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Accurate collection and recording of high quality ethnicity data

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					2004 Ethnicity Data Protocols Supplementary Notes

On 1 July 2009 the ethnicity classification codes to be used in conjunction
with the 2004 Ethnicity Data Protocols for the Health and Disability Sector
(Protocols) will be updated to align with the Statistics New Zealand Statistical
Standard for Ethnicity 2005 (2005 Standard).

The objective of alignment is to ensure ethnicity is collected in accordance
with Statistics New Zealand (SNZ) to allow comparability across government
agencies and with the census.

The purpose of these notes is to support the use of a consistent Ethnicity
Classification codeset (codeset) across the whole Health and Disability
System and to

    1. Provide supplementary information to support the implementation of
       the codeset.

    2. Provide guidance to the sector on the impact of the codeset changes
       to the input and output of ethnicity data.

To ensure the Protocols align with the most current SNZ Ethnicity Standard,
they will be updated and republished once SNZ have finalised the Ethnicity
Standard to be used for the 2011 Census (expected late 2009/early 2010).

The 2009 Ethnicity Classification Level Codes are published as separate
Appendices so they can be easily inserted into existing copies of the
Protocols.

Background
Accurate collection and recording of high quality ethnicity data ensures that
the Government is able to track health trends by ethnicity and effectively
monitor its performance to improve health outcomes and reduce health
inequalities. It also provides Maori in particular with quality information about
their health status and enables Maori to participate in, and contribute to,
strategies for Maori health improvement. Ethnicity data informs the health
and disability system about the health status of specific groups and enables
the development and targeting of health services.

Having a standard way to record, analyse and report on ethnicity data helps
provide a high level of data quality. Service providers, managers, analysts and
strategists can then have confidence in the data when they make decisions
about health interventions.

Ethnicity Data Protocols for the Health and Disability Sector (Protocols)
describe procedures for the standardised collection, recording and output of
ethnicity data within health information systems.

The Ministry of Health (MOH) will implement changes as part of the 2009
National Collections Annual Maintenance Project (NCAMP) to information


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systems, including the National Health Index (NHI), National Data Collections
and reports that record and aggregate ethnicity codes at Level 2 and above.

When should the NHI be updated?
The NHI database should be updated if a healthcare user provides a more
specific or different specific ethnicity than that already held for that person.

1 July 2009 codeset changes
Ethnicity is recorded on the NHI and is submitted to National Data Collections
using Level 2 ethnicity codes.

Ethnicity is analysed and reported from National Data Collections at Level 0,
Level 1 and Level 2.

Alignment of the „Ethnicity Data Protocols for the Health and Disability Sector‟
with the SNZ Standard at Level 2 is achieved through the following changes:-

Level 2 Ethnicity Codeset
Addition of:
    Code „61‟ - „Other ethnicity‟.
    Code „94‟ - „Don‟t know‟
    Code „95‟ - „Refused to Answer‟
    Code ‟97‟ - ‟Response Unidentifiable‟

The SNZ Standard guidelines for the use of these codes is as follows:-

Code „61‟ – Other
This category should be used to record the following ethnic response:

       Central American Indian
       Inuit
       North American Indian
       South American Indian
       Mauritian
       Seychelles Islander
       South African Coloured

Code „94‟ - Don't Know
The use of this category is necessary when the respondent is unsure of their
ethnic group in an interviewer administered survey (i.e. asked verbally) or
writes this in as a response.

Code „95‟ - Refused to Answer
This category is only used when it is known that the respondent has
purposefully chosen not to respond to the question. Its use is most applicable
in face-to-face or telephone interviews, but may be used in self-completed
questionnaires if the respondent has clearly indicated they refuse or object to
answering the question.




                                      Page 2
97 - Response Unidentifiable
This category is used when there is a response given, but the response is
illegible, or it is unclear what the meaning or intent of the response is - this
most commonly occurs when the response being classified contains
insufficient detail, is ambiguous or is vague.

