not all neighbourhoods benefitted equally from this drop and there were even areas where crime increased. In our second study, we used information on changing crime levels, adding neighbourhood crime rates between 2004 and 2013 to our dataset. Participants’ addresses during this time were available from GP registration records.

Our findings revealed that young adults who stayed in the same neighbourhood while crime levels were increasing were more likely to report mental illness in the 2011 census and to receive antidepressant prescriptions from their GPs. This provides stronger evidence for the impact of neighbourhood crime on individual mental health.

We also found that middle-aged adults who moved into higher-crime areas were more likely to report mental illnesses and have antipsychotics prescribed during the study period. Although it is difficult to tease out exact pathways, this can be due to people with more severe mental health conditions moving to more affordable but often disadvantaged and higher crime areas.

Our studies confirm that local crime is an important predictor of mental health service use, independent of other individual- or area-level risk factors, but the associations differ across type of medication, and between sex and age groups.

Crime and violence reduction programmes, targeting crime hotspots and rehabilitating deprived areas, might be beneficial for population mental health. Mental health promotion in local schools, prevention initiatives for high-risk individuals and enhanced mental health services in high-crime areas might provide opportunities for those most in need.

The project team included Gergő Baranyi, Mark Cherrie, Sarah Curtis, Chris Dibben and Jamie Pearce from the Centre for Research on Environment, Society and Health, University of Edinburgh. Gergő Baranyi presented this research at the UKCenLS conference in Cardiff on September 20. This blog post is based on two papers:

Baranyi G, Cherrie M, Curtis S, Dibben C, Pearce JR. Neighborhood Crime and Psychotropic Medications: A Longitudinal Data Linkage Study of 130,000 Scottish Adults. Am J Prev Med. 2020;58(5):638-647 https://doi.org/10.1016/j.amepre.2019.12.022;

Baranyi G, Cherrie M, Curtis S, Dibben C, Pearce JR. Changing levels of local crime and mental health: a natural experiment using self-reported and service use data in Scotland

J Epidemiol Community Health 2020;74:806-814. https://jech.bmj.com/content/74/10/806;

Language in Northern Ireland: Who has lost, gained or retained knowledge of Irish?

By Chris A Garrington, on 1 September 2022

In 2020, the New Decade New Approach (NDNA) deal for Northern Ireland outlined  a strategy for the Irish language. Then in May 2022 the Identity and Language Bill was introduced in Westminster, providing for the strategy to be granted official status. But who knows Irish, and what changes have occurred? Dr Ian Shuttleworth discusses findings from a research project using Census data to look at changes between 2001 and 2011. 

There is considerable political, media and policy interest in the use of both the Irish and Ulster-Scots languages in Northern Ireland. And because Census data from the Northern Ireland Longitudinal Study (NILS) tracks a large sample of the population – 28 per cent – over time, it can provide us with valuable insights above and beyond what official statistics offer.

We set out to answer a series of questions, aimed at adding new evidence on key socio-demographic, household, and health factors:

• Is Irish language knowledge associated with socio-economic status, type of household or health?
• How did self-reported Irish language knowledge change between the 2001 and 2011 Censuses?
• What changes could be observed among young people over the 10-year period in the knowledge of Irish language?

We found the main factors linked to having Irish language knowledge were being aged 11-15 years, being born in the Republic of Ireland, being Catholic, having no religion of upbringing (compared to Protestants), having Irish national identity, having degree-level education and living with others who had Irish language knowledge. However, about 8% of those who knew Irish in either 2001 or 2011 were Protestant.  

We also found people living in the 20 per cent most deprived areas and those living in the West and South of Northern Ireland were more likely to have Irish language knowledge. 

When we looked at change between 2001 and 2011, we found the highest proportion of people learning Irish were aged 3-19 years (13.6 per cent) in 2001, while the highest proportion of those losing Irish were those aged 11-15 years in 2001 (13.3 per cent).

Change was strongly connected with changes in religious affiliation: 45.7 per cent of those who said they were Catholic in 2001 but not in 2011 lost Irish over the same period, while 43.5 per cent of those who were not Catholic in 2001 but were Catholic in 2011 gained the language. 

Over a 10-year period, around a third of Irish-speakers retained their knowledge, around a third lost it and a further similar number gained knowledge despite not having had it at the start. 

For both Censuses – and for the previous one in 1991 – the peak age for Irish language knowledge was 13. In each Census year, between 20 and 30 per cent of 13-year-olds had that knowledge. But in each year, the proportion of those in their mid-20s who had it was much lower, at between 10 and 13 per cent.

Why would this be? The Census can’t tell us, but we can offer some insight – those with Irish language, like those with Ulster Scots, tended to have a higher level of education than the general population. Those who spoke Irish at age 13 or less would have been likely, over the next 10 years, to have moved on to university and possibly to be living in student accommodation or not in Northern Ireland at all. So the Census will have been unable to pick up some of them. We might also speculate, of course, that their parents may have marked them down on the Census as Irish speakers, whereas they may not have felt strongly as adults that they had that ability.

