Inner West Sydney Medicare Local. Canterbury Local Government Area. Final Population Health Sub Regional Profile. HealthConsult Pty Ltd

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1 Inner West Sydney Medicare Local CANTERBURY LOCAL GOVERNMENT AREA HEALTH PROFILE Final Population Health Sub Regional Profile HealthConsult Pty Ltd ACN /93 Liverpool Street, Sydney, New South Wales, 2000 Phone (02) Fax (02) Stonebridge Way, Attwood, Victoria 3049 Phone (03) (02) January, 2013 / v5.0

2 Contents INTRODUCTION... 1 POPULATION AND COMMUNITY CHARACTERISTICS POPULATION CHARACTERISTICS BIRTHS AND MATERNAL HEALTH CULTURAL CHARACTERISTICS EDUCATION LEVELS SOCIO-ECONOMIC CHARACTERISTICS ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITY HOMELESSNESS HEALTH RISKS OF THE POPULATION HEALTH RISK FACTORS LONG TERM CONDITIONS, CHRONIC DISEASE AND DISABILITY CHRONIC DISEASES CANCER MORTALITY INFECTIOUS DISEASES DISABILITY HEALTH SERVICE UTILISATION PRIMARY CARE UTILISATION EMERGENCY AMBULATORY-CARE SENSITIVE ADMISSIONS HOME AND COMMUNITY CARE HEALTH SERVICE AVAILABILITY HOSPITALS AND DAY SURGERY GENERAL PRACTICE ALLIED HEALTH COMMUNITY HEALTH SERVICES AGED CARE APPENDIX A: POSTCODE TO LGA / SLA CORRESPONDENCES APPENDIX B: DATA LIMITATIONS AND ASSUMPTIONS... 34

3 1 Introduction This health profile is one of a series of profiles that outlines the health of residents of the Inner West Sydney Medicare Local (IWSML) and Sydney Local Health District (SLHD) catchment area. The catchment comprises Local Government Areas (LGAs) of Ashfield, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Strathfield and Statistical Local Areas (SLAs) of Sydney South and Sydney West and is referred to as the Inner West Sydney catchment. This profile describes the characteristics of the (LGA) population and compares it with the populations of the Inner West Sydney catchment and NSW. 1 (pop: 137,454) occupies 33.4 kilometres and is the largest LGA in Inner West Sydney. It is comprised of 17 suburbs including Croydon Park (postcode 2133), Belfield (postcode 2191), Belmore (postcode 2192), Ashbury (postcode 2193), Canterbury (postcode 2193 ), Hurlstone Park (postcode 2193), Campsie (postcode 2194), Lakemba (postcode 2195), Wiley Park (postcode 2195), Punchbowl (postcode 2196), Roselands (postcode 2196), Clemton Park (postcode 2206), Earlwood (postcode 2206), Kingsgrove (postcode 2208 ), Beverly Hills (postcode 2209), Narwee (postcode 2209), and Riverwood (postcode 2210). Canterbury is rich in cultural diversity and is home to residents from over 129 different countries. 2 Over half of the population was born overseas, with 46% born in non-english speaking countries. Canterbury is also home to a large number of humanitarian entrants, with the majority from China, Sierra Leone, Burma and Iraq. With high levels of unemployment and the average household income level lower than that of any other LGA within Inner West Sydney, Canterbury is challenged in terms of levels of disadvantage, ranking as the 17 th most-disadvantaged LGA within NSW and the most disadvantaged LGA within the catchment. In comparison to other LGAs within the catchment, Canterbury has higher rates of smoking (19.6%), physical inactivity (42%) and obesity (16.3%). Levels of physical inactivity and obesity in Canterbury are also higher than the NSW average. The prevalence of some chronic conditions including Type 2 Diabetes, circulatory system conditions and lung cancer is higher in Canterbury 1 Users of this information are strongly advised to refer to the source data to ensure accuracy, and to take note of the data explanations which accompany the profile to ensure the information provided is interpreted appropriately and that the data limitations are understood. Reference can be made to the source data through the links and/or references provided. This health profile should be read in conjunction with more detailed information on the health of the local population provided by IWSML and SLHD on their websites: and Additional information can also be obtained from the NSW Chief Health Officer s Report 2010 and Health Statistics NSW. Available at and from the NSW Adult Population Health Surveys: 2 Canterbury County Council, Community Strategic Plan: Imagine Canterbury, viewed 30 th October 2012, Inner West Sydney Medicare Local and Sydney Local Health District Page 1 Population Health LGA/SLA Profile v1.0 February 2013

4 than the catchment and NSW. Another area of concern is the rate of Hepatitis B which at 8.69% is higher than the catchment (4.68%) and NSW (0.28%). Given the population profile of Canterbury, the challenge will not only be providing high quality services but also delivering services which are culturally sensitive and appropriate. Indicator Table 1: Characteristics of the Canterbury LGA at a glance Value LGA Rank within Inner West Sydney Inner West Sydney NSW Population^ 137,454* 1 st 548,627 6,917,656 Population growth forecast (2011 to 2025) # 12.0% 8 th 22.1% 20.3% % Indigenous persons # 0.6% 5 th 0.9% 2.5% Median annual household income^ $53,508 9 th $78,930 α $64,324 Unemployment # 7.3% 1 st 5.5% 5.7% % English as primary language^ 32.3% 9 th 54.9% 72.5% Private Health Insurance coverage # 35.6% 9 th 50.9% 48.2% Broadband internet penetration # 63% 9 th 73.4% 69.9% Disability has need for assistance with core activities^ 5.3% 2 nd 4.2% 4.9% Actual Births^ 2,442 1 st 9,041 97,602 Source: ^Australian Bureau of Statistics; # Public Health Information Development Unit and Australian Bureau of Statistics Note: α Derived by HealthConsult based on income data published by the Australian Bureau of Statistics (2011) * This population number is based on first count data. The values based on estimated resident data (ERP) are 144,751 and 582,100 respectively. Inner West Sydney Medicare Local and Sydney Local Health District Page 2 Population Health LGA/SLA Profile v1.0 February 2013

