Ethnic Minorities Needs Assessment for Stoke-On-Trent

ETHNIC MINORITIES NEEDS ASSESSMENT FOR STOKE-ON-TRENT

Public Health Department

Stoke-on-Trent City Council

January 2015

Report author

Paul Trinder Senior Epidemiologist Public Health Department Stoke-on-Trent City Council First Floor Civic Centre Glebe Street Stoke-on-Trent Staffs ST4 1HH

Email: [email protected]

Contents Page

Executive summary v

1 Introduction 1

2 Scope of the needs assessment 1

3 Demography 2

3.1 Population 2 3.2 Changes in population 3 3.3 Births 4 3.4 Age and sex 4 3.5 Geographical location 6 3.6 Time in the UK 9 3.7 Religion 10 3.8 Asylum seekers 11 3.9 Demography summary 11

4 Socioeconomic characteristics 11

4.1 Socioeconomic status 11 4.2 Industry 12 4.3 Socioeconomic summary 13

5 Social determinants of health 14

5.1 Employment 14 5.2 Housing 15 5.3 Education 17 5.4 Social determinants of health summary 18

6 Health outcomes 18

6.1 General health 19 6.2 Long-term health problems 19 6.3 Emergency hospital admissions 20 6.4 HIV 21 6.5 Smoking 22 6.6 4 week smoking quitters 23 6.7 Obesity 24 6.8 Physical activity 26 6.9 Health outcomes summary 26

7 Access to general practice 27

iii

Page

8 Conclusion 28

Appendices 30

References 46

Executive summary

According to the former Commission for Racial Equality, anyone who would tick a box other than ‘White British’ in response to an ethnicity question on a census form could be said to belong to an ethnic minority. On this basis, there were an estimated 33,786 people from ethnic minority groups in Stoke-on-Trent in 2011 (13.6% of the total population, compared with 20.2% in England).

Health and health outcomes are known to vary by ethnic status. For instance, compared with the general population, the Health Survey for England found that: the prevalence of angina and heart attack was highest in Pakistani men and Indian men and women; doctor diagnosed diabetes was significantly higher in Black Caribbean, Indian, Pakistani and Bangladeshi men and women; Black Caribbean and Irish men had the highest prevalence of obesity; Bangladeshi and Pakistani men and women and Black Caribbean women were more likely to report bad or very bad health; Pakistani women and Bangladeshi men were more likely to report a limiting longstanding illness.

Alongside differences in health status, ethnic minorities may potentially face additional difficulties in accessing appropriate, timely and effective health care services. Language and cultural barriers, lifestyle differences, potential discrimination, and poorly delivered health care can further compound the poorer health status of ethnic minorities.

Scope of the needs assessment

The aim of this needs assessment is to pull together and explore in detail the demographic, geographic, and health and social care needs of ethnic minority populations in Stoke-on- Trent. Five main areas are explored:

• demography • socioeconomic characteristics • social determinants of health • health outcomes • access to general practice

Main findings

Compared with the White British population, the Non White British population of Stoke-on- Trent tended to be younger (with a greater proportion of people aged under 40). Between the 2001 and 2011 Census, the number of people from ethnic minorities increased in the city from 15,452 to 33,786.

Across a range of health and lifestyle indicators, outcomes for ethnic minorities in Stoke-on- Trent were favourable. However, we know from other sources that this is not always the case, and evidence presented in this report has shown differences in outcomes in regards to emergency hospital admissions, HIV, and excess weight among schoolchildren.

1 Introduction

According to the former Commission for Racial Equality (now replaced by the Equality and Human Rights Commission (EHRC)), anyone who would tick a box other than ‘White British’ in response to an ethnicity question on a census form could be said to belong to an ethnic minority [Donaldson and Scally 2009]. On this basis, 20.2% of the population of England (around 10.7 million people) were from ethnic minorities according to the 2011 Census. The five largest ethnic minority groups were: Other White (4.6%), followed by Indians (2.6%), those of Mixed ethnic backgrounds (2.3%), Pakistanis (2.1%), and Black Africans (1.8%).

2 Scope of the needs assessment

The purpose of a health needs assessment is to examine the health of a particular population and to target resources towards improving the health of those most at risk or in need. Locally, information around the health and social care needs of ethnic minorities is patchy. The Joint Strategic Needs Assessment for the city routinely considers variations by ethnicity for a limited number of issues (such as school attainment, provision of carers), alongside other demographic factors such as age, sex and social class. Beyond this however, information is somewhat limited.

• demography • socioeconomic characteristics • social determinants of health • health outcomes • access to general practice

For the purpose of this needs assessment (and following the EHRC recommendation), anyone other than ‘White British’ is defined as an ethnic minority.

3 Demography

3.1 Population

The most up-to-date source available to enable us to look at the demography of ethnic minorities is the 2011 Census. Based on the Census, there were an estimated 33,786 people from ethnic minority groups in Stoke-on-Trent in 2011 (13.6% of the total population, compared with 20.2% in England). The largest ethnic minority groups locally were Pakistanis (4.2%), followed by White Other (which included White Irish, White Gypsy or Irish Traveller, and Other White, 2.2%), Mixed (1.8%), Asian Other (1.4%), and then Black Africans (1.0%).1 Compared with England, there was a significantly higher percentage of Pakistanis locally, whilst, in contrast, there was a significantly lower percentage of White Other, Mixed, Asian Other and Black Africans (figure 1).

Figure 1 Ethnicity by 2011 Census

White British White Other Mixed Indian Pakistani Bangladeshi % Asian Other Black African Black Caribbean Black Other Other

Stoke-on-Trent

England

Source: Office for National Statistics 2013

Further information on the ethnic status of people in Stoke-on-Trent (based on country of birth), shows that 4.4% (10,897 people) were born in the Middle East and Asia, 2.2% (5,405 people) were born in Other European countries, 1.1% (2,805 people) were born in Africa, whilst 0.3% (731 people) were born in the Americas and the Caribbean (table 1).

1 See Appendix 1 for more information

Table 1 Ethnicity by country of birth in Stoke-on-Trent in 2011 Country White Mixed Asian Black Other Total % Europe 214,439 3,822 8,607 1,152 274 228,294 91.7 Ireland 529 9 11 17 5 571 0.2 Other Europe 4,684 174 204 137 206 5,405 2.2 Africa 358 169 163 1,931 184 2,805 1.1 ME/Asia 312 241 9,419 73 852 10,897 4.4 Am/Caribbean 249 56 15 378 33 731 0.3 Oceania 141 20 23 53 68 305 0.1 Total 220,712 4,491 18,442 3,741 1,622 249,008 100 Source: Office for National Statistics 2013

3.2 Changes in population

In 2001, there were 15,452 people from ethnic minority groups in Stoke-on-Trent, which was equivalent to 6.4% of the total population. By the time of the 2011 Census, this number had increased to 33,786 (13.6% of the total population). During this same period in England, the percentage of people from ethnic minorities increased from 13.0% to 20.2%.

Within Stoke-on-Trent, there was an increase in all ethnic minorities between the 2001 and 2011 Census, with the two largest increases being among Black African (an increase from 259 to 2,536), and Asian Other (an increase from 449 to 3,363). Nationally, the two largest increases were among Asian Other and Black Other (figure 2).2

Figure 2 Changes in ethnicity between 2001 and 2011 Census 1,000

800

600

400

% change % Stoke England 200

-200

Ethnicity Source: Office for National Statistics 2013

2 See Appendix 2 for more information

3.3 Births

Births have increased significantly in England over the past 10 years, and the picture is similar in Stoke-on-Trent, where the numbers of births have risen from 2,741 in 2001 to 3,809 in 2011. During this period, the proportion of births to mothers in Stoke-on-Trent who were born outside the UK increased from 12.0% in 2001 to 18.8% in 2011 [Newall 2013].

The profile of non-UK born mothers has changed significantly during this 10 year period. The proportion of births to mothers from the Middle East and Asia remains the largest locally, however, there have been significant increases in the numbers of births to women from the New European Union Countries, from 0.1% in 2001 to 3.0% in 2011. The rise in births to African women is also evident, changing from 0.4% in 2001 to 2.5% in 2011 [Newall 2013].

Local maternity data captures some of these recent changes (table 2). For instance, the percentage of births among White British mothers fell from 83.8% in 2007 to 75.2% in 2013.

