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Public Health

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Short Communication

Census categories for mixed race and mixed

ethnicity: impacts on data collection and analysis
in the US, UK and NZ

S.A. Valles a,*, R.S. Bhopal b, P.J. Aspinall c

a
Lyman Briggs College and Department of Philosophy, Michigan State University, Holmes Hall, 919 E. Shaw Lane,
Room W25-C, East Lansing, MI 48825, USA
b
Edinburgh Migration, Ethnicity and Health Research Group, Public Health Sciences, University of Edinburgh,
Edinburgh, UK
c
Centre for Health Services Studies, School of Social Policy, Sociology and Social Research, University of Kent,
Canterbury, Kent, UK

article info
Article history:
Received 2 July 2014
Received in revised form
15 December 2014
Accepted 21 December 2014
Available online 25 February 2015
Introduction
Public health researchers and practitioners have made
increasing efforts to study mixed race and mixed ethnicity
populations, with national census categories at the founda-
tion of data collection. Public health research and practice in
these populations must contend with a series of challenges.
First, the total self-reported mixed race/mixed ethnicity group
remains small though growing: 1.2 million persons of ‘mixed/
multiple’ ethnicity in England and Wales in 2011, or 2.2% of
the total population; nine million persons of ‘two or more
races’ in the USA in 2010, or 2.9% of the total population; 453
thousand persons of multiple ethnicity in New Zealand in
2013, or 11.2% of its population.1,2 Second, combinations of
racial and ethnic status are necessarily heterogeneous. Third,
development of terminology and categories suitable for use
with mixed populations is challenging and there are no
inherently ‘correct’ terms. Fourth, the body of existing evi-
dence on mixed populations' health remains scattered and
small, impeding the creation of well-informed public health
policies.
These challenges need to be overcome since the limited
evidence suggests mixed race/ethnicity populations have
distinct health needs. For example, the Scottish Health and
Ethnicity Linkage Study (SHELS) shows high relative risks of
lung cancer among mixed populations.3 The National Health
Interview Survey shows high relative risks among mixed
populations for conditions including heart disease and
asthma.4 Meanwhile, other data suggest that mixed pop-
ulations have relatively good health in certain domains, e.g.
high rates of physical activity among US adults reporting two
or more races.4
The US, UK and NZ have distinct histories of racial/ethnic
diversity and migration, as well as locally contingent needs for
demographic classification and monitoring. Despite those
differences they have ended up experiencing a closely related
set of obstacles in the recording and reporting of mixed pop-
ulations. The US system is designed to account for a combi-
nation of European colonization, indigenous populations,
forced migration (slavery) and voluntary migration.5,6 The UK
system is designed to account for migration from regions that
it has colonized, along with a variety of other migrants.1 The

* Corresponding author. Tel.: þ1 517 884 0592; fax: þ1 517 432 2758.
E-mail address: valles@msu.edu (S.A. Valles).
http://dx.doi.org/10.1016/j.puhe.2014.12.017
0033-3506/© 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
 p u b l i c h e a l t h 1 2 9 ( 2 0 1 5 ) 2 6 6 e2 7 0 267

Table 1 e Census formats for mixed race/ethnicity responses in US, UK and NZ.
Country, census year Census question format for mixed race/ethnicity
The United States, 2010 One question about race, with option to tick one or more of 15
boxes; a separate question about whether or not one is of Hispanic
origin (ethnicity)
England and Wales, 2011 One question about ethnic group, including option to choose only
one of 18 tick boxes, including three dual-ethnicity tick box options
(e.g. ‘White and Black Caribbean’) and a tick box with write-in
space for other multi-ethnic responses.
New Zealand, 2013 One question about ethnic group, with option to tick one or more of
nine boxes.