5 2 Population and community characteristics Headlines The most disadvantaged LGA within the catchment, with the lowest average annual income and highest unemployment rate (7.34%); Most culturally and linguistically diverse of any LGA, with 32.3% of residents identifying English as their primary language, 16.9% Southern European, 15.3% Middle- Eastern and 15.1% Eastern Asian; Lowest proportion of residents with private health insurance coverage (35.6%) of any LGA; High intake of refugees and migrants, particularly from China, Sierra Leone, Burma and Iraq; and Significant numbers of persons living in overcrowded dwellings. 2.1 POPULATION CHARACTERISTICS The population profile of the Canterbury LGA includes a higher proportion of young children and teenagers compared to the overall catchment, but a relatively lower proportion of adults aged between 20 to 44 years. The proportion of middle-aged and elderly residents is generally consistent with the overall catchment, but is lower than the equivalent population proportions for persons aged 50 years and above across NSW. Figure 1: Population profile (by age) vs Inner West Sydney and state comparators, 2011 Source: Public Health Information Development Unit and Australian Bureau of Statistics (2012) Inner West Sydney Medicare Local and Sydney Local Health District Page 3 Population Health LGA/SLA Profile v1.0 February 2013

6 Population growth estimates shown in Figure 2 indicate significantly lower population growth in Canterbury for all age groups (except 85+ years), compared to population growth estimates for the catchment and NSW. Growth in persons aged 60 years and below is forecast to be well below 10% in most cases, compared to an average population growth rate of 17.5% across the catchment for persons aged below 60 years. High population growth is expected to be fuelled by two key developments the former Sunbeam Factory and the Riverwood North Redevelopment, representing a total of 1,450 new dwellings. The highest rate of population growth is expected to occur in older persons aged 60 years or above. Although growth rates for persons aged 60 years and above are also below forecasts for the catchment and NSW, the interaction between very low growth in young persons and sustained growth in the aged population will create significant challenges to meeting population health needs in the medium-to-long-term. The consistent growth in aged persons will require an expansion of health service availability, however, the low population growth in persons of working age is likely to create workforce supply shortages. This is a significant consideration that will require a coordinated response from a broad range of organisations and agencies, to ensure that an adequate supply of health care services will be available to service the diverse cultural and health needs of Canterbury residents. Figure 2: Forecast population growth (by age) vs Inner West Sydney and state comparators, 2011 to 2025 Source: Public Health Information Development Unit and Australian Bureau of Statistics (2012) Table 2 and Figure 3 illustrate the projected changes in population numbers and number of people in different age groups in the City of Canterbury LGA from The projected population numbers are based on the estimated resident population numbers released by the NSW Planning Department in 2009 and differ from those in Figure 2. In 2007/08, the population density in Canterbury was 4,099.9 (population/area). 3 3 NSW Department of Local Government 2009, Comparative Information on NSW Local Government Councils 2007/08, accessed 28 June Available at: Inner West Sydney Medicare Local and Sydney Local Health District Page 4 Population Health LGA/SLA Profile v1.0 February 2013

7 Table 2: Projected population, Canterbury LGA and Inner West Sydney 2006, 2011, 2016, 2021 and 2031 Population Canterbury Inner West Sydney projections Total population 135, , , , , , , , , ,211 Aged 0 4 years 9,775 10,851 10,843 10,805 10,946 31,043 37,279 38,469 39,425 41,571 Aged 5 14 years 17,192 17,664 18,568 19,155 19,301 49,018 53,637 60,076 64,014 66,763 Aged years 17,840 18,012 18,552 18,646 19,739 73,914 75,761 77,464 79,603 87,569 Aged years 42,063 41,789 42,220 42,648 44, , , , , ,486 Aged years 30,780 32,987 34,108 34,555 34, , , , , ,676 Aged years 16,083 16,708 17,829 19,162 22,217 54,463 59,580 67,995 76,761 94,544 Aged 85 years+ 1,872 2,343 2,755 2,928 3,679 7,388 8,890 10,388 11,381 15,603 Source: NSW Health Population Projection Series 1, 2009 Figure 3: Canterbury LGA projected population by age groups 2006, 2011, 2016, 2021 and 2031 Source: NSW Health Population Projection Series 1, 2009 Concurrent with population growth are proposed increases in the number of local homes and jobs. The NSW Government s Metropolitan Strategy, South Subregion, Draft Subregional Strategy has set a target of an additional 7,100 dwellings from 2004 to and a target of 31,000 local jobs in 2031, an increase of 500 from BIRTHS AND MATERNAL HEALTH Table 3 and Figure 4 show the number of births to Canterbury residents in the period The annual number of births increased between 2006 and 2010 and then decreased in The fertility rate has increased steadily between 2006 and 2010/2011. The fertility rate in Canterbury (2.21) is higher than that for NSW (1.91). 4 Department of Planning, NSW Government, NSW Government s Metropolitan Strategy, South Subregion, Draft Subregional Strategy. Accessed 20 July Available at: 5 Department of Planning, NSW Government, NSW Government s Metropolitan Strategy, South Subregion, Draft Subregional Strategy. Accessed 20 July Available at:http://www.metrostrategy.nsw.gov.au/linkclick.aspx?fileticket=z1r5gtrkuva%3d&tabid=65 Inner West Sydney Medicare Local and Sydney Local Health District Page 5 Population Health LGA/SLA Profile v1.0 February 2013