Table 2 Percentage of births by ethnicity in Stoke-on-Trent between 2007 and 2013 Ethnic group 2007 2008 2009 2010 2011 2012 2013 White British 83.8 83.7 83.5 81.9 80.8 77.4 75.2 White Other 0.7 0.9 1.0 2.1 2.4 2.9 3.7 Mixed 1.1 1.8 1.5 1.6 2.0 2.0 1.8 Indian 0.6 0.7 0.6 0.9 1.1 0.8 1.5 Pakistani 8.9 7.5 8.0 7.1 7.4 8.5 10.0 Bangladeshi 0.8 0.7 0.6 0.6 0.4 0.9 0.5 Asian Other 1.5 1.7 1.7 1.8 2.0 2.4 1.8 Black 1.5 1.4 1.5 1.8 1.7 2.0 1.9 Chinese 0.5 0.8 0.7 0.7 0.6 0.6 0.4 Other 0.7 0.9 1.1 1.5 1.5 2.5 3.2 Total 100 100 100 100 100 100 100 Source: University Hospital of North Staffordshire 2014

These changes are reflected in the population make-up of local schools. Between January 2004 and January 2013, for instance, the number of pupils from Black ethnic minorities (attending all schools) increased from 259 to 763, mixed pupils increased from 617 to 1,383, and Asian pupils increased from 2,875 to 4,788 (overall, the number of White pupils fell from 33,365 to 28,065. If these general and more specific trends continue, the ethnic minority profile of Stoke-on-Trent is likely to undergo further changes over the coming years.

3.4 Age and sex

Variations in the age and sex structure of ethnic minorities to some extent reflect the overall differences which occur in fertility, migration and deaths. Figures 3 and 4 highlight how the age and sex structure of the Non White British population in Stoke-on-Trent varies from the White British population.3

3 See Appendix 3 for more information

Figure 3 Percentage of White British and Non White British males in Stoke-on-Trent by age group in 2011

85+

80-84

75-79

70-74

65-69

60-64

55-59

50-54

45-49 Non White British 40-44 White British Age group Age 35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

-10 -5 0 5 10 15 % Source: Office for National Statistics 2013

Figure 4 Percentage of White British and Non White British females in Stoke-on- Trent by age group in 2011

85+

80-84

75-79

70-74

65-69

60-64

55-59

50-54

45-49 Non White British 40-44 White British Age group Age 35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

-10 -5 0 5 10 15 % Source: Office for National Statistics 2013

Compared with the White British population, the Non White British population of Stoke-on- Trent tended to be younger (with a greater proportion of people aged under 40), along with a smaller proportion of people aged 50 and over (which broadly reflects the national picture).

Recognising and appreciating these differences can help us understand how local health and social care services may need to be tailored towards particular age groups, both in regard to the existing and future provision of services.

3.5 Geographical location

As mentioned earlier, 13.6% of the population of Stoke-on-Trent (33,786 people) were classified as Non White British. Among the 37 wards of the city, the percentage of people who were Non White British ranged from 3.3% in the ward of Meir Hay to 49.3% in the ward of Hanley Park and Shelton (map 1).4-5 Along with the ward of Lightwood North and Normacot (36.3%) in the south, the wards with the largest concentration of Non White British people were located in the west of the city, particularly around the three wards of Hanley Park and Shelton (49.3%), Etruria and Hanley (49.0%), and Moorcroft (48.2%).

Between 2001 and 2011, the proportion of the total population in these four wards that were either Mixed, Asian, Other or from Black ethnic minorities nearly doubled (from 21.8% to 42.1%).

Alongside the overall ward variation in regards to the Non White British population, there was also considerable variation among the specific ethnic minority groups.6 For example, among Pakistanis (the largest ethnic minority group in Stoke-on-Trent), the largest proportions were located in the two wards of Lightwood North and Normacot (27.5%) and Moorcroft (22.4%); among White Other, the two largest concentrations were in the wards of Burslem Central (6.6%) and Etruria and Hanley (6.4%); whilst among Indians, the largest concentration was in the ward of Hanley Park and Shelton (10.0%).

Three of the four wards with the largest concentrations of Non White British people (Hanley Park and Shelton, Etruria and Hanley, and Moorcroft) were also located among the most deprived areas of the city (map 2). The one exception to this was the ward of Lightwood North and Normacot, which, whilst containing an area of relatively high deprivation, also contained a large area classified as being among the least deprived in the city.

4 See appendix 4 for more information

5 See appendix 5 for a list of ward numbers

6 See appendix 6 for more information

Map 1 Percentage of Non White British population by wards in Stoke-on-Trent in 2011

Map 2 2010 Index of Multiple Deprivation in Stoke-on-Trent

3.6 Time in the UK

Compared with England, a significantly higher proportion of the city’s population were born in the UK (91.7% versus 86.2%), which means, conversely, a smaller proportion being born outside of the UK (table 3). However, if we look at just those born outside the UK, another picture emerges. For instance, 61.5% of those born outside the UK have arrived in Stoke- on-Trent since 2001 compared with 50.2% in England. Similarly, 25.0% of people born outside the UK arrived in the city before 1991 (compared with 33.2% in England). Therefore, as a proportion of those born outside the UK, a larger proportion have moved to Stoke-on- Trent in the last 10 years compared with England, and more people have arrived during this period compared with the preceding 50 years.

Table 3 Year of arrival in the UK (2011 Census) Stoke-on-Trent England Year of arrival Number % Number % Born in the UK 228,294 91.7 45,675,317 86.2 Arrived before 1991 5,188 2.1 2,435,722 4.6 Arrived 1991-2000 2,778 1.1 1,218,499 2.3 Arrived 2001-2003 3,119 1.3 769,202 1.5 Arrived 2004-2006 4,192 1.7 1,126,327 2.1 Arrived 2007-2009 3,729 1.5 1,193,078 2.3 Arrived 2010-2011 1,708 0.7 594,311 1.1 Total 249,008 100 53,012,456 100 Source: Office for National Statistics 2013

Alongside year of arrival, the 2011 Census provides information on age of arrival. The age profile of those who arrived in the UK from elsewhere has a number of important implications for the provision of both health and social care services.

Looking at those people born outside the UK, the majority of people in Stoke-on-Trent (and England) were aged between 16 and 44 years when they arrived in the county (table 4). A relatively small proportion was aged 45 and over.

Table 4 Age of arrival among people born outside the UK (2011 Census) Stoke-on-Trent England Age of arrival Number % Number % 0-4 2,611 12.6 918,145 12.5 5-15 3,552 17.1 1,180,831 16.1 16-24 7,119 34.4 2,385,997 32.5 25-44 6,728 32.5 2,519,516 34.3 45+ 704 3.4 332,650 4.5 Total 20,714 100 7,337,139 100 Source: Office for National Statistics 2013

Another dimension of time in the UK is length of residence (table 5). Among those born outside the UK, people living in Stoke-on-Trent were significantly more likely to have lived here for less than 10 years compared with people in England (60.3% versus 49.3%).

Table 5 Length of residence in the UK Stoke-on-Trent England Residence in UK Number % Number % Less than 2 years 2,523 12.2 928,025 12.6 2-5 years 4,062 19.6 1,170,307 16.0 5-10 years 5,899 28.5 1,521,867 20.7 More than 10 years 8,230 39.7 3,716,940 50.7 Total 20,714 100 7,337,139 100 Source: Office for National Statistics 2013

In summary, the majority of people born outside the UK have arrived in Stoke-on-Trent since 2001, have lived here for less than 10 years, and were predominantly aged between 16 and 44 years on arrival into the country.

3.7 Religion

Religion can impact people’s health in many ways. Examples include differing attitudes to risk and variations in lifestyle behaviours. However, in trying to examine the impact of religion on health and health outcomes, there are many confounding factors, such as ethnicity, culture and socioeconomic status. Many cultural traits are shared by people from different religious groups (for example, the Asian diet), whilst many religions include people from different ethnic groups (for example, Christianity). Notwithstanding these differences, however, the religion of local people (by ethnicity) is shown in table 6.

Among people who were White, Mixed or from a Black ethnic minority, the main recorded religion was Christian (65.5%, 43.4% and 73.4% respectively). Among Asians (66.6%) and Other (61.6%), the main religion was Islam.

Table 6 Religious belief (percentage) by ethnicity in Stoke-on-Trent in 2011 Religion White Mixed Asian Black Other Total Christian 65.5 43.4 10.7 73.4 21.1 60.9 Buddhist 0.1 0.5 2.8 0.1 1.6 0.3 Hindu 0.0 0.3 7.2 0.2 0.4 0.6 Jewish 0.0 0.0 0.0 0.0 0.1 0.0 Muslim 0.2 15.7 66.6 12.1 61.6 6.0 Sikh 0.0 0.2 2.7 0.3 2.5 0.2 Other 0.4 0.4 0.2 0.2 0.2 0.4 No religion 27.2 32.6 5.0 7.7 7.2 25.2 Not stated 6.5 6.9 4.8 6.0 5.2 6.4 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

3.8 Asylum seekers

Within the broader context of ethnic minorities, asylum seekers may be viewed as a discrete subset. An asylum seeker is someone who is fleeing persecution from their own country and has sought legal protection in another country. As such, asylum seekers often have distinct needs, and, in some cases, very complex needs.

Asylum seekers have been given accommodation by the UK Border Agency in the city since 2000. The numbers of people claiming asylum and requiring support whilst their asylum application is processed has fallen dramatically in the city from 1,001 (at the end of the first quarter of 2004) to 448 (at the end of the fourth quarter of 2013). The total number of asylum seekers has remained relatively stable during the last two years [Home Office 2014].