Where possible, code 54 should be made inactive from selection in any
ethnicity list in a patient administration/management system to minimise the
likelihood of its future selection. If it is not possible to make the list item
inactive, then modification of the ethnicity description should discourage its
future use:-

Modify ethnicity description of:
    Code „54‟ – „Other‟
to
    Code „54‟ – „zz Do Not Use (Other Retired)‟

The suggested description used when reporting ethnicity at Level 2 is

      Code „54‟ – „Other (Retired)‟

Level 0 and Level 1 Ethnicity Classification Groupings
The SNZ classification structure no longer contains a Level 0 but this level is
used as an output category for many health and disability statistics. Where
information systems group ethnicity there are no changes to the Level 0
codeset.

Alignment of the „Ethnicity Data Protocols for the Health and Disability Sector‟
with the SNZ Standard at Level 1 is achieved with the following codeset
changes:-

Level 1
Addition of :
•      Code 6 - „Other‟

Modification of description
•      Code 5 – „Other ethnic groups‟
To
•      Code 5 – „„Middle Eastern/Latin American and African‟ (MELAA)‟


Collection of Ethnicity Data
Protocol requirements for ethnicity data collection are:-

      The standard ethnicity question for the health and disability sector is
       the Statistics New Zealand 2001 Census ethnicity question (with no
       changes to format, font size or dimensions).
      A proxy response should be used where a respondent is unable to fill
       in a form or questionnaire themselves.



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      The respondent must identify their own ethnicity and the collector
       should not guess ethnicity on behalf of the respondent

Standardised ethnicity recording
Protocol requirements for ethnicity data recording are:-

      The Protocols define the ethnicity codes standard text descriptions to
       be used to store ethnicity in health information systems.
      Ethnicity must be recorded at Level 2 as the minimum level of
       specificity.
      Any recording system must be capable of recording a minimum of
       three ethnicities
      A prioritisation process must be followed if more than three ethnicities
       are given.

How to classify the ‘New Zealander’ response
When a respondent has entered „New Zealander‟ or „Kiwi‟ in the free text
space on the ethnicity question, the current practice is to classify this
response as „NZ European‟.

The SNZ 2005 Standard changed the classification of this response.
However, SNZ are currently reviewing their classification of the „New
Zealander‟ response in preparation for the 2011 census.

Continue to follow the current practice of classifying the „New Zealander‟
response as NZ European.

Where a respondent gives multiple ethnicity responses use the prioritisation
system outlined in the Protocols.

What is the impact of 2009 codeset changes to outputting ethnicity
data?
Government, analysts and researchers will need to be aware of the impact of
1 July 2009 codeset changes on the way that historical data is compared and
reported at Level 1.

The SNZ 2005 Standard states

 “Level one data is not comparable to previous level one data with the
introduction of the level one groups, „Middle Eastern, Latin American and
African‟ (MELAA) and Other Ethnicity.”

It is recognised that it will take time for the sector to implement and align
ethnicity data with the SNZ Standard. National Data Collections will not reject
ethnicity data submitted as Code 54 (Other ethnicity).

Level 1 output
From 1 July 2009 health systems and data, with the exception of Code 54
(Other), Level 2 ethnicity codes starting with „5‟ will be reported as „MELAA‟,
Code 5 at Level 1.


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Code 61 (Other ethnicity) and Code 54 will be reported as „Other ethnicity‟,
Code 6 at Level 1.




                                    Page 5
APPENDIX


Summary of Proposed Codeset Changes to align Ethnicity Data
Protocols for the Health & Disability Sector with Statistics New Zealand
Statistical Standard for Ethnicity 2005

Level 1 Codeset Changes

Current State                           Proposed Change
Five Level 1 Codes (1, 2, 3, 4, 5)      Seven Level 1 Codes (1, 2, 3, 4, 5, 6,
                                        9)
Code 5 = Other ethnic Groups            Code 5 = Middle Eastern/Latin
                                        American/African
                                        Change to the meaning of Code 5
                                        Addition of:
                                        Code 6 – Other Ethnicity
                                        Code 9 – Residual Categories*

*The Ministry of Health currently uses Code 9 at Level 1 in National Data
Collection reporting but Code 9 is not in the Ethnicity Data Protocols.