8 Table 3: Births to Canterbury Residents and Fertility Rate Year Canterbury births Canterbury total fertility rate NSW total fertility rate , , , , , , Source: ABS 2011 Catalogue No DO004_2011 Figure 4: Births to Canterbury Residents Source: ABS 2011 Catalogue No DO004_2011 The overall immunisation coverage rates for children aged 0 to 84 months calculated from the General Practice Immunisation Incentives Scheme for the August 2012 quarter for the Inner West Sydney catchment is 89.4%. Maternal indicators are presented in Table 4 and have been extracted from NSW Health Chief Health Officer s Report 2010 and Australian Bureau of Statistics web pages. Whilst smoking in pregnancy rates are significantly below the State average, so are antenatal attendance rates. Inner West Sydney Medicare Local and Sydney Local Health District Page 6 Population Health LGA/SLA Profile v1.0 February 2013

9 Table 4: Maternal health indicators, Canterbury LGA and NSW Maternal indicator Canterbury NSW Actual births ,442 99,054 Total fertility rate Smoking at all during pregnancy, 2008 to 2010 combined, number of mothers who smoked per year, smoothed estimate of standardised prevalence ratio First antenatal visit before 14 weeks of gestation, 2008 to 2010 combined, smoothed percent of pregnancies, smoothed standardised prevalence ratio 163 (58.8) % (87.6) - Source: ABS 2011 Catalogue No DO004_2011 and NSW Health Chief Health Officer s Report # 2010 only; - below the state average at 1% level of significance 11,235 (100) 79.3% # (100) 2.3 CULTURAL CHARACTERISTICS The Canterbury LGA is characterised by a high level of cultural and linguistic diversity, and it is the most culturally diverse LGA within the catchment. As shown in Figure 5, the spread of persons that speak a language other than English at home is far greater than the cultural mix of the catchment or NSW. Aside from persons that speak primarily English, the Canterbury population is comprised mostly of persons that identify their primary language as Arabic (14.5%), Chinese (12.7%), Greek (10.6%), Indo-Aryan/Indian (8.7%), Mon-Khmer (4.1%) and Italian (3.1%). 14.7% of residents indicated that they speak English not well or not at all. Figure 5: Primary language spoken at home vs Inner West Sydney and state comparators, 2011 Source: Australian Bureau of Statistics (2011) Table 5 also shows that the cultural diversity of the Canterbury LGA is underpinned by a large number of refugee entrants under the Humanitarian Migration Stream between 2005 and Canterbury is registered as receiving more than five times the number of refugees (1,365) than the Sydney City SLA, which accepted the next highest number of refugees (259). Although refugee arrivals to Canterbury were from a broad variety of countries, most arrived from China (276; 20.3%), Sierra Leone (216; 15.8%), Burma (127; 9.3%) and Iraq (113; 8.3%). The high numbers of refugee entrants add a further degree of complexity to the complex cultural and health needs of the Canterbury population. 6 ABS Births Australia Available at Accessed 11 November Total fertility rate represents the number of children a female would bear during her life if she experienced current age-specific fertility rates at each age of her reproductive life. (ABS 2007) 8 ABS Births Australia Available at Accessed 11 November Inner West Sydney Medicare Local and Sydney Local Health District Page 7 Population Health LGA/SLA Profile v1.0 February 2013

10 Table 5: Humanitarian entrants to LGAs within the Inner West Sydney Medicare Local, 2005 to 2011 Country of Origin Leichhardt Marrickville Sydney Canterbury Ashfield Burwood Canada Bay Strathfield TOTAL BANGLADESH BURMA CHINA PEOPLES REP EGYPT ARAB REP OF ETHIOPIA GUINEA INDONESIA IRAN IRAQ LEBANON MONGOLIA NEPAL PAKISTAN PALESTINIAN AUTHORITY SIERRA LEONE SRI LANKA SUDAN THAILAND TURKEY ORIGIN UNKNOWN TOTAL , ,350 Source: NSW Refugee Health Service Inner West Sydney Medicare Local and Sydney Local Health District Page 8 Population Health LGA/SLA Profile v1.0 February 2013

11 2.4 EDUCATION LEVELS Within the Canterbury LGA, 53% of people aged over 15 years have completed Year 12 schooling (or equivalent). 9 This rate of completion is lower than Greater Sydney (55%) and the catchment overall, but higher than the rate of NSW (47.6%). 2.5 SOCIO-ECONOMIC CHARACTERISTICS The Socio-Economic Indexes For Areas (SEIFA) are used to rank geographic areas across Australia according to their socio-economic characteristics. The Index of Relative Socioeconomic Disadvantage (IRSD) contains indicators of disadvantage such as low income, high unemployment and low levels of education. Relative disadvantage is associated with a low number. The average across Australia is 1,000. A number below 1,000 indicates lower socioeconomic status. Canterbury is the most disadvantaged LGA within Inner West Sydney by a significant margin. The Canterbury LGA s Socio-Economic Indexes For Areas (SEIFA) score for Advantage and Disadvantage is 939, which places it in the 34 th percentile of advantage and disadvantage across NSW, as shown in Figure 6. In comparison, the vast majority of other LGAs within the catchment are among the least disadvantaged across NSW. Figure 6: Comparison of SEIFA Advantage and Disadvantage percentiles across Inner West Sydney, 2011 Source: Australian Bureau of Statistics (2011) Following from its low socio-economic ranking, average annual household incomes within the Canterbury LGA are the lowest of any LGA with the Inner West Sydney. A large proportion of households currently live on incomes between $32,000 and $78,000 per annum, which is a higher proportion than NSW, and significantly greater than the catchment overall. Disadvantage within the Canterbury LGA is reinforced by its high level of unemployment, which is the highest by far of any LGA within the catchment at 7.2%, compared with a NSW average unemployment rate of 5.7% 10. Considering its high level of disadvantage and lower than average incomes, it is not surprising that the Canterbury LGA has the lowest proportion of residents with private health insurance 9 Profile.Id: Canterbury, accessed from 10 Public Health Information Development Unit and Australian Bureau of Statistics (2009) Inner West Sydney Medicare Local and Sydney Local Health District Page 9