3.9 Demography summary

Based on the 2011 Census, 13.6% of the total population of Stoke-on-Trent (33,786 people) were from ethnic minority groups (compared with 20.2% in England). The largest ethnic minority group locally were Pakistani (4.2%). Between 2001 and 2011, the numbers of people from ethnic minority groups more than doubled from 15,452 to 33,786. The two largest increases were among Black Other and Asian Other.

The largest concentrations of Non White British people were located in the west of the city, around the wards of Hanley Park and Shelton, Etruria and Hanley, and Moorcroft.

Compared with the White British population, the Non White British population of the city had a greater proportion of people aged under 40, and a smaller proportion aged 50 and over. The majority of people born outside the UK have arrived in Stoke-on-Trent since 2001, and were predominantly aged between 16 and 44 years on arrival into the country.

4 Socioeconomic characteristics

This next section of the needs assessment examines the socioeconomic characteristics of ethnic minorities, and explores two areas: socioeconomic status and type of industry employed in.

4.1 Socioeconomic status

Socioeconomic status reflects a person’s social and economic position in society. Whilst there are a number of different approaches to looking at socioeconomic status, one of the main approaches is the National Statistics Socioeconomic Classification system (NS-SEC). NS-SEC is an occupational based measure, and examines employment relations and conditions of occupations [Rose and O’Reilly 1998].

Asians (14.1%) had the smallest proportion of people employed in higher/lower managerial/professional occupations compared with other ethnic minorities (figure 5). However, they had the highest proportion of people who were small employers (13.6%). People from Mixed (29.0%) and Black ethnic minorities (27.1%) were more likely to be employed in semi-routine/routine occupations, whilst in regards to people who had never worked/long term unemployed, Other (23.6%) and Asians (20.2%) were highest.7

Figure 5 Socioeconomic classification (16 and over) by ethnicity in Stoke-on-Trent in 2011 100%

90%

80%

70%

Not classified 60% Never worked/LT unemployed Routine occupations 50% Semi-routine occupations Lower supervisory/technical Small employers 40% Intermediate occupations Lower managerial/professional 30% Higher managerial/professional

20%

10%

0% White Mixed Asian Black Other Total Ethnicity Source: Office for National Statistics 2013

4.2 Industry

Within Stoke-on-Trent, the three main types of industry people were employed in were: the wholesale and retail trade (19.7%), health and social work activities (14.6%), and manufacturing (13.6%, figure 6). People from Mixed and Black ethnic minorities were most likely to be employed in these three industries, although people from Black ethnic minorities were most likely to be employed in health and social work activities (27.3%). Along with wholesale (18.4%) and health (17.0%), the third most common type of industry Asians were employed in was accommodation and food service (16.1%).8

7 See appendix 7 for more information

8 See appendix 8 for more information

Figure 6 Type of industry (16 and over) by ethnicity in Stoke-on-Trent in 2011 100%

90%

80% O N 70% M L 60% K J 50% I H G 40% F E 30% D C 20% B A

10%

0% White Mixed Asian Black Other Total Ethnicity Source: Office for National Statistics 2013

A Agriculture/energy I Real estate B Manufacturing J Professional/scientific C Construction K Administrative/support service D Wholesale/retail L Public administration E Transport/storage M Education F Accommodation/food service N Health/social work G Information/communication O Other H Financial/insurance

4.3 Socioeconomic summary

Asians had the highest proportion of people who were small employers (13.6%), whilst Mixed (29.0%) and Black ethnic minorities (27.1%) people were more likely to be employed in semi-routine/routine occupations.

People from Mixed and Black ethnic minorities were most likely to be employed in the wholesale and retail trade, health and social work activities, and manufacturing. Along with these two industries, accommodation and food services was the third most common type of industry Asians were employed in.

5 Social determinants of health

Health is determined by many factors. In helping to understand the impact of these different factors on health, one of the most useful and widely used approaches is the Social Model of Health [Dahlgren and Whitehead 1991]. In the model (figure 7), it is broadly proposed that a person’s health is determined by many competing factors, which, alongside hereditary factors, include: lifestyle choices, the social and community networks in which people live and interact, living and working conditions, along with the wider economic, cultural and environmental conditions prevalent in society. The model emphasises interactions: individual lifestyles are embedded in social and community networks, and in living and working conditions, which in turn are related to the wider cultural and socioeconomic environment.

Figure 7 Social determinants of health

This next section of the needs assessment examines some of these social determinants of health, and explores three areas: employment, housing, and education.

5.1 Employment

Among the main ethnic minorities in Stoke-on-Trent, Asians (33.9%) had the smallest proportion of people employed as full-time (or part-time) employees, whilst they were the group most likely to be self-employed (12.4%, figure 8). Black ethnic minorities had the highest proportion of people unemployed (11.5%), Asians had the highest proportion of people looking after the home or family (12.7%), whilst the percentage of people who were classified as long-term sick or disabled was highest in Mixed ethnic minorities (5.8%).9

9 See appendix 9 for more information

Figure 8 Economic activity (16 and over) by ethnicity in Stoke-on-Trent in 2011 100%

90%

80%

70% L K

60% J I H 50% G F 40% E D

30% C B A 20%

10%

0% White Mixed Asian Black Other Total Ethnicity Source: Office for National Statistics 2013

Economically active Economically inactive A Employee: part-time H Retired B Employee: full-time I Student (including full-time student) C Self-employed: part-time J Looking after home or family D Self-employed: full-time K Long-term sick or disabled E Full-time student L Other F Unemployed (excluding full time students) G Unemployed (full time students)

5.2 Housing

In regards to housing tenure, Asians were most likely to either own their property outright (19.5%) or to own their property with a mortgage (37.0%, figure 9). Nearly half of people (46.7%) from Black ethnic minorities were living in socially rented accommodation (rented from the local authority or other socially rented), whilst Other ethnic minorities had the highest proportion of people living in privately rented accommodation (38.2%).10

Compared with the majority White population, all ethnic minority groups had one fewer room than required for their household size, which is indicative of overcrowding (figure 10). For instance, 17.4% of Asians had one fewer room than required (compared with 5.2% of the White population). In regards to surplus rooms, Black ethnic minorities (25.7%) were least likely to have two or more surplus rooms compared with other ethnic minorities.11

10 See appendix 10 for more information

11 See appendix 11 for more information

Figure 9 Housing tenure by ethnicity in Stoke-on-Trent in 2011 100%

90%

80%

70%

60% Other private rented Rented privately 50% Other social rented Rented from LA 40% Owned with mortgage Owned outright 30%

20%

10%

0% White Mixed Asian Black Other Total Ethnicity Source: Office for National Statistics 2013

Figure 10 Household overcrowding by ethnicity in Stoke-on-Trent in 2011 100%

90%

80%

70%

60%

-1 or less 50% 0 +1 40% +2 or more

30%

20%

10%

0% White Mixed Asian Black Other Total Ethnicity Source: Office for National Statistics 2014

5.3 Education

Educational attainment is explored here at three points: Key Stage 2 (10-11 year olds), Key Stage 4 (15-16 year olds), and qualifications among adults aged 16 and over.

In regards to Key Stage 2 performance, the percentage of pupils in 2013 achieving Level 4+ (expected level of attainment in Reading, Writing and Mathematics) was lowest among White Other pupils (52.9%, table 7). Asian pupils (68.1%) performed best among the different ethnic minorities. The greatest improvement in performance between 2008 and 2013 was among pupils from Black ethnic minorities (a relative increase of 24.2%).

Table 7 Key Stage 2 pupils achieving Level 4+ (in Reading, Writing and Mathematics) by ethnicity in schools in Stoke-on-Trent in 2013 2008 2013 Ethnic group Number Total % Number Total % White British 1,650 2,412 68.4 1,372 1,852 74.1 White Other 22 46 47.8 28 53 52.9 Mixed 49 77 63.6 51 80 63.7 Asian 152 264 57.6 258 379 68.1 Black 15 32 46.9 32 55 58.2 Other 14 23 60.9 18 30 60.0 Total 1,902 2,854 66.6 1,759 2,449 71.8 Source: Stoke-on-Trent City Council 2014

As children move through the education system, the performance of White Other pupils remains poorest (table 8). In 2012, for instance, only 35.5% of White Other pupils achieved 5+ A*-C GCSEs (including English and Mathematics), compared with a city wide average of 51.9%. Having said this, the greatest improvement in performance between 2008 and 2012 was among White Other pupils (a relative increase of 308.1%).