Level 2 Codeset Changes

Current State                            Proposed Change
Twenty Five Level 2 Codes (3 not         Twenty Seven Level 2 Codes (2 not
used in MOH Systems)                     used in MOH Systems)
Code 54 - Other                          Retire Code 54

                                         Addition of:
                                         Code 61 – Other Ethnicity
Residual Codes                           Addition of:
Code 96 – Repeated Value (Not            Code 94 – Don‟t Know
Used)                                    Code 95 – Refused to Answer
Code 97 – Response Unidentifiable        Code 97 – Response Unidentifiable
(Not Used)
Code 98 – Response Outside Scope
(Not Used)
Code 99 – Not Stated




                                     Page 6
Level 3 Codeset Changes

Current State                            Proposed Change
Forty one Level 3 Codes (three not       Forty two Level 3 Codes (two not
used in MOH Systems)                     used in MOH Systems)
Code 120 – Other European NFD            Retire Code 120

Code 541 - Other                         Retire Code 541

                                         Addition of:
                                         Code 611 – Other Ethnicity
Residual Codes                           Addition of:
Code 966 – Repeated Value (Not           Code 944 – Don‟t Know
Used)                                    Code 955 – Refused to Answer
Code 977 – Response Unidentifiable
(Not Used)                         Introduce use of:
Code 988 – Response Outside Scope Code 977 – Response Unidentifiable
(Not Used)
Code 999 – Not Stated




                                     Page 7
Level 4 Codeset Changes

Current State                          Proposed Change
Two hundred and thirty one Level 4     Two hundred and thirty nine Level 4
codes (three not used in MOH           codes (two not used in MOH
Systems)                               Systems)
Code 12100 – Other European NFD        Retire
Code 37100 – Other Pacific Peoples     Code 12100
NFD                                    Code 37100
Code 53111 - Black                     Code 53111
Code 54100 – Other NFD                 Code 54100

Code 12111 – Celtic                    Code 12111 – Celtic NFD
                                       (Description Change)
                                       Addition of:
                                       12516 – Bosnian
                                       12949 – Afrikaner
                                       12950 – Zimbabwean
                                       43117 – Anglo Indian
                                       44416 – Eurasian
                                       53120 – Eritrean
                                       53121 – Ethiopian
                                       53122 – Ghanaian
                                       53199 – African nec
                                       61111 – Central American Indian
                                       61112 – Inuit
                                       61113 – North American Indian
                                       61114 – South American Indian
                                       61115 – Mauritian
                                       61116 – Seychelles Islander
                                       61117 – South African Coloured
                                       61118 – New Zealander
                                       61199 – Other Ethnicity nec
Existing Residual Codes                Additional Residual Codes:
Code 96666 – Repeated Value (Not       Code 94444 – Don‟t Know
Used)                                  Code 95555 – Refused to Answer
Code 97777 – Response
Unidentifiable (Not Used)              Introduction of use of
Code 98888 – Response Outside          Code 97777 – Response
Scope (Not Used)                       Unidentifiable
Code 999 – Not Stated




                                   Page 8
2009 Protocols Prioritisation for Level 2


             Ethnic
Priority     group
order        code (L2)   Ethnic group code description
         1          21   Maori
         2          35   Tokelauan
         3          36   Fijian
         4          34   Niuean
         5          33   Tongan
         6          32   Cook Island Maori
         7          31   Samoan
         8          37   Other Pacific Peoples
         9          30   Pacific Peoples not further defined
        10          41   Southeast Asian
        11          43   Indian
        12          42   Chinese
        13          44   Other Asian
        14          40   Asian not further defined
        15          52   Latin American / Hispanic
        16          53   African (or cultural group of African origin)
        17          51   Middle Eastern
        18          61   Other Ethnicity
        19          54   Other
        20          12   Other European
        21          10   European not further defined
        22          11   New Zealand European
        94          94   Don‟t Know
        95          95   Refused to Answer
        97          97   Response Unidentifiable
        99          99   Not stated




                                    Page 9
Republish the Appendices (as per 2004 EDP)

Level one

Code                               Description
1                                  European
2                                  Maori
3                                  Pacific Peoples
4                                  Asian
5                                  Middle Eastern/Latin
                                   American/African
6                                  Other ethnicity
9                                  Residual Categories

