As health promotion is inextricably linked
with tackling inequalities in health, the role of statistics in describing inequalities is
vitally important in enabling us to see those patterns of health injustice that
we are so concerned to eradicate. Clearly, our work depends on having reliable
data. Equally clearly, many governments and agencies have a vested interest in not
providing that data, or in presenting statistics in the best light. Statistics
are thus political. One of the books from my own undergraduate days was called
something like ‘How to lie with statistics’ and I suspect it’s still in print.
Statistics provide the bedrock of understanding, enabling us to see what’s
happening now and what direction we want to go in for the future. For example, the Radical
Statistics group has as their slogan, “Using
statistics to support progressive social change” See: http://www.radstats.org.uk/journal/issue108/
It’s therefore alarming to see that the UK
government is considering, as part of its cuts programme drawn up by the Office
of National Statistics, to halt the publication of politically sensitive
official statistics on areas such as smoking, drinking, teenage pregnancy and
infant mortality. The ONS is considering cuts to the ‘wellbeing programme’ which
includes data on inequalities. It’s also considering the scale of the official
crime survey. At the moment, these cuts are merely being talked about, but faced
with the demands for savings being made across government departments, it would
not be surprising if they were enacted. It’s proposed to stop all statistics on
smoking and drinking and also under threat are data on cancer survival rates,
analysis of healthy life expectancy figures, and reducing the causes of death
data to the legally required minimum. Many of the issues under threat are those
where the UK fares badly in comparison with other European countries.
It’s only when good quality quantitative
research is carried out that the scale of certain health issues can be fully
outlined and explained. Thus the first comprehensive report of its kind, on
violence against women, recently published by the WHO, shows comparative data from
81 countries. The director–general of the WHO, Dr. Margaret Chan commented,
“These findings send a powerful message that violence against women is a global
health problem of epidemic proportions. We also see that the world’s health
systems can and must do more for women who experience violence”. Although we
already know this, the fact that we have the data means that we have a
foundation, a line in the sand, from which to advance argument and action.
The data from this work, Global and
regional estimates of violence against women: Prevalence and health effects of
intimate partner violence and non-partner sexual violence – see http://www.who.int/mediacentre/news/releases/2013/violence_against_women_20130620/en/index.html
by Dr. Claudia Garcia-Moreno
and Professor Charlotte Watts, show that 45.6% of women in Africa, 40.2% in
South-East Asia, 36.4% in the Eastern Mediterranean, 36.1% in the Americas,
27.9% in the Western Pacific and 27.2% in Europe will suffer physical or sexual
violence at some point in their lives. That’s a third of all women worldwide –
35.6%. Of all those who experience violence, 42% sustain injuries that bring
them to the attention of healthcare staff. Most of this violence comes from women’s
partners/husbands – 11.9% of African women are sexually attacked by a
non-intimate partner, 12.6% in wealthy countries.
The authors call for the numbers to be a
wake up call. It makes the point that it’s only when numbers are collected that
we can see progress in the rights of particular groups. For example, the Labour
Force Survey in the UK has reported recently that more disabled people are
likely to be employed today than they were ten years ago. Of course we have to
be suspicious of how ‘disability’ is defined and whether there are changes in
that definition, but it seems to be the case that the gap between non-disabled and
disabled people in employment has shrink by 10% in the last 14 years.
Universities are required to collect data on the characteristics of graduates
and their ‘first destination employment’ and these show that around 40,000
‘disabled’ people graduate each year from UK universities and of these 60% find
work within six months, which is about the same proportion as their
non-disabled peers.
The Radical Statistics Group’s journal is a
useful source for critical discussion of why and how certain statistics are
collected, and of debate about how to measure key concepts such as
wellbeing. See for example, Carr-Hill’s
paper on ‘Measuring Wellbeing’:
Another recent paper unpicks the fallacy
that schizophrenia rates are constant across societies, and relates them to the
political structures of various countries:
Of course, statistics are a starting point
and it’s then necessary for social science to make sense of those statistics
and come up with explanatory frameworks. Amongst my PhD students for example, I
have one looking at male sexuality in Zambia, particularly in relation to the
use of microbicides to prevent HIV (with Professor Alan White, an expert in
men’s health) and another looking at sexual abuse of orphans and vulnerable
children in Botswana (with Professor Nick Frost, an expert in child
protection). Both will emerge with
theory to explain the statistics behind the practice and attitudes that can
lead to gender-based violence.
In summary, statistics and epidemiology
make a key contribution to the practice of health promotion and we have to be
vigilant about how such data is collected, constructed and used. Construction
of statistics, what is collected and how, are political acts, just as health
promotion activity to tackle inequalities, is a political act.
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