Table 8 Key Stage 4 pupils achieving 5+ A*-C GCSEs (including English and Mathematics) by ethnicity in schools in Stoke-on-Trent in 2012 2008 2012 Ethnic group Number Total % Number Total % White British 936 2,494 37.5 1,092 2,077 52.6 White Other 2 23 8.7 11 31 35.5 Mixed 16 55 29.1 25 50 50.0 Asian 72 219 32.9 102 210 48.6 Black 10 25 40.0 17 37 45.9 Other 7 8 87.5 7 13 53.8 Total 1,043 2,824 36.9 1,254 2,418 51.9 Source: Stoke-on-Trent City Council 2014

Based on the 2011 Census, Asians (aged 16 and over) in Stoke-on-Trent were most likely to have no formal educational qualifications (28.7%, figure 11). Compared with the White population, apprenticeships were relatively low among ethnic minorities, whilst people from Black ethnic minorities (27.7%) and Asians (25.3%) were most likely to have a degree or

higher degree (although locally, figures for Asians and people from Black ethnic minorities were below the national average).12

Figure 11 Educational qualifications (16 and over) by ethnicity in Stoke-on-Trent in 2011 100%

90%

80%

70%

60% Other qualifications Level 4 and above 50% Level 3 Apprenticeship Level 2 40% Level 1 No qualifications 30%

20%

10%

0% White Mixed Asian Black Other

Ethnicity Source: Office for National Statistics 2013

5.4 Social determinants of health summary

Asians (12.4%) were most likely to be self-employed, and to be looking after the home or family (12.7%), Black ethnic minorities had the highest levels of unemployment (11.5%), whilst Mixed ethnic minorities were most likely to be classified as long-term sick or disabled (5.8%).

Asians were most likely to own their property (56.4%), nearly half of people from Black ethnic minorities (46.7%) were living in socially rented accommodation, whilst Other ethnic minorities had the highest proportion (38.2%) of people living in privately rented accommodation. In terms of overcrowding, all ethnic minority groups were more likely to have less space than required (compared with the White population).

White Other pupils performed poorest at school (at Key Stage 2 and 4), whilst among adults (aged 16 and over), Asians were most likely to have no formal qualifications (28.7%), whilst people from Black ethnic minorities (27.7%) were most likely to have a degree (or higher degree).

12 See appendix 12 for more information

6 Health outcomes

Health is known to vary by ethnicity. In this next section of the needs assessment, some key health outcomes and lifestyle indicators are examined.

6.1 General health

Compared with the majority White population of Stoke-on-Trent, all ethnic minorities had a higher percentage of very good or good health according to the 2011 Census (figure 12). These percentages were comparable to national averages. Among ethnic minorities with bad or very bad health, the highest percentage was among Other minorities (5.7%).13

Figure 12 General health by ethnicity in Stoke-on-Trent in 2011 100%

90%

80%

70%

60%

50% Bad or very bad health Fair health Very good or good health 40%

30%

20%

10%

0% White Mixed Asian Black Other Total Ethnicity Source: Office for National Statistics 2013

6.2 Long-term health problems

In regards to another dimension of general health – long-term health problems or disability – the day-to-day activities of all ethnic minorities in Stoke-on-Trent (based on the 2011 Census) were less likely to be ‘limited a lot’ compared with the majority White population (figure 13). These percentages, once more, were comparable to national averages.14

13 See appendix 13 for more information

14 See appendix 14 for more information

Figure 13 Long-term health problem or disability by ethnicity in Stoke-on-Trent in 2011 100%

90%

80%

70%

60%

50% Not limited Limited a little

40% Limited a lot

30%

20%

10%

0% White Mixed Asian Black Other Total

Ethnicity Source: Office for National Statistics 2013

6.3 Emergency hospital admissions

Other minorities (52.8%), Black ethnic minorities (51.2%) and Asians (49.7%) were significantly more likely to have an emergency admission to hospital in 2011/2012 compared with other ethnic minorities (including the White population) in Stoke-on-Trent (figure 14). Compared with England, emergency admissions were higher across all ethnic minorities locally.

Figure 14 Emergency admissions to hospital (all ages) as a percentage of total hospital admissions by ethnicity in 2011/2012 60

% 30 Stoke England

0 White Mixed Asian Black Chinese Other Total Ethnicity Source: Public Health England 2013

6.4 HIV

HIV is associated with serious morbidity, high costs of treatment and care, significant mortality and a high number of potential years of life lost. Thousands of people are diagnosed with HIV each year, and the infection is still frequently regarded as stigmatising and has a prolonged ‘silent’ period during which it often remains undiagnosed. Anti-retroviral therapy has resulted in substantial reductions in AIDS incidence and deaths in the UK. People diagnosed promptly with HIV can expect near normal life expectancy. Challenges remain however, with high rates of late HIV diagnoses and an ageing population [Public Health England 2014a].

There were 296 people accessing HIV related care (or living with HIV) in Stoke-on-Trent in 2012 compared with 71 in 2002. Of all those with HIV in 2012, 155 people (52.4%) were Non White (figure 15). Just under half (45.3%) of all people with HIV in Stoke-on-Trent were Black African. This relatively high percentage of Black African people is likely to be a reflection of HIV infection prior to immigration to this country.

There were 20 new cases of HIV in Stoke-on-Trent in 2012 compared with 22 in 2002. Just under half (45.0%) of the new cases in 2012 were among Non White people.

Figure 15 People with HIV accessing care by ethnicity in Stoke-on-Trent in 2012 60

% 30 Males Females All

0 White Black African Other

Ethnicity Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID) 2014

6.5 Smoking

Smoking is the biggest single preventable cause of disease and premature death in the UK. One in two regular smokers are killed by tobacco, with half dying before the age of 70, and losing an average of 21 years of life. Smoking is a major risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease and heart disease. It is also associated with cancers in many other organs, such as the mouth, throat and stomach [Public Health England 2014b].

In a local Lifestyle Survey undertaken in 2013, 27.0% of adults (aged 18 and over) were estimated to be current smokers in the city (figure 16). This compares with a national estimate of 19.5% (for 2012). Among the different ethnic minorities within the city, 14.3% of Asians and 3.2% of people from Black ethnic minorities were current smokers (due to small numbers among Mixed and Other ethnic minorities, estimates are not reliable).

Figure 16 Smoking status of adults (18 and over) by ethnicity in Stoke-on-Trent in 2013 100%

90%

80%

70%

60%

50% Non smoker Ex smoker Smoker 40%

30%

20%

10%

0% White Mixed Asian Black Other Total

Ethnicity Source: Stoke-on-Trent City Council 2013

6.6 4 week smoking quitters

Helping people to stop smoking remains at the forefront of saving lives and improving the health of smokers, as well as those exposed to the harmful effects of second hand smoke. Surveys suggest around two thirds of adult smokers would like to give up smoking, and around one quarter of adult smokers attempt to give up smoking each year. In helping people to stop smoking, the NHS Stop Smoking Service provides counselling and support to smokers wanting to quit [Public Health England 2014b].

The percentage of people (all ages) who had quit smoking at four weeks in Stoke-on-Trent in 2012/2013 was 58.5% (figure 17). Among the different ethnic minority groups in the city, the quit rate among Pakistani people (66.9%) was significantly higher than the White population (58.0%). At 50.0%, the four week quit rate was lowest among Mixed ethnic minorities (due to small numbers among Asian Other, Black ethnic minorities and Other, estimates are not reliable).

Figure 17 4 week smoking quitters (all ages) by ethnicity in Stoke-on-Trent in 2012/2013 100%

90%

80%

70%

60%

50% LTFU Not quit 40% Quit

30%

20%

10%

0% White British White Other Mixed Indian Pakistani Bangladeshi Asian Other Black Other Total

Ethnicity Source: Stoke-on-Trent City Council 2013

LTFU = lost to follow-up (information about people not recorded)

6.7 Obesity

People who are obese tend to have poorer health and often find themselves at increased risk of heart disease, high blood pressure, diabetes and certain types of cancers. Obesity has also been found to be associated with poverty and deprivation. One of the consequences of this is that obese people have a reduced life expectancy of around nine years compared with the general population [Public Health England 2014c].

Exploring obesity levels among different ethnic groups is not straightforward, due primarily to a lack of clarity and agreement around appropriate Body Mass Index (BMI) cuts offs for certain ethnic groups. This has led to difficulties in interpreting ethnicity based obesity data [World Health Organisation 2004]. For instance, (historical) data from the 2004 Health Survey for England found that, in spite of the established higher risk of diabetes and heart disease among Asians, average BMI levels were lower for Asians in England compared with the general population [Health and Social Care Information Centre 2005]. Asian males also had a much lower proportion of people who were obese (with a BMI over 30).

Recent guidelines from the National Institute for Health and Care Excellence [2013] have suggested lower BMI thresholds for ethnic minorities. Similarly, waist-hip ratio has been considered as an alternative or complimentary measure of risk [Yusuf et al 2005]. Based once again on national data from the 2004 Health Survey for England, Indian, Pakistani and

Irish men, along with Black Caribbean, Pakistani, Bangladeshi and Irish women had raised waist-hip ratios compared with the general population. Due to access issues and limitations with existing data, adult obesity data for ethnic minorities in Stoke-on-Trent is currently not available.

