ABSTRACT
CONTENTS 5.1 Introduction ................................................................................................. 95 5.2 Data and Methods ...................................................................................... 97
5.2.1 Population Density as a Measure of Rurality ............................ 97 5.2.2 Carstairs Index of Deprivation at the Pseudo
Postcode Sector Level..................................................................... 99 5.2.3 Ranking the Carstairs Index ......................................................... 99 5.2.4 Difference between Output Area and Pseudo
Postcode Sector Carstairs Scores ................................................ 101 5.2.5 Carless Carstairs Ranking ........................................................... 105 5.2.6 Difference between Output Area and Pseudo
Postcode Sector Carless Carstairs Scores .................................. 105 5.3 Funding and Homogeneity of Deprivation in Health Boards .......... 106 5.4 Conclusions................................................................................................ 109 5.5 Future Research......................................................................................... 111 Acknowledgments ............................................................................................. 111 References ........................................................................................................... 112
There are many examples of research that make use of composite measures of material and=or social deprivation calculated at the area level to depict the socioeconomic status of an area (Townsend, 1987; Carstairs and Morris, 1991; Salmond et al., 1998; Department of the Environment Transport and the Regions, 2000; Kearns et al., 2000; Senior, 2002). Much of this research has focused on populations at the ward level in England and Wales, or the pseudo postcode sector level in Scotland. The ward and pseudo postcode sector level are typically used to preserve confidentiality of residents and
minimize problems associated with statistics carried out on areas with a small number of observations. Pockets of deprivation could be defined as small areas that are signifi-
cantly more deprived than their neighboring areas. When deprivation indices are calculated at the ward and pseudo postcode sector levels, there is a possibility that the assigned value to an area might hide pockets of deprivation: enumeration districts in England and Wales or output areas in Scotland that are notably less affluent than the ward=pseudo postcode sector in which they are located. A recent paper by Haynes and Gale (2000) suggests that the large geographical space that is covered by a Census ward in rural areas might be too large to be homogeneous and that pockets of deprivation do exist. In rural areas, a ‘‘neighbor’’ might be a number of miles, rather than a matter of meters, away. Nevertheless, there is every possibility that the ward contains residents of less affluent status than is assigned to the ward by way of a socioeconomic indicator or deprivation index. At present, many public sector organizations use both deprivation indices
and=or health data to determine their catchment area’s demographic profiles and resource allocation, typically at the pseudo postcode sector level (Mc Laren and Bain, 1998). Health boards, for example, are funded based on the Arbuthnott deprivation index, which accounts for remoteness (Scottish Executive Health Department, 1999). However, the use of the pseudo postcode sector for this type of analysis in rural areas potentially fails to identify small neighborhoods that are most in need of funding. In more remote parts of Scotland, the pseudo postcode sectors cover a large area and in some cases only include one or two output area(s), so the possibility of obscuring deprived households is significant. This chapter investigates whether pockets of deprivation exist in Scotland
using pseudo postcode sectors and output areas, and it is expected that such areas are particularly likely to exist in rural areas. We first use the Carstairs index of deprivation (Carstairs and Morris, 1991) to identify the most deprived output areas that are not located in the most deprived pseudo postcode sectors. Second, we consider the difference between output area Carstairs and the Carstairs score of the pseudo postcode sector in which the output area is located. A high positive value will identify situations in which an output area is significantly more deprived than the pseudo postcode sector in which it is located. We also recalculate the Carstairs index excluding the car ownership
variable, henceforth known as the carless Carstairs index, because access to a motor vehicle in rural areas is a necessity rather than a measure of affluence, as is often the case in urban areas (Higgs and White, 2000). We repeat the ranking and difference calculation on the carless Carstairs index. The implications our results have on policy are then assessed in relation
to health boards in Scotland. It is assumed that since deprivation indices are commonly used in resource allocation, areas that are more homogeneous are likely to gain more support from funding bodies. The more
heterogeneous the output areas within a pseudo postcode sector, the more likely areas of significant deprivation will be ignored. Using the mean standard deviation of the difference between output area Carstairs and the Carstairs score of the pseudo postcode sector, we calculate the heterogeneity of deprivation in health boards across Scotland. This measure should give high values for health boards where pseudo postcode sectors are heterogeneous and low values where they are homogeneous.