Given the policy context, our work has offered a useful picture of the socio-demographic, household and health associations of those who have knowledge of the Irish language, and we hope it will inform further Government initiatives in the future.

The research on profiling the Irish language in Northern Ireland was led by Dr Ian Shuttleworth from the School of Natural and Built Environment at Queen’s University, Belfast, supported by researchers in the Northern Ireland Statistics and Research Agency (NISRA) and endorsed by the Department for Communities. Dr Shuttleworth will be presenting the work at the British Society for Population Studies conference in Winchester on September 7.

Person or place? Finding out more about what drives health inequalities

By Chris A Garrington, on 25 July 2022

It is known that life expectancy is higher in some areas of the UK than in others. These inequalities in health are linked to the socio-demographics of the area: poorer health and shorter life expectancy tends to be a feature of less affluent areas of the country. In this blog, the third in a series on cancer and social inequality, Fiona Ingleby discusses research which uses data from cancer patients included in the ONS Longitudinal Study to assess the evidence on health inequalities and cancer outcomes.

The NHS has set out a plan for healthcare over the next decade that specifically aims to reduce inequalities. The research that this plan is based on uses area-level statistics. In other words, the UK is split into small areas about the size of a single postcode, and each area is given a score according to a variety of measures, such as how many people in the area are unemployed or on income benefits. These scores are used to identify the more deprived areas of the country that might be in greater need of healthcare resources.

This system is convenient and widely used, but by design it is a simplification of reality. Actually, communities tend to be a mix of people from all types of occupations, educational levels and income groups. So, what does the NHS’ plan mean for people who, for example, are unemployed or on a low income, but live in an area that is scored as being quite affluent overall? Will these people be overlooked by healthcare policy that is focussed only on less affluent areas? Or do these people experience health benefits from the overall affluence of the area they live in?

We set out to explore these questions in the context of cancer. Cancer is a major health issue in the UK, with a large proportion of NHS resources dedicated towards it. Around 350 people die of cancer every day in the UK. Strikingly, it has been estimated that as many as 1 in 10 cancer deaths in the first 5 years following diagnosis are due to health inequalities.

Our study used data from cancer patients included in the ONS Longitudinal Study to assess whether there is evidence for health inequalities in terms of cancer outcomes. We used census data to group patients according to their individual circumstances, including their type of occupation, the qualifications they held, and their estimated income. We used statistical models to determine if there were differences in cancer outcomes across these occupation, education, and income groups. Our analysis therefore considered health inequalities in terms of differences among individual circumstances, as well as using the type of area they live in.

The results revealed that there are inequalities in cancer survival across different individual circumstances, in addition to the well-known inequalities across different areas. For example, women on low incomes tended to have lower survival from breast cancer than women on high incomes. In addition, for both men and women with colorectal cancer, people without many qualifications tended to experience poorer outcomes than those with a higher level of qualifications.

We expected to find that inequalities in cancer outcomes would be larger when estimated at an individual level than when estimated based on area-level scores. This is because area-level scores are a sort of average across all the people within each area. Because of this, we thought that area-level scores might only show a diluted measure of the real, underlying inequality. But we didn’t find this. In fact, inequalities were of a similar size when estimated at an individual-level and at an area-level. This suggests that a person’s individual circumstances are just as important as the overall affluence of the area they live in. It is likely that both approaches, individual- and area-level, are useful and might highlight different types of inequality, rather than one approach being more accurate than the other.

We also used our statistical models to address the question of whether the health inequalities we found across individual-level circumstances were the same across more and less affluent areas of the country. Is the experience of a cancer patient on a low income living in an affluent area the same as a cancer patient on the same income but living in a relatively poor area?

We found that the answer to this question depended on the type of cancer. For colorectal cancer, for instance, the answer was simply that differences across individual circumstances were the same, no matter where someone lived.

On the other hand, for breast and prostate cancers, inequalities between people with different types of occupation were much bigger in the poorest areas, and much smaller in the most affluent areas: a kind of amplification of inequalities in poorer areas. This means there is a sub-group of individuals who are both individually deprived and live in a poor area who experience the poorest cancer outcomes by quite some margin. These people may benefit somewhat from existing efforts to allocate NHS resources to areas of the country in greatest need. However, it’s likely that even with such policies in place, these cancer patients will still be at a disadvantage compared to more affluent individuals within their community. Additional healthcare policies that focus on individual-level inequalities could be used to target all possible sources of health inequalities.

This kind of innovative approach to healthcare policy could help to reduce inequalities more effectively. Of course, individualised health policies are often more complicated and expensive to carry out than broader, area-level approaches. Our research helps to pinpoint specific types of cancer and types of inequality that could be targeted in order to make policies more cost effective. Future research of this kind, using individual-level resources like the ONS-LS, will help to identify specific policies that could help to reduce inequalities in health overall.