12 coverage, at 35.6% 11. This is over 15 percentage points lower than the average across the Inner West Sydney (50.9%), and suggests that residents of Canterbury are far more likely than others across the catchment to engage with the public health system for their health needs than the private system. 2.6 ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITY Canterbury was originally home to the Bediagal people. Indigenous Australians comprise a total of 0.6% of the total population of the Canterbury LGA, which is below the average for both the catchment (0.9%) and NSW (2.5%). The Indigenous population is predominantly young, with over 45% of all Indigenous persons within Canterbury aged 24 or below. Nonetheless, the proportion of Indigenous persons aged 24 or below is generally in line with the proportion across the catchment (43.6%) and is significantly lower than across NSW (55.6%) 12. It is widely recognised that the Aboriginal population has poorer overall health status, however indicators at an LGA level were not available. 2.7 HOMELESSNESS Homelessness data published by the Australian Bureau of Statistics shows that the per-capita rate of homelessness in Canterbury (3.5 persons per 1,000) is significantly lower than the catchment (6.9 persons per 1,000) and slightly above NSW (3.4 persons per 1,000). Figure 7 shows that crowding is a significant issue within Canterbury, as a much higher proportion of people live in severely crowded dwellings (2.0 persons per 1,000) and other crowded dwellings (6.6 persons per 1,000), compared to both the catchment and NSW averages. The rates of overcrowding in Canterbury are the second-highest of any LGA within the catchment, behind Burwood. When both severe and other overcrowding are taken together, the number of persons per-capita living in overcrowded housing in Canterbury (8.6 persons per 1,000) is approximately 60% greater than the catchment overall (5.4 persons per 1,000) 13. Figure 7: Housing and homelessness indicators vs Inner West Sydney and state comparators, 2006 Source: Australian Bureau of Statistics (2006) 11 ibid ( ) 12 Public Health Information Development Unit and Australian Bureau of Statistics (2012) 13 Australian Bureau of Statistics (2006) Inner West Sydney Medicare Local and Sydney Local Health District Page 10

13 Population characteristics of the Canterbury LGA are provided in Table 6. They include indicators reflecting people and culture, disability, the labour force, education and family composition from the Australian Bureau of Statistics (ABS) 2011 Census of Population and Housing. Table 6: Population characteristics of the Canterbury LGA and NSW Population Characteristics Canterbury NSW People and Culture Total persons 137,454 6,917,658 Indigenous persons (comprises Aboriginal and Torres Strait 794 (0.6%) 172,621 (2.5%) Islander) Persons born overseas 66,130 (48.1%) 1,778,548 (25.7%) Country of birth (3 most common responses other than Australia) United Kingdom * 274,823 (4.0%) China 9,806 (7.1%) 156,034 (2.3%) New Zealand * 114,233 (1.7%) Lebanon 6,754 (4.9%) * Greece 5,339 (3.9%) * Language spoken at home English only spoken at home 40,804 (29.7%) 5,013,342 (72.5%) Three most common languages other than English spoken at home Arabic 18,175 (13.2%) 184,252 (2.7%) Mandarin 7,696 (5.6%) 139,825 (2.0%) Cantonese ** 136,374 (2.0%) Greek 13,411 (9.8%) ** Disability 14 Has need for assistance with core activities 7,238 (5.3%) 338,362 (4.9%) Carers 15 Unpaid assistance provided to a person with a disability 12,347 (9.0%) 638,614 (9.2%) Education 16 Highest Year of School Completed Year 12 or equivalent 57,994 (54.9%) 2,631,287 (49.2%) Highest Year of School Completed Year 10 or equivalent 15,727 (14.9%) 1,278,047 (23.9%) Labour force status Total labour force 59,517 3,334,857 Employed full time 34,275 (57.6%) 2,007,925 (60.2%) Unemployed 4,855 (8.2%) 196,526 (5.9%) Income Median individual income ($/weekly) Median household income ($/weekly) 1,029 1,237 Family characteristics Couple families with children 18,544 (51.2%) 831,850 (45.5%) Couple families without children 10,497 (29.0%) 669,019 (36.6%) 14 Source: ABS 2006 CDATA Online. This variable has been developed to measure the number of people with a profound or severe disability. (ABS, 2006, Census Dictionary, 2006, (Reissue) 15 Source: ABS 2006 CDATA Online. This variable recorded people who in the two weeks prior to Census Night spent time providing unpaid care, assistance or help to family members or others because of a long term illness, disability or problems related to old age. It included people who were in receipt of a Carer Payment or Carer Allowance. It did not include work performed via a voluntary group or organisation. (ABS, 2006, Census Dictionary, 2006, (Reissue) 16 Proportion calculated on the total persons 15 years and over who are no longer attending primary or secondary school Inner West Sydney Medicare Local and Sydney Local Health District Page 11

14 One parent families 6,362 (17.6%) 297,904 (16.3%) Household composition occupied private dwellings Family household 34,634 (75.4%) 1,777,398 (71.9%) Lone person household 9,746 (21.2%) 599,148 (24.2%) Dwelling characteristics Total private dwellings 48,657 2,736,637 Median rent ($/weekly) (occupied private) Median housing loan repayment ($/monthly) (occupied private) 2,000 1,993 Occupied private dwellings - fully owned 14,112 (29.0%) 820,006 (30.0%) Occupied private dwellings - rented including rent-free 16,750 (34.4%) 743,050 (27.2%) Source: ABS 2011 Census of Population and Housing * Not one of the three most common responses ** Not one of the three most common languages other than English spoken at home Inner West Sydney Medicare Local and Sydney Local Health District Page 12