Through the National Child Measurement Programme (NCMP), we have a good picture and understanding of childhood obesity among ethnic minorities. Every year, as part of the NCMP (which started in 2006), children in Reception (aged 4-5 years) and Year 6 (10-11 years) have their height and weight measured during the school year.

In 2011/2012, 12.6% of Reception schoolchildren in Stoke-on-Trent were obese (figure 18). Compared with the general population, levels of obesity were highest among White Other (21.2%) and Mixed pupils (16.7%). Combining the categories of overweight and obese, White Other (39.4%) and Black ethnic minority pupils (35.7%) had the highest levels of excess weight compared with the general population (26.6%).

Figure 18 Prevalence of obesity in Reception schoolchildren by ethnicity in Stoke- on-Trent in 2011/2012 100%

90%

80%

70%

60%

Obese 50% Overweight Healthy Weight 40% Underweight

30%

20%

10%

0% White British White Other Mixed Asian Black Other Total

Ethnicity Source: Public Health England 2013

Among Year 6 schoolchildren in Stoke-on-Trent, there were no statistically significant differences between ethnic minorities (figure 19). There was a higher prevalence of excess weight among White Other pupils (46.2% compared with 38.9% in the general population), but due to small numbers (for many of the ethnic minority groups in both Reception and Year 6), the estimates of obesity and excess weight are not reliable.

Figure 19 Prevalence of obesity in Year 6 schoolchildren by ethnicity in Stoke-on- Trent in 2011/2012 100%

90%

80%

70%

60%

Obese 50% Overweight Healthy Weight 40% Underweight

30%

20%

10%

0% White British White Other Mixed Asian Black Other Total Ethnicity Source: Public Health England 2013

6.8 Physical activity

Being physically active and taking part in sport and recreation is one way through which people can try to avoid becoming overweight and obese, as well as increasing overall fitness levels, which is beneficial to health.

National estimates from the Active People Survey found that 48.6% of adults (aged 16 and over) from Black and minority ethnic groups in Stoke-on-Trent in 2010/2011 had not taken part in any sport during the previous week, compared with 56.8% of the general population [Sport England 2014]. The proportion of adults from Black and minority ethnic groups not participating in any sport (during the previous week) has fallen from 56.7% in 2005/2006 to its current lower level.

6.9 Health outcomes summary

All ethnic minorities in Stoke-on-Trent had a higher proportion of very good or good health compared with the majority White population (based on the 2011 Census), whilst day-to-day activities for all ethnic minorities were less likely to be ‘limited a lot’ compared with White people. Asians, Black ethnic minorities and Other were more likely to have an emergency admission to hospital in 2011/2012, whilst rates of HIV were highest among Black Africans, especially Black African women.

Across a range of lifestyles indicators in Stoke-on-Trent, ethnic minorities had lower rates of smoking (compared with the White population), whilst quit smoking rates at four weeks were highest among Pakistani people. Whilst local data for adult obesity was not available, childhood obesity data revealed that White Other pupils (in both Reception and Year 6) had the highest levels of excess weight. Adults (aged 16 and over) from Black and minority ethnic groups were less likely to be inactive (based on sport participation in the previous week) than the general population.

7 Access to general practice

Both the quality of services and the ease with which people access services have an impact on people’s health. To examine an aspect of this, information from the General Practice Patient Survey (GPPS) has been used [NHS England 2013].

The GPPS is designed to give patients the opportunity to comment on their experiences of their GP practice, and asks patients about a range of issues related to their local GP practice and other local NHS services. In total, around 2.6 million patients are invited to take part in the survey during the year.

Although based on small numbers, some general trends emerged from the 2013 GPPS in Stoke-on-Trent, including:

• compared with White British (15.4%), Other ethnic minorities (26.0%) and Pakistanis (21.9%) were more likely to find it ‘not very easy’ to get through to someone at the GP surgery on the phone

• Pakistanis (30.8%), White Other (29.7%) and Other ethnic minorities (26.8%) were less likely to be able to see their preferred GP ‘always or almost always’ compared with White British (43.3%)

• 53.8% of Indians were able to get an appointment to see or speak to someone compared with 72.9% of White British

• Pakistanis (51.5%), Other ethnic minorities (51.0%), White Other (40.4%) and Indians (50.0%) were less likely to ‘definitely’ have confidence and trust in their GP compared with White British (62.8%)

• these same four ethnic minorities were also less likely to ‘definitely’ have confidence and trust in their practice nurse

• 33.7% of Pakistanis and 34.3% of White Other reported their overall experience of their GP surgery as being ‘very good’ compared with 47.5% of White British

• 47.8% of White British people would ‘definitely’ recommend their GP surgery to someone who had just moved into the local area compared with 41.3% of Pakistanis 35.9% of White Other

8 Conclusion

Based on the 2011 Census, there were an estimated 33,786 people from ethnic minority groups in Stoke-on-Trent. This equates to 13.6% of the total population (compared with 20.2% in England). The largest ethnic minority group locally were Pakistanis (4.2% of the total population). There was considerable variation in the ethnic make-up of wards across the city, with the ethnic minority population ranging from 3.3% (of the total) in the ward of Meir Hay to 49.3% in Hanley Park and Shelton. The largest concentration of ethnic minorities was in the west of the city.

Compared with the White British population, the Non White British population of Stoke-on- Trent tended to be younger (with a greater proportion of people aged under 40). Within the different ethnic minorities, there was considerable variation among the different age groups. People from Mixed ethnic minorities were largely aged under 25, the majority of Asians were aged under 40, Black Caribbean’s were most likely to be aged 45-64, whilst White Other and Black Caribbean’s had the largest proportions of people aged 65 years and over. In the short term, the current health needs of different ethnic minorities will reflect these differing age profiles. In the medium to longer term, as the Asian population ages, for instance, there may well be an increase in diseases for which Asians are known to be at greater risk, such as diabetes and coronary heart disease.

Between the 2001 and 2011 Census, the number of people from ethnic minorities increased in the city from 15,452 to 33,786. This may well continue as a consequence of higher birth rates among the majority of ethnic minority groups. This, coupled with a higher proportion of women of child bearing age among ethnic minorities, could well result, over time, in higher fertility rates for the population of Stoke-on-Trent, a growth in the ethnic minority population, and a growth in the numbers of children and young people from ethnic minorities and the population as a whole. These potential changes need to be noted and considered in the future planning and provision of health and social care services, particularly maternity and children’s services. To fully meet both (the current) and future health and social care needs of ethnic minorities, these services will need to be delivered in a culturally sensitive way, which may well involve further engagement and consultation with minority groups.

At Key Stage 2 (10-11 year olds), performance among all ethnic minority schoolchildren was poorer compared with White British children, and this poorer performance was mirrored at Key Stage 4 (15-16 year olds) for all ethnic minorities (apart from Other). All ethnic minorities in the city were more likely to be receiving free school meals (in secondary schools) compared with White British children. All ethnic minorities in Stoke-on-Trent were more likely to be unemployed compared with their White counterparts. Black ethnic minorities had the highest levels of unemployment, whilst Mixed and Black ethnic minorities were more likely to be employed in semi-routine/routine occupations. Education and employment are key determinants of health, and policies and interventions aimed at improving the performance of all schoolchildren in Stoke-on-Trent, not least those from ethnic minorities, need to be considered.

Across a range of health and lifestyle indicators, outcomes for ethnic minorities in Stoke-on- Trent were favourable. However, we know from other sources that this is not always the case [Health and Social Care Information Centre 2005], and evidence presented in this

report has shown differences in outcomes in regards to emergency hospital admissions, HIV, and excess weight among schoolchildren. To more fully understand the health and health needs of ethnic minorities locally, it would have been ideal to have utilised data from primary care, secondary care (including A&E), and mortality data. For a variety of reasons, however, these data sources could not be used.

In regards to primary care (or general practice) data, on-going national issues around accessing individual patient level data meant this data source was not available. As a consequence, the prevalence of a range of conditions which are known to vary by ethnicity – such as hypertension, diabetes, coronary heart disease, mental health problems – could not be examined. We also know, historically, that levels of ethnicity recording have varied among general practices locally, and future investment may be required to improve ethnicity recording. In terms of secondary care and mortality data, the ability to examine and understand patterns and trends in hospital admissions and deaths was limited by the lack of ethnicity recording on hospital admission records and death certificates. As with primary care, additional investment, resources and lobbying may be required to improve ethnicity recording in local hospitals and on death certificates.

Accessing timely and appropriate health care services is essential for maintaining and promoting good health. Findings from the General Practice Patient Survey showed that the experiences of ethnic minorities in Stoke-on-Trent differed from their White counterparts in a number of ways. These included, among others: finding it more difficult to access services (on the phone); being less likely to see their preferred GP; being less likely to ‘definitely’ have confidence and trust in their GP or practice nurse; being less likely to report having a ‘very good’ experience of their GP. Whilst it may be difficult to disentangle the reasons for these differences, they may in part be the result of a lack of cultural and religious awareness among some health care professionals, which suggests that additional training may be required in regards to this. Alongside this, there is the continuing need for the on-going engagement and consultation of ethnic minorities by their local primary care (and wider health care) services. Local community and voluntary organisations are often best placed to facilitate this and reflect the concerns of their communities.