The project team at the Inequalities in Cancer Outcomes Network are Fiona Ingleby, Aurelien Belot, and Laura Woods from the London School of Hygiene and Tropical Medicine, Iain Atherton from Edinburgh Napier University, Lucy Elliss-Brookes from Public Health England and Matthew Baker from NCRI Consumer Forum. The research is described in two papers:

• An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales BMC Public Health
•  Are deprivation-specific cancer survival patterns similar according to individual based and area-based measures? A cohort study of patients diagnosed with five malignancies in England and Wales, 2008–2016 BMJ Open
•  Project website 

Does social position affect our chances of contracting bowel cancer?

By Chris A Garrington, on 13 July 2022

We know cancer incidence is linked to socio-economic status, but that this differs according to types of cancer. In the second of three blogs on research using the ONS-LS to explore cancer and social status, Charlotte Sturley has examined diagnoses of bowel cancer, and found some clear evidence of a social effect.

Bowel cancer – also known as colorectal cancer – is the fourth most common cancer in the UK. Over 42,000 people are diagnosed with it in the UK each year so it is a major public health problem. 

Cancer incidence varies between different groups of people, and differences have been found based on gender, age, ethnicity and where people live.   

In England, for most cancer types, incidence is higher in the most deprived areas compared with the least deprived. The deprivation gap is largest for lung cancer, reflecting the fact that more deprived groups are more likely to smoke. Conversely some cancer types, such as breast cancer in females and prostate cancer in males, are more common in the least deprived areas.

The association between colorectal cancer and deprivation is less clear, and findings from previous studies have been inconsistent. In the 1980s, affluence was associated with an increased risk of colon and rectal cancer in Europe. But more recently, evidence has emerged of links between this type of cancer and living in a deprived area.  

Understanding the causes

Given this apparent shift in the relationship between socio-economic deprivation and colorectal cancer, it is important for researchers to monitor recent data to see if the patterns are changing. We also need to understand the extent to which inequalities are associated with both individual and area-level factors to better target their underlying causes.

Most research on inequalities in cancer incidence has focussed on indicators of deprivation at area level, largely because cancer registries do not collect data on indicators of socio-economic position, such as the patient’s level of education or occupation.

Using Census Data to dig deeper

The Office for National Statistics Longitudinal Study (ONS LS) offers the opportunity to investigate variations in cancer incidence using information gathered in the census on individuals’ socioeconomic positions. My study used measures of educational attainment, occupational social class and housing tenure, along with an area-based measure of deprivation called the Townsend deprivation score. 

My sample were LS members who were present at the 2001 Census and were aged 50 years or over, as incidence of colorectal cancer is very low among people aged under 50. 

Among the study sample of 178,116 individuals present at the 2001 census, there were 4,418 cases of colorectal cancer recorded by the end of 2015. Because the ONS LS links census responses to cancer diagnoses, we could measure the average length of time between the 2001 census and the diagnosis.

Results

The study found evidence of socio-economic inequalities in colorectal cancer incidence and that these differences varied by indicator of socio-economic position. LS members with a degree were less likely to have a colorectal cancer diagnoses compared to those without a degree, after accounting for differences by age, sex, ethnicity and area deprivation. A statistically significant association was also observed between housing tenure and colorectal cancer incidence, but only for those in social rented housing, who were at an increased risk of colorectal cancer compared to owner-occupiers.

Those employed in manual occupations were more likely to have a colorectal cancer diagnosis, compared to those in non-manual occupations – however this association was not statistically significant when adjusted for other variables. There was no statistically significant difference in colorectal cancer risk among study members in private rented accommodation compared to those in owner-occupied housing. No significant variation in colorectal cancer incidence was found by the level of area deprivation.

So, we can say individual measures of socio-economic position based on educational attainment and housing tenure are associated with colorectal cancer. My finding that there is not a link with area-level deprivation differs from other recent research which reported an emerging association between this type of cancer and deprivation, measured at the area-level. But these other studies used a different measure of deprivation which means comparisons are more difficult. The longitudinal nature of the LS data and the long-follow up period enabled time-to-event analysis to be employed in my study, whereas previous studies have tended to be more of a snapshot.

Not all individuals living in deprived areas will experience the same level of deprivation, and that could explain why I did not find area effects even though I did find individual ones.

Risk factors

One explanation for an association between colorectal incidence and socio-economic position could be different levels of exposure to risk factors such as poor diet or smoking. There is strong evidence to link socio-economic disadvantage with such behaviours.

My study highlights the complexity of the relationship between socio-economic circumstances and health outcomes and the need to investigate socio-economic inequalities by a range of different indicators in order to implement targeted policy interventions to reduce cancer incidence.

Future work

An interesting next step using the LS would be to investigate if and how change in individual socio-economic position and area deprivation over a person’s lifetime might influence their risk of having a colorectal cancer diagnosis. Linking the LS to data from the bowel cancer screening programme to investigate the impact of screening on colorectal cancer incidence and socioeconomic inequalities would also provide valuable insight.

Further information

Charlotte Sturley, who carried out this study as part of her PhD research, presented the work at the 19^th International Medical Geography Symposium 2022, which is being held at the Royal College of Surgeons of Edinburgh from 19^th-24^th June

Her presentation is available here: (PDF) Contrasting socio-economic influences on colorectal cancer incidence and survival (researchgate.net)

Read the full paper