NZ system is designed to account for the interactions between
European colonists, indigenous Ma  ori and regional migrants.7
The UK and NZ utilize ethnicity concepts, while the US utilizes
a combination of race concepts and ethnicity concepts; all
three collect data on mixed populations. However, an over-
lapping set of impediments in the processes of data input and
data output of mixed race/ethnicity data has prevented health
care services in the three countries from adequately attending
to mixed populations' public health needs.
This paper provides a limited selection of relevant literature
from the three different contexts, analyses them, and high-
lights similarities between them. Its aim is to present pre-
liminary findings from continuing research in order to
stimulate conversation and research regarding the public
health needs of mixed populations. So long as the impedi-
ments described in this paper remain in place, it is not possible
to adequately monitor and respond to the health needs of
mixed populations. Mixed populations present unique race/
ethnicity classification challenges,1 but it remains imperative
that public health experts attend to their needs.
England and Wales version of the census question is included
in Fig. 2; Scotland and Northern Ireland each use a generic
‘mixed’ tick box accompanied by write-in space. Generic
‘mixed’ categories in Scotland and Northern Ireland may
change as the mixed populations increase in size and greater
subgroup specificity is required. In the meantime, all three UK
systems are poorly suited for collecting information about
those who identify with less common two-ethnicity combina-
tions (e.g. Black African and Asian), or with three or more
ethnicities.
New Zealand
NZ's mixed population terminology has moved from ‘race’ to
‘ethnic origin’ and finally to ‘ethnic group.’7 Of the three
countries reviewed in this paper, NZ has by far the largest
proportion of its population identifying as mixed (11.2%).2 Yet,

Mixed race/ethnicity in three countries' censuses

Table 1 summarizes the mixed race/ethnicity measurement

approaches taken in the US, UK and NZ. The full census
questions appear in the three figures.

The United States

In 1997, the Office of Management and Budget standards were

revised to begin allowing the reporting of multiple races,
rather than just one. These standards still provide the mini-
mum requirements for federal demographic data collec-
tiondfive race categories plus Hispanic ethnicitydbut it is
permissible to expand individual categories or to add an
‘Other’ option, as shown in Fig. 1, the 2010 census categories.
In clinical contexts, race and ethnicity data collection is
inconsistent and data sharing is very limited due to the
country's complex network of public and private health care
providers, insurers, records offices, etc.5