15 3 Health risks of the population Headlines Highest proportion of physically inactive persons of any LGA in the catchment (42.8%); Highest reported levels of psychological distress (14.7%) of any LGA in the catchment; Highest proportion of obese persons of any LGA in the catchment (16.3%), but the lowest rate of mortality from obesity-related conditions of any LGA; Highest levels of smoking (19.6%) and risky consumption of alcohol (5.8%) of any LGA; and Highest proportion of women smoking while pregnant of any LGA in the catchment (6.7%). 3.1 HEALTH RISK FACTORS Figure 8 shows that the health risk profile of Canterbury residents is significantly higher than benchmarks at both the catchment and NSW level. Canterbury has the highest proportion of physically inactive residents (42.8%) of any LGA in the catchment by a significant margin (approximately eight percentage points compared to the catchment and NSW averages). It is likely that these low levels of physical activity are related to the high proportion of obese persons in Canterbury (16.3%), which is around three percentage points higher than both the catchment and NSW average. Residents of Canterbury also reported higher behavioural risk factors compared to the catchment and NSW average, including the highest proportion of smokers (19.6%) and persons consuming dangerous amounts of alcohol (5.8%) of any LGA in the catchment. Levels of psychological distress in Canterbury (14.7%) are also the highest across the catchment. A greater proportion of pregnant women in Canterbury (6.7%) smoke during pregnancy than any other LGA in the catchment Public Health Information Development Unit (2005 to 2007) Inner West Sydney Medicare Local and Sydney Local Health District Page 13

16 Figure 8: Health risk factors vs Inner West Sydney and state comparators, Source: Public Health Information Development Unit and Australian Bureau of Statistics National Health Survey Refer to Appendix B 1.3 for definitions of Health Risk Factors described above Table 7 provides detail reflecting health behaviours of residents covered by the Inner West Sydney catchment and NSW and has been extracted from the NSW Population Health Survey 2011 Report on Adult Health. Table 7: Health behaviours of the residents of Inner West Sydney and NSW Indicator Inner IWS trend NSW NSW trend West Sydney Consumes more than 2 standard drinks per 23.9% Since 2002 steady 29.6% Steady day when drinking alcohol, persons aged 16 with slight years and over, 2011 reduction Current smoking, persons aged 16 years and 14.9% Decreasing since 14.7% Decreasing over, since 1997 Recommended fruit consumption, persons 51.5% Steady 50.4% Steady aged 16 years and over, 2011 Recommended vegetable consumption, 7.1% Steady 8.4% Steady persons aged 16 years and over, 2011 Adequate physical activity, persons aged % Overall slight 54.6% Overall slight years and over, 2011 increase since increase since Recent Recent decline. decline. Vaccinated against influenza in the last % Increase since 72.4% Increase since months, persons aged 65 years and over, Vaccinated against pneumococcal disease, 54.0% Increase since 59.5 Increase since persons aged 65 years and over, % 2002 Source: NSW Adult Population Health Survey (SaPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health available at Health Statistics. Vaccination rates for adults within the Inner West Sydney are lower than that for NSW, with other indicators reflecting a similar health behaviour pattern to the rest of the state. Inner West Sydney Medicare Local and Sydney Local Health District Page 14

17 4 Long term conditions, chronic disease and disability Headlines Generally healthy population compared to most state and national benchmarks. Mortality from cancer (all types combined), circulatory system and respiratory diseases is lower than the state and national rate; Highest prevalence of lung cancer of any LGA in the catchment (0.52 persons per 1,000); Prevalence of chronic respiratory conditions is significantly lower than the NSW and national average); and Highest prevalence of Hepatitis B of any LGA in the catchment (8.7 persons per 1,000). 4.1 PREVALENCE OF CHRONIC DISEASE Following from its high health risk profile, the prevalence of most chronic diseases in Canterbury is greater than the prevalence across the catchment. The prevalence of circulatory system conditions appears to be the greatest concern, with 14.6% of residents having a circulatory system condition, compared to 13.8% across the catchment. Although the prevalence of Type 2 Diabetes, mood disorders and musculoskeletal conditions are only marginally higher than the catchment rate, the consistently higher prevalence of these conditions compared to Inner West Sydney and state benchmarks points to a need to enhance preventative measures or patient education to reduce the burden of chronic disease. Figure 9 shows that the prevalence of respiratory system conditions in Canterbury (20.7%) is lower than the catchment (24.2%) and NSW (25.4%) averages. This is surprising considering the high rate of smoking. Inner West Sydney Medicare Local and Sydney Local Health District Page 15

18 Figure 9: Prevalence of selected chronic conditions in Canterbury compared with vs Inner West Sydney and NSW, Source: Public Health Information Development Unit and Australian Bureau of Statistics National Health Survey Note: Mood disorders include depression, anxiety, dysthymia and bipolar; Circulatory system conditions include ICD-10-AM codes I00 to I99; Respiratory system diseases include ICD-10-AM codes J00 to J99; musculoskeletal conditions include ICD-10-AM codes M00 to M99. The information in Tables 8 and 9 reflecting the health status of NSW residents and residents covered by the catchment has been extracted from the NSW Population Health Survey 2010 and 2011 Report on Adult Health and NSW Health Chief Health Officer s Report Table 8: Indicators reflecting health status of residents of Inner West Sydney and NSW Indicator Inner West NSW Sydney Excellent, very good, or good self-rated health status by age, 81.3% 80.4% persons aged 16 years and over, 2011 Current asthma, persons aged 16 years and over, % 11.3% Diabetes or high blood glucose, persons aged 16 years and over, 8.5% 7.4% 2010 Hysterectomy, females aged 20-69, % 11.3% Overweight and obesity, persons aged 16 years and over, % 52.2% Visited a dental professional in the last 12 months, people aged % 58.6% and over, 2010 Has private health insurance for dental expenses, people aged % 51.2% and over, 2010 Source: NSW Population Health Survey 2010 and 2011 (HOIST). Centre for Epidemiology and Research, NSW Ministry of Health. As shown in Table 9, residents of Canterbury are significantly more likely to be hospitalised for diabetes than the NSW average. However, they are significantly less likely to be hospitalised in general, including for potentially preventable causes, for coronary heart disease, chronic obstructive pulmonary disease, high body mass index, smoking or alcohol attributable reasons than the overall NSW population. They are also less likely than the overall NSW population to die from potentially avoidable causes or a high body mass attributable cause. Inner West Sydney Medicare Local and Sydney Local Health District Page 16

