Abstract:

This paper is a case history, describing research carried out for the Department of Health in England. The research was designed to find out why, when safe and effective vaccines were available, many children in our society remained unprotected by immunisation, and therefore susceptible to serious - and in some cases fatal - infectious diseases. In England, the proportion of children immunised against diseases such as polio, measles and whooping cough varies widely between different health districts. This study explores possible reasons for the variation, and attempts to distinguish between the influence of social and geodemographic factors, and the management of the immunisation programmes. Multiple regression techniques are used to identify the relative importance of different factors. The findings show a strong link between low levels of uptake and socially disadvantaged inner city areas. Using social statistics to control, at least in part, for population differences, it is possible to identify those differences in practice and management which are associated with higher uptake rates - that is, rates which are higher than average after taking into account the type of population served. The methodology described in this paper is relevant not only in the field of health, but also in other areas of social research, such as education, or law and order, where the performance of a service provider, as indicated by external measures - for example, school examination results, or crime statistics - is strongly linked to population differences. By linking survey data to population statistics and performance indicators, and using multivariate analysis techniques, it is possible to assess the relative importance of those factors which can be directly controlled by service providers, compared to those which cannot.