Level two

Code                               Description
10                                 European nfd
11                                 New Zealand European
12                                 Other European
21                                 Maori
30                                 Pacific Peoples nfd
31                                 Samoan
32                                 Cook Islands Maori
33                                 Tongan
34                                 Niuean
35                                 Tokelauan
36                                 Fijian
37                                 Other Pacific Peoples
40                                 Asian nfd
41                                 Southeast Asian
42                                 Chinese
43                                 Indian
44                                 Other Asian
51                                 Middle Eastern
52                                 Latin American
53                                 African
61                                 Other ethnicity
94                                 Don‟t Know
95                                 Refused to Answer
97                                 Response Unidentifiable
99                                 Not Stated




                               Page 10
Level three

Code              Description
100               European nfd
111               New Zealand European
120               Other European nfd
121               British and Irish
122               Dutch
123               Greek
124               Polish
125               South Slav
126               Italian
127               German
128               Australian
129               Other European
211               Maori
300               Pacific Peoples nfd
311               Samoan
321               Cook Islands Maori
331               Tongan
341               Niuean
351               Tokelauan
361               Fijian
371               Other Pacific Peoples
400               Asian nfd
410               Southeast Asian nfd
411               Fillipino
412               Cambodian
413               Vietnamese
414               Other Southeast Asian
421               Chinese
431               Indian
441               Sri Lankan
442               Japanese
443               Korean
444               Other Asian
511               Middle Eastern
521               Latin American / Hispanic
531               African
611               Other Ethnicity
944               Don‟t Know
955               Refused to Answer
977               Response Unidentifiable
999               Not Stated




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Level 4

Code          Description
10000         European NFD
11111         New Zealand European
12000         Other European NFD
12100         British NFD
12111         Celtic
12112         Channel Islander
12113         Cornish
12114         English
12115         Gaelic
12116         Irish
12117         Manx
12118         Orkney Islander
12119         Scottish (Scots)
12120         Shetland Islander
12121         Welsh
12199         British NEC
12211         Dutch/Netherlands
12311         Greek (including Greek Cypriot)
12411         Polish
12500         South Slav (formerly Yugoslav
              groups) NFD
12511         Croat/Croatian
12512         Dalmatian
12513         Macedonian
12514         Serb/Serbian
12515         Slovene/Slovenian
12599         South Slav (formerly Yugoslav
              groups) NEC
12611         Italian
12711         German
12811         Australian
12911         Albanian
12912         Armenian
12913         Austrian
12914         Belgian
12915         Bulgarian
12916         Belorussian
12917         Corsican
12918         Cypriot Unspecified
12919         Czech
12920         Danish
12921         Estonian
12922         Finnish
12923         Flemish
12924         French



          Page 12
Code        Description
12925       Greenlander
12926       Hungarian
12927       Icelander
12928       Latvian
12929       Lithuanian
12930       Maltese
12931       Norwegian
12932       Portuguese
12933       Romanian / Rumanian
12934       Romany / Gypsy
12935       Russian
12936       Sardinian
12937       Slavic / Slav
12938       Slovak
12939       Spanish
12940       Swedish
12941       Swiss
12942       Ukrainian
12943       American (US)
12944       Burgher
12945       Canadian
12946       Falkland Islander / Kelper
12947       New Caledonian
12948       South African
12949       Afrikaner
12950       Zimbabwean
12999       European NEC
21111       Maori
30000       Pacific peoples NFD
31111       Samoan
32100       Cook Island Maori NFD
32111       Aitutaki Islander
32112       Atiu Islander
32113       Mangaia Islander
32114       Manihiki Islander
32115       Mauke Islander
32116       Mitiaro Islander
32117       Palmerston Islander
32118       Penrhyn Islander
32119       Pukapuka Islander
32120       Rakahanga Islander
32121       Rarotongan
33111       Tongan
34111       Niuean
35111       Tokelauan
36111       Fijian (except Fiji Indian / Indo-Fijian)
37111       Admiralty Islander