19 Table 9: Indicators reflecting health status of residents of the Canterbury LGA and NSW Indicator Canterbury NSW (Ratio only) Hospitalisations to , smoothed number of 48,058 (100) separations per year, Smoothed Standardised Separation Ratio (sssr) 18 (93.9) - Potentially preventable hospitalisations to , 3,220 (100) smoothed number of separations (sssr) (89.2) - Diabetes hospitalisations to , smoothed number of 401 (100) separations per year (sssr) (109.7) + Coronary heart disease hospitalisations to (100) smoothed number of hospitalisations per year (sssr) Chronic obstructive pulmonary disease hospitalisations, persons aged 65+, to smoothed number of hospitalisations per year (sssr) High body mass index attributable hospitalisations, smoothed number of separations per year to (sssr) Alcohol attributable hospitalisations, to , smoothed number of hospitalisations per year, (sssr) Smoking attributable hospitalisations, to , smoothed number of hospitalisations per year, sssr Fall-related injury hospitalisations, persons aged 65 years and over, to combined, smoothed number of hospitalisations per year, sssr Potentially avoidable deaths, persons aged under 75 years, 2006 to 2007 combined, smoothed number of deaths per year, Smoothed Standardised Mortality Ratio (ssmr) 19 Deaths potentially avoidable by primary prevention, persons aged under 75 years, 2006 to 2007 combined, smoothed number of deaths per year (ssmr) Potentially avoidable deaths from causes amenable to health care, persons aged under 75 years, 2006 to 2007 combined, smoothed number of deaths per year (ssmr) (83.0) (91.2) (86.8) (70.7) (82.7) (98.4) 183 (90.6) (89.8) 77 (93.1) High body mass attributable deaths 2006 to 2007, Smoothed 23 (100) Number of Deaths per Year, ssmr (41.1) - Alcohol attributable deaths, 2006 to 2007, smoothed number of 21 (100) deaths per year (ssmr) (89.8) Smoking attributable deaths, 2006 to 2007, smoothed number of 90 (100) deaths per year (ssmr) (91.6) Source: Health Statistics NSW and NSW Health Chief Health Officer s Report below the state average at 1% level of significance -- below the state average at 5% level of significance + above the state average at 1% level of significance ++ above the state average at 5% level of significance (100) (100) (100) (100) (100) (100) (100) (100) Table 10 provides details of the ten most common reasons for hospitalisation in 2007/ The smoothed Standardised Separation Ratio (sssr) can be interpreted as a 'relative risk', and is compared to the NSW average which is set to The smoothed Standardised Mortality Ratio (ssmr) can be interpreted as relative risk and is compared to the NSW average which is set to 100. Inner West Sydney Medicare Local and Sydney Local Health District Page 17

20 Table 10: Ten most common reasons for hospitalisation in 2010/11 in the Canterbury LGA and NSW NSW 2010/11s Canterbury Canterbury Rank NSW Separations Digestive system 6073 (18.15%) (16.59%) 1 Pregnancy, childbirth and the puerperium (10.18%) (10.43%) 2 Musculoskeletal system and connective 3020 (9.02%) (10.00%) 3 tissue Circulatory system 2889 (8.63%) (8.21%) 4 Respiratory system 2254 (6.73%) (5.75%) 6 Eye 1862 (5.56%) (4.55%) 11 Ear, nose, mouth and throat 1706 (5.10%) (5.31%) 7 Kidney and urinary tract 1689 (5.05%) (4.74%) 10 Female reproductive system 1659 (4.96%) (5.91%) 5 Skin, subcutaneous tissue and breast 1605 (4.80%) (4.95%) 9 Source: Sydney Local Health District, Flow Info V NSW Rank 4.2 CANCER Figure 10 shows that the prevalence of cancer within the Canterbury LGA is mixed against catchment and NSW benchmarks. Although a lower number of breast and cervical cancer and melanomas were reported for Canterbury residents, the incidence of colon, lung, prostate and stomach cancer is greater than the incidence rate per 1,000 persons reported across the catchment. Figure 10: Incidence of selected cancers per 1,000 persons vs Inner West Sydney and state comparators, 2004 to 2008 Source: Cancer Institute NSW (2010); Note: Incidences reported are crude rates (not age-standardised) Information on cancer screening rates is not available at an LGA level. For the Inner West Sydney catchment level, cancer screening information is available for both breast and cervical cancer screening. The NSW Cancer Plan includes a target to increase breast cancer screening participation in the age group years so that over 70% of women aged years have 2 yearly mammograms by In the period , the participation rate in the catchment was 47%, compared to 52.7% for NSW Health Statistics NSW Accessed 19 November 2012 Inner West Sydney Medicare Local and Sydney Local Health District Page 18