Looking forward, to help more fully understand the health and health needs of ethnic minorities in Stoke-on-Trent, patient profiling – the linkage of primary and secondary care patient level data – is recommended. Whilst providing the backdrop to monitoring disease prevalence and examining secondary care usage, patient profiling can help informed decisions to be made about commissioning priorities and resource allocation to help address the health needs of ethnic minorities locally.

Appendix 1 Ethnicity by 2011 Census Stoke-on-Trent England Ethnic group Total % Total % White British 215,222 86.4 42,279,236 79.8 White Irish 636 0.3 517,001 1.0 White Gypsy or Irish Traveller 183 0.1 54,895 0.1 White Other 4,671 1.9 2,430,010 4.6 Mixed White and Black Caribbean 1,892 0.8 415,616 0.8 Mixed White and Black African 559 0.2 161,550 0.3 Mixed White and Asian 1,347 0.5 332,708 0.6 Mixed Other Mixed 693 0.3 283,005 0.5 Asian/Asian British Indian 2,329 0.9 1,395,702 2.6 Asian/Asian British Pakistani 10,429 4.2 1,112,282 2.1 Asian/Asian British Bangladeshi 1,097 0.4 436,514 0.8 Asian/Asian British Other Asian 3,363 1.4 819,402 1.5 Black/Black British African 2,536 1.0 977,741 1.8 Black/Black British Caribbean 834 0.3 591,016 1.1 Black/Black British Other Black 371 0.1 277,857 0.5 Chinese 1,224 0.5 379,503 0.7 Other ethnic group Arab 408 0.2 220,985 0.4 Other ethnic group Any other 1,214 0.5 327,433 0.6 Total 249,008 100 53,012,456 100 Source: Office for National Statistics 2013

Appendix 2 Changes in ethnicity between 2001 and 2011 Stoke-on-Trent England Stoke-on-Trent England Ethnic group 2001 2011 2001 2011 Change Change White British 225,197 215,222 42,747,136 42,279,236 -9,975 -467,900 White Other 2,944 5,490 1,932,225 3,001,906 2,546 1,069,681 Mixed 2,153 4,491 643,373 1,192,879 2,338 549,506 Indian 1,102 2,329 1,028,546 1,395,702 1,227 367,156 Pakistani 6,369 10,429 706,539 1,112,282 4,060 405,743 Bangladeshi 567 1,097 275,394 436,514 530 161,120 Asian Other 449 3,363 237,810 819,402 2,914 581,592 Black African 259 2,536 475,938 977,741 2,277 501,803 Black Caribbean 629 834 561,246 591,016 205 29,770 Black Other 194 371 95,324 277,857 177 182,533 Other 786 2,846 435,300 927,921 2,060 492,621 Total 240,649 249,008 49,138,831 53,012,456 8,359 3,873,625 Source: Office for National Statistics 2013

Appendix 3 Ethnicity (percentage) in Stoke-on-Trent by age group in 2011

Males Age group Ethnic group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 Total White British 6.2 5.3 5.7 6.4 7.2 6.6 5.7 6.2 7.6 7.7 6.8 6.3 6.6 5.3 4.0 3.0 2.1 100 White Other 7.7 4.8 4.1 3.8 8.6 16.1 15.6 8.3 6.4 5.3 4.3 2.8 3.2 1.9 2.4 1.5 1.5 100 Mixed 17.7 15.8 10.6 12.1 11.0 7.5 4.7 3.8 4.8 4.0 2.5 1.8 0.7 0.8 0.7 0.7 0.6 100 Indian 6.2 5.8 3.6 4.0 28.1 19.0 7.6 8.3 5.2 2.6 2.6 1.6 1.6 1.5 1.0 0.9 0.0 100 Pakistani 13.5 12.8 9.6 8.9 8.0 10.7 10.3 6.9 5.4 3.0 2.9 3.1 1.3 1.3 1.1 0.6 0.4 100 Bangladeshi 14.6 13.2 9.5 7.7 5.9 8.0 11.0 10.4 6.8 4.6 3.8 2.0 0.2 0.7 1.1 0.4 0.2 100 Asian Other 9.4 7.3 7.1 7.3 8.7 14.4 14.7 13.2 7.4 4.4 2.7 1.4 0.7 0.4 0.7 0.2 0.0 100 Black African 9.0 8.5 6.2 5.6 10.1 10.7 15.7 14.6 9.7 4.0 2.6 2.0 0.6 0.6 0.0 0.1 0.0 100 Black Caribbean 2.0 2.4 2.2 7.8 6.4 5.4 5.8 8.4 12.6 15.6 10.6 5.8 2.4 2.4 3.4 3.6 2.8 100 Black Other 18.5 9.0 2.8 10.4 8.1 8.1 4.7 10.0 9.0 11.4 5.2 1.4 0.5 0.5 0.5 0.0 0.0 100 Other 8.2 4.0 4.4 6.0 12.2 14.3 16.0 14.4 7.4 5.4 2.5 2.4 1.1 0.5 0.5 0.5 0.1 100 Total 6.9 5.9 5.9 6.6 7.7 7.4 6.5 6.6 7.4 7.2 6.3 5.7 5.9 4.7 3.6 2.7 1.8 100 Source: Office for National Statistics 2013

Females Age group Ethnic group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 Total White British 5.9 5.0 5.2 6.2 7.2 6.6 5.6 6.1 7.1 7.2 6.6 6.0 6.6 5.1 4.3 3.7 3.0 100 White Other 7.3 4.5 4.0 3.3 10.6 17.2 12.6 6.7 5.6 4.5 5.1 3.7 3.2 2.4 3.2 2.0 2.4 100 Mixed 21.3 12.9 11.4 12.6 10.6 7.3 4.3 4.6 4.4 3.7 2.4 1.4 0.7 0.7 0.6 0.6 0.4 100 Indian 10.3 5.8 3.7 5.8 13.8 10.7 13.5 11.2 7.5 3.3 3.6 3.0 3.4 1.5 1.0 1.3 0.3 100 Pakistani 14.1 12.4 9.6 7.6 9.5 11.3 9.5 7.6 5.0 3.1 3.0 3.0 1.5 0.9 0.8 0.6 0.4 100 Bangladeshi 14.4 11.3 9.8 9.3 11.5 12.2 10.0 7.3 3.6 3.5 1.6 1.3 2.0 0.9 0.9 0.5 0.0 100 Asian Other 12.0 9.7 9.2 6.0 6.4 8.7 11.0 16.0 9.5 3.7 3.5 1.5 1.0 0.6 0.7 0.3 0.2 100 Black African 12.9 6.6 6.1 8.3 12.4 10.2 15.1 11.4 7.4 4.0 2.9 1.2 0.3 0.8 0.3 0.0 0.1 100 Black Caribbean 1.8 2.1 3.6 6.0 11.7 6.6 5.4 4.2 6.9 12.3 9.6 3.6 6.6 4.5 7.8 5.7 1.8 100 Black Other 23.8 8.8 5.0 9.4 8.8 5.0 8.8 9.4 5.0 8.8 6.3 0.0 0.0 0.6 0.0 0.0 0.6 100 Other 11.0 6.1 8.1 6.1 14.4 14.6 10.6 9.0 6.0 4.8 2.4 3.3 1.2 0.8 0.3 0.4 0.5 100 Total 6.8 5.5 5.6 6.3 7.6 7.2 6.2 6.3 6.9 6.7 6.2 5.5 6.0 4.6 3.9 3.3 2.7 100 Source: Office for National Statistics 2013