The United Kingdom

Mixed ethnicity status is recognized in the UK censuses for

Scotland, England and Wales, and Northern Ireland. The Fig. 1 e The United States.
268 p u b l i c h e a l t h 1 2 9 ( 2 0 1 5 ) 2 6 6 e2 7 0
Fig. 2 e England and Wales.
as discussed in the next section, the country has faced diffi-
culties when trying to create statistical policies to record its
diversity. The current census classifications are provided in
Fig. 3.
Fig. 3 e New Zealand.
International challenges
There are two classes of problems related to application of
census mixed race/ethnicity categories for the monitoring of
mixed populations' health in all three countries studied: data
input problems and data output problems. The data input
problems relate to the design of census race and ethnicity
categories and their implementationdgathering census data,
collecting patients' demographic information in hospitals, etc.
Data output problems include deciding when, where and how
race or ethnicity data should be reported, e.g. using prioriti-
zation to prevent confusion due to double-counting of sub-
jects who report two ethnicities.
Data input
In the domain of data input, all three countries recognize the
importance of collecting data on mixed populations, with the
censuses leading such efforts, but practice has failed to live up
to recommended standards of completeness and precision. A
2010 report notes the wide divergence between NZ mixed
ethnicity identifications in the 2006 census (10.4% of the
population) vs. medical records (<0.5% of the population).7
This indicates that providing resources for multiple race/
ethnicity patient recording is insufficient for adequate collec-
tion. Similarly, in the UK there are indications that the quality
of ethnicity data are inconsistent, especially for mixed
ethnicity groups (‘for patients who self-report being of mixed
ethnic groups, [Hospital Episode Statistics] records are usually
discordant.’).8 In the US, inconsistent ‘health information
technology’ resources impede data collection, such as soft-
ware systems that require entering race data in a single tick
box (including common dual-race combinations), rather than
allowing the selection of multiple tick boxes.5 In one attempt
to partially fill this data gap, SHELS has linked the census,
 p u b l i c h e a l t h 1 2 9 ( 2 0 1 5 ) 2 6 6 e2 7 0
death records and hospitalization and cancer registry data, as
a means of producing data on a wide range of groups including
those of mixed ethnicity.3
A difficulty in all three countries is the lack of reproduc-
ibility of data. Peer groups, geography, social status, etc. all
continuously shape individuals' ethnic and racial identities.
Data from Britain indicate that almost half (45%) of a sample
of 326 young mixed race/ethnicity respondents reported that
they switched identities depending on situation and
context.1 In the US a postcensus validation survey of non-
Hispanic panel respondents reporting two or more races in
the 2000 Census found that only 40% (724,686/1,814,610) ‘also
reported two or more races in the [Census Quality Survey]
initial contact,’ 60% switching to reporting a single race.6 An
analysis of the 1991 and 1996 NZ censuses suggests sub-
stantial ethnicity mobility, e.g. 23% inflow and 6% outflow
for the Ma  ori ethnic group in 1996 compared to the 1991
group.9
Data output
In the domain of data output, while data collection methods in
all three countries allow multiple ethnicities to be recorded,
publications frequently exclude mixed populations. These
exclusions may arise because of small numbers, lack of pri-
ority or difficulties in interpretation. Small subpopulation
sizes can sometimes cause problems in protecting the ano-
nymity of subjects. Such problems can be managed by means
other than removing those subpopulations from reports, such
as data perturbation strategies that modify data in order to
protect the anonymity of subjects.10
Data prioritization practices conceal data about mixed
race/ethnicity people by funnelling their data into single racial
or ethnic categories during data preparation and analysis.
This has the benefit of allowing easy and intuitive compari-
sons when examining phenomena, such as relative rates of a
disease in black vs. white populations by treating those pop-
ulations as non-overlapping.5 For example, in a study of
reproductive health care in the US, the authors describe, ‘in-
dividuals who reported multiple races/ethnicities were clas-
sified giving first priority to identification as ‘Hispanic’ and
second priority to identification as ‘black.’ Based on this cod-
ing, dummy variables were constructed for black, Hispanic, and
Asian compared to white.’11 The US context makes such
practices particularly problematic because race and ethnicity
are considered by the census to be distinct types of categories,
so those reporting Hispanic ethnicity do not have their self-
identified race(s) reported.
Statistics New Zealand, the government office responsible
for the census, recommended against prioritization in 2004,
but the practice is common in NZ biomedical research publi-
cations.7 A 2012 article reiterates that the benefits of prioriti-
zation are greatly outweighed by the costs, partly due to data
ambiguities such as whether or not growing rates of mela-
noma in the Ma  ori category are concentrated amongst those
 ori and European ethnic groups.12 In the
recording (both) Ma
US, it is common practice in various contexts to reclassify
mixed race individuals into a single race category when
reporting demographic data, including ‘when addressing civil
rights claims.’5
269
Due to the relatively small sizes of mixed populations,
two troubling trends have remained prevalent: 1) neglecting
mixed populations and hence contradicting government ef-
forts to include them in demographic data, and 2) lumping
mixed populations in with single race/ethnicity populations
in a manner that conceals substantial population heteroge-
neity. The net result is that people report their complex
ethnic/racial identities only to have that complexity ignored,
preventing adequate public health surveillance of these
populations.
Conclusion
This analysis has shown the difficulties three nations have in
using their census categories for collecting and disseminating
data on mixed race/ethnicity populations. Despite widely
varying local contexts (histories, populations, etc.) a common
set of challenges has arisen, in the domains of data input and
data output. Identifying that these challenges are indeed
common across contexts is an important step toward their
amelioration. The authors stress that progress cannot be
made until greater attention is paid to the existing practical
and theoretical obstacles.
Author statements
Acknowledgements
The authors thank Laurence Gruer, Kyle Whyte and the
Edinburgh Migration, Ethnicity and Health Research Group for
their comments on this work.
Ethical approval
Not required; the project only examines previously published
literature and does not involve interactions with human/ani-
mal participants/tissue or protected data.
Funding
None declared.
Competing interests
None declared.
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