21 Cervical cancer screening rates in NSW for women aged in 2009 and 2010 combined were 56.5% and in the catchment were 54.9%. 21 The count and age standardised incidence rates (per 100,000) for cancers ( ) in the Canterbury LGA and NSW are presented in Table 11. Over this period, 2,984 people from the Canterbury LGA were diagnosed with cancer, a rate of per 100,000 (less than the state rate of per 100,000). The most common cancers were prostate, lung and breast. Incidence rates for lung, colon, rectal, stomach, thyroid, ovarian, liver, pancreas, bladder and head and neck cancers were higher than for the state. Notably melanoma incidence rates were less than half that for the state. Table 11: Count and age standardised incidence rates (per 100,000) for cancers, , Canterbury LGA and NSW Cancer Site Canterbury NSW Count Standardised Incidence Rate/100,000 Count Standardised Incidence Rate/100,000 All Cancers 2, , Bladder , Brain , Breast , Cervix , Colon , Head and Neck , Kidney , Leukaemia , Lip , Liver , Lung , Melanoma , Mesothelioma , Non-Hodgkins Lymphoma , Oesophagus , Ovarian Cancer ,191 6 Pancreas , Prostate , Rectal , Stomach , Testicles , Thyroid , Uterus , Cancer at Indef & Unspec Site , Other Cancers , Source: Incidence and Mortality data is from the NSW Central Cancer Registry. Population estimates are from HOIST, Epidemiology and Surveillance Branch, NSW Health Department Health Statistics NSW Accessed 19 November 2012 Inner West Sydney Medicare Local and Sydney Local Health District Page 19

22 The count and age standardised mortality rates (per 100,000) for cancers ( ) in the Canterbury LGA and NSW are presented in Table 12. Over this period 1,282 residents of Canterbury LGA died from cancer, representing a higher rate than that for NSW. The most common cancer sites resulting in death were lung, colon and breast. Standardised mortality rates for lung, colon, prostate, pancreatic, stomach, liver, head and neck, bladder and brain cancers were all higher than for NSW. 22 Cancer Institute NSW, Central Cancer Registry Statistical Reporting Module website. Accessed 10 November Available at: Inner West Sydney Medicare Local and Sydney Local Health District Page 20

23 Table 12: Count and age standardised mortality rates (per 100,000) for cancers, , Canterbury LGA and NSW CANCER SITE CANTERBURY NSW Count Mortality Rate/100,000 Count Mortality Rate/100,000 All Cancers 1, , Bladder , Brain , Breast , Cervix Colon , Head and Neck , Kidney , Leukaemia ,248 6 Lip NA NA NA NA Liver , Lung , Melanoma of skin , Mesothelioma Non-Hodgkins Lymphoma , Oesophagus , Ovaries , Pancreas , Prostate , Rectal , Stomach ,232 6 Testicles NA NA NA NA Thyroid NA NA Uterus Cancer at Indef & Unspec , Site Other Cancers , Source: Incidence and Mortality data is from the NSW Central Cancer Registry. Population estimates are from HOIST, Epidemiology and Surveillance Branch, NSW Health Department. 23. NA denotes no figure available as total count was under Cancer Institute NSW, Central Cancer Registry Statistical Reporting Module website. Accessed 10 November Available at: 24 Additional information relating to Cancer can be obtained from the Cancer Institute NSW, Central Cancer Registry Statistical Reporting Module web page. Available at: Inner West Sydney Medicare Local and Sydney Local Health District Page 21

24 4.3 MORTALITY The median age of death for and the standardised rate of deaths from all causes for residents of the Canterbury LGA and NSW is provided in Table 13. Table 13: Life expectancy and deaths from all causes for residents of the Canterbury LGA and NSW Indicator Canterbury NSW Deaths from all causes 2011, Indirectly Standardised Death Rate ^ Deaths from suicide and self-inflicted injuries , average annual ASR per 100,000 of population# Males Females Males Females Median Age of Death Source: ^SSWLHD & SLHD Centre for Research, Evidence Management and Surveillance; # Public Health Information Development Unit In spite of its high risk profile and higher prevalence of most chronic diseases, the Canterbury LGA reported lower rates of preventable mortality (0.94 persons per 1,000) than both the overall catchment (1.03 per 1,000) and NSW (0.98 per 1,000), as shown in Figure 11. Across the entire Canterbury population (137,454), the difference in preventable mortality equates to a saving of 5.2 lives per year, compared to the rate of preventable mortality across NSW, and a saving of 12.9 lives compared to the catchment preventable mortality rate per 1,000 persons. This profile is consistent with that of a population with high numbers of immigrants. The Healthy Migrant Effect is the term used to describe the better than average of health status of migrant communities. Studies show that this health advantage reduces with length of residency. Figure 11: Preventable mortality * in Canterbury compared with Inner West Sydney and NSW Source: Public Health Information and Development Unit and Australian Bureau of Statistics Note: * Data relates to persons aged from 0 to 74 years where mortality is caused by a number of conditions specified by the Public Health Information Development Unit. Mortality rates reported are crude rates (not age-standardised). Rates of premature mortality for persons aged 0 to 74 years are also surprisingly consistent with catchment and NSW benchmarks, considering the high health risk profile of the Canterbury LGA. As shown in Figure 12, the number of premature deaths from chronic disease, cancer and external causes per 1,000 persons are all below the catchment and NSW rate. 25 Public Health Information Development Unit Social Health Atlas of Australia: Statistical Local Area and Local Government Area accessed 10/11/12 Inner West Sydney Medicare Local and Sydney Local Health District Page 22