Appendix 4 Non White British population by wards in Stoke-on-Trent in 2011 White Non White % Non White Ward British British Total British Abbey Hulton & Townsend 9,368 550 9,918 5.5 Baddeley, Milton & Norton 16,646 604 17,250 3.5 Bentilee & Ubberley 9,980 799 10,779 7.4 Birches Head & Central Forest Park 9,672 1,650 11,322 14.6 Blurton East 4,951 252 5,203 4.8 Blurton West & Newstead 5,761 543 6,304 8.6 Boothen & Oakhill 4,707 1,037 5,744 18.1 Bradeley & Chell Heath 5,436 315 5,751 5.5 Broadway & Longton East 5,009 252 5,261 4.8 Burslem Central 4,867 1,339 6,206 21.6 Burslem Park 4,485 623 5,108 12.2 Dresden & Florence 3,953 1,136 5,089 22.3 Eaton Park 4,312 164 4,476 3.7 Etruria & Hanley 3,427 3,292 6,719 49.0 Fenton East 5,702 567 6,269 9.0 Fenton West & Mount Pleasant 5,346 455 5,801 7.8 Ford Green & Smallthorne 5,344 483 5,827 8.3 Goldenhill & Sandyford 5,020 513 5,533 9.3 Great Chell & Packmoor 9,547 450 9,997 4.5 Hanford & Trentham 11,170 666 11,836 5.6 Hanley Park & Shelton 3,278 3,189 6,467 49.3 Hartshill & Basford 5,188 1,462 6,650 22.0 Hollybush & Longton West 5,634 244 5,878 4.2 Joiner's Square 3,568 1,430 4,998 28.6 Lightwood North & Normacot 3,312 1,884 5,196 36.3 Little Chell & Stanfield 5,370 1,040 6,410 16.2 Meir Hay 4,599 157 4,756 3.3 Meir North 5,334 429 5,763 7.4 Meir Park 4,736 205 4,941 4.1 Meir South 5,201 590 5,791 10.2 Moorcroft 2,799 2,607 5,406 48.2 Penkhull & Stoke 5,415 1,103 6,518 16.9 Sandford Hill 5,953 425 6,378 6.7 Sneyd Green 4,764 578 5,342 10.8 Springfields & Trent Vale 5,930 886 6,816 13.0 Tunstall 4,541 1,691 6,232 27.1 Weston Coyney 4,897 176 5,073 3.5 Total 215,222 33,786 249,008 13.6 Source: Office for National Statistics 2013

Appendix 5 2014 wards in Stoke-on-Trent

Appendix 5 Continued

Key Number Ward 1 Abbey Hulton & Townsend 2 Baddeley, Milton & Norton 3 Bentilee & Ubberley 4 Birches Head & Central Forest Park 5 Blurton East 6 Blurton West & Newstead 7 Boothen & Oakhill 8 Bradeley & Chell Heath 9 Broadway & Longton East 10 Burslem Central 11 Burslem Park 12 Dresden & Florence 13 Eaton Park 14 Etruria & Hanley 15 Fenton East 16 Fenton West & Mount Pleasant 17 Ford Green & Smallthorne 18 Goldenhill & Sandyford 19 Great Chell & Packmoor 20 Hanford & Trentham 21 Hanley Park & Shelton 22 Hartshill & Basford 23 Hollybush & Longton West 24 Joiner's Square 25 Lightwood North & Normacot 26 Little Chell & Stanfield 27 Meir Hay 28 Meir North 29 Meir Park 30 Meir South 31 Moorcroft 32 Penkhull & Stoke 33 Sandford Hill 34 Sneyd Green 35 Springfields & Trent Vale 36 Tunstall 37 Weston Coyney

Appendix 6 Ethnicity (percentage) by wards in Stoke-on-Trent in 2011 Ethnic group Ward WB WO M I P B AO BA BC BO O Total Abbey Hulton & Townsend 94.5 1.6 1.7 0.2 0.2 0.1 0.3 0.5 0.2 0.2 0.6 100 Baddeley, Milton & Norton 96.5 1.1 1.1 0.1 0.3 0.1 0.2 0.2 0.1 0.0 0.2 100 Bentilee & Ubberley 92.6 3.0 1.8 0.1 0.4 0.1 0.4 0.9 0.3 0.1 0.2 100 Birches Head & Central Forest Park 85.4 2.5 2.2 0.5 3.6 0.4 1.3 1.3 0.4 0.2 2.1 100 Blurton East 95.2 0.9 1.3 0.5 0.5 0.0 0.3 0.7 0.2 0.1 0.5 100 Blurton West & Newstead 91.4 1.7 1.3 1.3 0.9 0.0 0.7 1.5 0.2 0.0 1.0 100 Boothen & Oakhill 81.9 3.5 2.0 1.4 3.3 0.7 2.7 1.9 0.4 0.1 2.1 100 Bradeley & Chell Heath 94.5 1.4 1.3 0.3 0.3 0.0 0.3 1.1 0.2 0.3 0.4 100 Broadway & Longton East 95.2 1.3 0.9 0.4 1.0 0.1 0.2 0.3 0.1 0.1 0.3 100 Burslem Central 78.4 6.6 2.7 0.4 5.0 1.0 1.9 1.4 0.7 0.2 1.6 100 Burslem Park 87.8 2.6 1.9 0.6 3.1 0.6 1.0 0.9 0.4 0.2 1.1 100 Dresden & Florence 77.7 1.6 1.5 0.6 14.5 0.7 1.7 0.7 0.1 0.3 0.6 100 Eaton Park 96.3 1.4 0.7 0.1 0.2 0.1 0.2 0.3 0.1 0.1 0.3 100 Etruria & Hanley 51.0 6.4 4.4 1.8 21.6 2.2 3.0 3.9 1.1 0.3 4.3 100 Fenton East 91.0 1.5 1.5 1.1 2.2 0.4 0.8 0.7 0.2 0.1 0.6 100 Fenton West & Mount Pleasant 92.2 1.9 1.7 0.4 1.4 0.1 0.4 1.0 0.4 0.1 0.5 100 Ford Green & Smallthorne 91.7 1.5 1.9 0.3 0.9 0.3 0.8 0.5 0.6 0.2 1.4 100 Goldenhill & Sandyford 90.7 2.7 1.8 0.1 2.2 0.2 1.0 0.5 0.2 0.1 0.5 100 Great Chell & Packmoor 95.5 1.1 1.2 0.2 0.7 0.0 0.3 0.5 0.2 0.1 0.3 100 Hanford & Trentham 94.4 1.4 0.9 0.8 0.7 0.1 0.6 0.3 0.1 0.1 0.7 100 Hanley Park & Shelton 50.7 4.1 3.6 10.0 15.2 1.0 4.1 4.4 1.3 0.4 5.2 100 Hartshill & Basford 78.0 3.5 2.1 3.1 3.2 0.7 5.0 1.2 0.4 0.2 2.6 100 Hollybush & Longton West 95.8 1.0 1.3 0.1 0.2 0.1 0.3 0.6 0.2 0.1 0.3 100 Joiner's Square 71.4 4.9 2.7 1.4 8.2 1.1 4.0 2.0 0.9 0.3 3.1 100 Lightwood North & Normacot 63.7 1.4 1.5 0.6 27.5 0.7 2.5 0.8 0.1 0.1 1.1 100 Little Chell & Stanfield 83.8 2.1 2.6 0.5 6.3 0.7 2.0 1.0 0.3 0.1 0.6 100 Meir Hay 96.7 0.4 0.7 0.3 0.9 0.0 0.1 0.4 0.2 0.2 0.2 100 Meir North 92.6 2.4 1.6 0.3 0.4 0.0 0.4 1.2 0.2 0.3 0.5 100 Meir Park 95.9 1.0 1.0 1.1 0.3 0.1 0.1 0.2 0.1 0.0 0.3 100 Meir South 89.8 1.9 2.0 0.3 3.7 0.4 0.3 0.4 0.6 0.1 0.5 100 Moorcroft 51.8 3.4 4.8 0.7 22.4 4.8 4.3 2.5 0.9 0.3 4.1 100 Penkhull & Stoke 83.1 3.0 1.8 2.8 2.5 0.1 3.2 1.2 0.4 0.1 1.6 100 Sandford Hill 93.3 1.5 1.5 0.2 1.3 0.4 0.7 0.4 0.1 0.1 0.3 100

Appendix 6 Continued Ethnic group Ward WB WO M I P B AO BA BC BO O Total Sneyd Green 89.2 1.6 1.9 0.3 2.0 0.0 1.9 0.9 0.5 0.2 1.5 100 Springfields & Trent Vale 87.0 1.7 1.5 2.2 1.1 0.4 3.2 1.2 0.2 0.1 1.2 100 Tunstall 72.9 2.4 2.4 1.0 15.1 0.5 2.6 1.2 0.3 0.3 1.4 100 Weston Coyney 96.5 1.1 0.9 0.1 0.6 0.0 0.3 0.1 0.1 0.0 0.2 100 Total 86.4 2.2 1.8 0.9 4.2 0.4 1.4 1.0 0.3 0.1 1.1 100 Source: Office for National Statistics 2013

WB White British WO White Other M Mixed I Indian P Pakistani B Bangladeshi AO Asian Other BA Black African BC Black Caribbean BO Black Other O Other

Appendix 7 Socioeconomic classification (percentage) by ethnicity (16 and over) in 2011

Stoke-on-Trent Ethnic group NS-SEC White Mixed Asian Black Other Total Higher managerial/professional 4.7 3.5 4.5 5.3 4.4 4.7 Lower managerial/professional 14.1 11.0 9.6 11.7 10.9 13.8 Intermediate occupations 11.7 9.9 6.3 7.0 2.5 11.3 Small employers 6.8 5.7 13.6 3.7 11.5 7.2 Lower supervisory/technical 8.9 5.5 5.0 5.8 7.0 8.6 Semi-routine occupations 18.4 14.3 11.6 14.9 12.5 17.8 Routine occupations 22.4 14.7 8.7 12.2 12.8 21.2 Never worked/LT unemployed 6.1 10.9 20.2 12.6 23.6 7.2 Not classified 6.8 24.6 20.5 26.9 14.8 8.2 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