        Page 13
Code        Description
37112       Australian Aboriginal
37113       Austral Islander
37114       Belau / Palau Islander
37115       Bismark Archipelagoan
37116       Bougainvillean
37117       Caroline Islander
37118       Easter Islander
37119       Gambier Islander
37120       Guadalcanalian
37121       Guam Islander / Chamorro
37122       Hawaiian
37123       Kanaka / Kanak
37124       I-Kiribati / Gilbertese
37125       Malaitian
37126       Manus Islander
37127       Marianas Islander
37128       Marquesas Islander
37129       Marshall Islander
37130       Nauru Islander
37131       New Britain Islander
37132       New Georgian
37133       New Irelander
37134       Ocean Islander / Banaban
37135       Papuan / New Guinean / Irian Jayan
37136       Phoenix Islander
37137       Pitcairn Islander
37138       Rotuman / Rotuman Islander
37139       Santa Cruz Islander
37140       Society Islander (including Tahitian)
37141       Solomon Islander
37142       Torres Strait Islander / Thursday
            Islander
37143       Tuamotu Islander
37144       Tuvalu Islander / Ellice Islander
37145       Vanuatu Islander / New Hebridean
37146       Wake Islander
37147       Wallis Islander
37148       Yap Islander
37199       Other Pacific peoples NEC
40000       Asian NFD
41000       Southeast Asian NFD
41111       Filipino
41211       Khmer / Kampuchean / Cambodian
41311       Vietnamese
41411       Burmese
41412       Indonesian (including Javanese /
            Sundanese / Sumatran)



        Page 14
Code        Description
41413       Lao / Laotian
41414       Malay / Malayan
41415       Thai / Tai / Siamese
41499       Other Southeast Asian NEC
42100       Chinese NFD
42111       Hong Kong Chinese
42112       Kampuchean Chinese
42113       Malaysian Chinese
42114       Singaporean Chinese
42115       Vietnamese Chinese
42116       Taiwanese Chinese
42199       Chinese NEC
43100       Indian NFD
43111       Bengali
43112       Fijian Indian / Indo-Fijian
43113       Gujarati
43114       Tamil
43115       Punjabi
43116       Sikh
43117       Anglo Indian
43199       Indian NEC
44100       Sri Lankan NFD
44111       Sinhalese
44112       Sri Lankan Tamil
44199       Sri Lankan NEC
44211       Japanese
44311       Korean
44411       Afghani
44412       Bangladeshi
44413       Nepalese
44414       Pakistani
44415       Tibetan
44499       Other Asian NEC
51100       Middle Eastern NFD
51111       Algerian
51112       Arab
51113       Assyrian
51114       Egyptian
51115       Iranian / Persian
51116       Iraqi
51117       Israeli / Jewish / Hebrew
51118       Jordanian
51119       Kurd
51120       Lebanese
51121       Libyan
51122       Moroccan
51123       Omani



        Page 15
Code        Description
51124       Palestinian
51125       Syrian
51126       Tunisian
51127       Turkish (including Turkish Cypriot)
51128       Yemeni
51199       Middle Eastern NEC
52100       Latin American / Hispanic NFD
52111        Argentinian
52112       Bolivian
52113       Brazilian
52114       Chilean
52115       Colombian
52116       Costa Rican
52117       Creole (Latin America)
52118       Ecuadorian
52119       Guatemalan
52120       Guyanese
52121       Honduran
52122       Malvinian (Spanish-speaking Falkland
            Islander)
52123       Mexican
52124       Nicaraguan
52125       Panamanian
52126       Paraguayan
52127       Peruvian
52128       Puerto Rican
52129       Uruguayan
52130       Venezuelan
52199       Latin American / Hispanic NEC
53100       African NFD
53112       Creole (US)
53113       Jamaican
53114       Kenyan
53115       Nigerian
53116       African American
53117       Ugandan
53118       West Indian / Caribbean
53119       Somali
53120       Eritrean
53121       Ethiopian
53122       Ghanian
53199       Other African NEC
61111       Central American Indian
61112       Inuit / Eskimo
61115       Mauritian
61113       North American Indian
61116       Seychelles Islander



        Page 16
Code        Description
61114       South American Indian
61117       South African Coloured
61118       New Zealander
61199       Other NEC
94444       Don't Know
95555       Refused to Answer
97777       Response unidentifiable
99999       Not stated




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