England Ethnic group NS-SEC White Mixed Asian Black Other Total Higher managerial/professional 10.2 8.4 10.7 6.9 10.1 10.1 Lower managerial/professional 21.3 17.9 14.4 18.3 14.2 20.6 Intermediate occupations 13.6 10.6 9.1 10.7 7.1 13.1 Small employers 9.6 6.4 8.9 5.3 8.5 9.3 Lower supervisory/technical 7.4 5.2 4.8 5.0 5.2 7.1 Semi-routine occupations 14.5 12.1 11.8 14.5 9.7 14.3 Routine occupations 12.0 8.9 8.0 9.5 8.7 11.5 Never worked/LT unemployed 4.7 10.0 14.7 12.2 16.5 5.9 Not classified 6.7 20.6 17.6 17.7 20.0 8.2 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

Appendix 8 Type of industry (percentage) by ethnicity (16 and over) in Stoke-on- Trent in 2011 Ethnic group Industry White Mixed Asian Black Other Total A 2.0 2.0 0.5 1.3 0.6 1.9 B 14.2 9.7 7.2 8.8 11.3 13.6 C 8.4 6.8 2.3 6.2 6.4 8.0 D 19.8 20.6 18.4 14.7 21.1 19.7 E 5.9 4.9 16.0 6.5 13.0 6.5 F 4.6 8.3 16.1 3.9 14.4 5.4 G 2.0 2.2 2.9 2.2 1.6 2.1 H 2.7 3.9 2.3 2.1 0.8 2.7 I 1.0 1.8 0.7 1.3 0.5 1.0 J 3.0 2.8 2.0 2.3 3.1 2.9 K 4.9 4.7 3.3 8.1 3.0 4.9 L 4.1 4.5 1.7 3.4 1.7 4.0 M 7.8 6.2 5.7 6.5 6.1 7.7 N 14.2 15.7 17.0 27.3 12.0 14.6 O 5.3 5.9 3.9 5.5 4.5 5.2 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

Appendix 9 Economic activity (percentage) by ethnicity (16 and over) in Stoke-on- Trent in 2011 Economic Ethnic group activity White Mixed Asian Black Other Total A 12.4 11.3 13.2 8.9 11.8 12.4 B 34.6 29.0 20.7 28.8 25.2 33.5 C 1.4 2.2 5.6 1.0 3.7 1.7 D 3.9 3.1 6.8 2.9 7.6 4.1 E 2.1 6.2 5.3 7.5 2.1 2.4 F 4.6 9.1 5.3 11.5 9.5 4.8 G 0.7 3.1 2.9 4.4 2.4 1.0 H 23.1 4.9 4.1 5.4 2.1 21.3 I 4.2 16.1 13.1 15.8 15.7 5.1 J 3.7 4.7 12.7 3.4 7.0 4.3 K 7.1 5.8 3.4 4.1 3.9 6.8 L 2.2 4.4 6.9 6.2 9.0 2.6 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

Appendix 10 Housing tenure (percentage) by ethnicity in 2011

Stoke-on-Trent Ethnic group Tenure White Mixed Asian Black Other Total Owned outright 29.7 10.9 19.5 6.5 6.0 28.5 Owned with mortgage 31.6 23.7 37.0 14.8 11.3 31.3 Rented from LA 18.2 28.3 10.3 34.7 37.1 18.3 Other social rented 5.8 10.5 3.9 12.0 7.3 5.8 Rented privately 12.1 22.7 23.2 25.9 34.6 13.2 Other private rented 2.6 3.8 6.3 6.2 3.6 2.8 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

England Ethnic group Tenure White Mixed Asian Black Other Total Owned outright 32.5 10.5 20.7 8.3 12.0 30.6 Owned with mortgage 33.9 26.0 37.4 24.7 21.5 33.6 Rented from LA 8.9 16.8 7.2 23.1 14.7 9.4 Other social rented 7.9 15.3 6.4 18.9 11.1 8.3 Rented privately 14.2 27.8 24.2 22.3 36.7 15.4 Other private rented 2.7 3.6 4.1 2.7 4.0 2.8 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

Appendix 11 Household overcrowding (percentage) by ethnicity in 2011

Stoke-on-Trent Occupancy rating Ethnic group (rooms) White Mixed Asian Black Other Total +2 or more 46.5 34.3 33.9 25.7 28.1 45.3 +1 29.3 27.6 25.3 30.5 28.4 29.1 0 19.0 25.8 23.3 28.6 28.6 19.5 -1 or less 5.2 12.3 17.4 15.2 14.8 6.1 Total 100 100 100 100 100 100 Source: Office for National Statistics 2014

England Occupancy rating Ethnic group (rooms) White Mixed Asian Black Other Total +2 or more 52.3 28.4 33.1 21.9 23.9 49.7 +1 23.2 22.7 20.9 20.3 19.5 22.9 0 17.6 29.0 23.2 30.3 28.8 18.6 -1 or less 6.8 19.9 22.8 27.5 27.7 8.7 Total 100 100 100 100 100 100 Source: Office for National Statistics 2014

Occupancy rating Occupancy rating provides a measure of whether a household's accommodation is overcrowded or under occupied. There are two measures of occupancy rating, one based on the number of rooms in a household's accommodation, and one based on the number of bedrooms. The ages of the household members and their relationships to each other are used to derive the number of rooms/bedrooms they require, based on a standard formula. The number of rooms/bedrooms required is subtracted from the number of rooms/bedrooms in the household's accommodation to obtain the occupancy rating. An occupancy rating of -1 implies that a household has one fewer room/bedroom than required, whereas +1 implies that they have one more room/bedroom than the standard requirement.

Appendix 12 Educational qualifications (percentage) by ethnicity (16 and over) in 2011

Stoke-on-Trent Ethnic group Qualification White Mixed Asian Black Other Total No qualifications 34.6 23.2 28.7 15.3 28.1 33.8 Level 1 14.4 19.2 13.0 14.3 15.2 14.4 Level 2 16.3 18.9 9.8 15.8 10.4 15.9 Apprenticeship 3.8 1.9 0.5 1.4 0.6 3.5 Level 3 12.1 15.4 9.2 15.4 8.7 11.9 Level 4 and above 14.6 15.2 25.3 27.7 18.8 15.5 Other qualifications 4.3 6.1 13.5 10.1 18.3 5.0 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

England Ethnic group Qualification White Mixed Asian Black Other Total No qualifications 23.2 15.6 18.8 14.6 17.9 22.5 Level 1 13.5 14.6 11.1 13.8 9.5 13.3 Level 2 15.6 17.6 10.4 16.0 9.4 15.2 Apprenticeship 4.0 1.7 0.7 1.4 0.7 3.6 Level 3 12.5 15.5 10.3 12.4 9.9 12.4 Level 4 and above 26.5 28.2 34.4 33.2 33.8 27.4 Other qualifications 4.7 6.8 14.3 8.7 18.8 5.7 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

Qualifications (approximate classifications) Level 1 1-4 O Levels/CSE/GCSEs (any grades) Level 2 5+ O Level (Passes)/CSEs (Grade 1)/GCSEs (Grades A*-C) Level 3 2+ A Levels/ 4+ AS Levels Level 4 and above Degree, Higher Degree Other qualifications Vocational/work related qualifications

Appendix 13 General health (percentage) by ethnicity in 2011

Stoke-on-Trent Ethnic group General health White Mixed Asian Black Other Total Very good or good health 75.4 88.0 86.0 86.4 86.6 76.6 Fair health 16.1 8.3 9.8 9.3 7.7 15.3 Bad or very bad health 8.5 3.8 4.2 4.3 5.7 8.0 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

England Ethnic group General health White Mixed Asian Black Other Total Very good or good health 80.6 89.6 85.3 86.2 84.7 81.4 Fair health 13.7 7.3 10.4 9.8 9.7 13.1 Bad or very bad health 5.7 3.1 4.4 4.0 5.5 5.5 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

Appendix 14 Long-term health problem or disability (percentage) by ethnicity in 2011

Stoke-on-Trent Ethnic group Day-to day-activities White Mixed Asian Black Other Total Limited a lot 12.6 5.6 4.5 5.1 6.3 11.8 Limited a little 11.6 4.8 5.6 6.3 5.8 10.9 Not limited 75.7 89.6 89.8 88.6 87.9 77.3 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

England Ethnic group Day-to day-activities White Mixed Asian Black Other Total Limited a lot 8.8 4.3 5.4 5.5 6.1 8.3 Limited a little 9.9 5.1 6.3 5.9 6.6 9.3 Not limited 81.3 90.5 88.2 88.7 87.3 82.4 Total 100 100 100 100 100 100 Source: Office for National Statistics 2013

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