25 Figure 12: Premature mortality * from chronic disease (ages 0 to 74 years) and external causes per 1,000 persons vs Inner West Sydney and state comparators, 2003 to 2007 Source: Public Health Information and Development Unit and Australian Bureau of Statistics (2012) Note: * Premature mortality is defined by PHIDU as mortality occurring prior to 75 years of age; Circulatory system conditions include ICD-10-AM codes I00 to I99; Respiratory system diseases include ICD-10-AM codes J00 to J99; External causes include deaths arising from transport accidents, accidental falls, accidental poisoning, assault and suicide; Death rates reported are crude rates (not age-standardised). 4.4 INFECTIOUS DISEASES In New South Wales, Inner West Sydney has the highest rate of Hepatitis B virus reflecting a high population from East Asian countries. Inner West Sydney has the second highest rate of HIV (reflecting a high population of gay and other homosexually active men) and the second highest rate of HCV (reflecting high rates of injecting drug use). Sydney LHD has the third highest rate of Chlamydia in the state. 26 Figure 13 shows that the prevalence of sexually transmissible infections (STIs) in Canterbury is generally lower than across other LGAs in the catchment, although Canterbury has a significantly higher incidence of STIs than the state and national averages. Of concern, however, is the reported prevalence of Hepatitis B in Canterbury (8.7 persons per 1,000), which is higher than the prevalence of chlamydia and is almost twice the average prevalence rate for Hepatitis B across the catchment (4.7%). The prevalence of Hepatitis B in Canterbury is particularly concerning when viewed in the context of the rate across NSW (0.38 persons per 1,000). 26 Australian Society for HIV Medicine Inner West Sydney Medicare Local and Sydney Local Health District Page 23

26 Figure 13: Prevalence of sexually transmissible infections per 1,000 persons vs Inner West Sydney and state comparators, 1998 to 2009 Source: Sydney Local Health District and NSW Health Centre for Epidemiology and Research (2010) Note: Rates reported are crude (not age standardised) 4.5 DISABILITY Figure 14 shows that the proportion of persons that require assistance with core activities in Canterbury is slightly higher for persons aged between 50 and 79 years, compared to the catchment and NSW averages; however the proportion of residents over 80 years that require assistance is well below the catchment and NSW average. This is contrary to most other LGAs in the catchment, where a much higher proportion of elderly persons require assistance, but a lesser proportion of persons aged below 69 years generally require assistance. Figure 14: Proportion of persons requiring assistance with core activities * vs Inner West Sydney and state comparators, 2011 Source: Australian Bureau of Statistics (2011) Note: * Core activities are defined by the ABS as needing help in one or more of three activity areas of self-care, mobility and communication Inner West Sydney Medicare Local and Sydney Local Health District Page 24

27 5 Health service utilisation Headlines Medicare primary care services billed were approximately consistent with the number per 1,000 persons billed across the catchment as a whole, but lower than the rate across NSW; The rate of Practice Nursing services represents a gap, with services provided per 1,000 persons in Canterbury, compared to per 1,000 in the broader area and per 1,000 across NSW; Highest number of admissions for potentially-preventable ambulatory-sensitive conditions per 1,000 persons, of any LGA in the catchment; and The proportion of non-english speaking HACC clients (41.0%) is significantly higher than the proportion across both the catchment (35.6%) and NSW (10.6%). 5.1 PRIMARY CARE UTILISATION Figure 15 shows that Medicare primary care services billed to the Medicare Benefits Schedule (MBS) in 2009/10 were approximately consistent with the number per 1,000 persons billed across the catchment as a whole, but lower than the rate across NSW. Practice Nurse services represent the largest gap, with services provided per 1,000 persons in Canterbury, compared to per 1,000 in the broader catchment and per 1,000 across NSW. Figure 15: Selected primary care services delivered vs Inner West Sydney and state comparators Source: Public Health Information Development Unit and Department of Health and Ageing Inner West Sydney Medicare Local and Sydney Local Health District Page 25

28 5.2 EMERGENCY Table 14 provides analysis of Emergency Department (ED) data across all three public hospitals within Inner West Sydney, and shows that residents of the Canterbury LGA made 29,244 visits to EDs within the Inner West Sydney catchment area, which represents 21.2% of all ED visits overall and 29.1% of visits for persons living within the Inner West Sydney catchment area. Compared to Canterbury s proportion of the total population within the catchment (25.1%), the proportion of ED visits by Canterbury residents are higher than its share of the catchment population. The vast majority of the 29,244 ED visits made by Canterbury residents were to the Canterbury hospital (81%), and visits from Canterbury residents comprised 65.8% of the Canterbury Hospital s total ED caseload. Table 14: Emergency department presentations by hospital, Canterbury Concord Royal Prince Hospital Hospital Alfred Hospital Total Presentations from Canterbury LGA 23,685 (81.0%) 1,658 (5.7%) 3,901 (13.3%) 29,244 (100%) ED presentations for all persons (within and outside Inner West Sydney Medicare Local) Total ED presentations for hospital (all persons) 35,998 (26.0%) 34,629 (25.1%) 67,586 (48.9%) 138,213 (100%) Canterbury % of Total 65.8% 4.8% 5.8% 21.2% Source: Statewide Emergency Data Data relating to patient triage classification across the catchment per 1,000 persons is provided in Table 4. Table 15 shows that on a per-capita basis, Canterbury residents present to emergency departments to a greater extent for resuscitation, urgent and semi-urgent triage classifications compared to the overall catchment. Across the entire catchment area, Canterbury residents present the third most often for urgent cases, and the second most often for semi-urgent reasons. LGA Table 15: Emergency department presentations per capita, by triage category, Triage classification - number of persons per 1,000 (not age standardised) Resuscitation Emergency Urgent Semi-urgent Non-urgent Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield Sydney South Sydney West Inner West Sydney Source: Statewide Emergency Data 5.3 AMBULATORY-CARE SENSITIVE ADMISSIONS As shown in Figure 16, rates of preventable hospitalisation for ambulatory-sensitive conditions in Canterbury (23.3 per 1,000 persons) are notably higher than those observed across the catchment (18.9 cases per 1,000), although preventable hospitalisations in Canterbury remain marginally below the rate across NSW (23.8 per 1,000 persons). Unfortunately, more detailed data is not Inner West Sydney Medicare Local and Sydney Local Health District Page 26

29 available that describes the conditions for which Canterbury residents were hospitalised for ACSCs. Figure 16: Preventable hospitalisations for ambulatory-care sensitive conditions per 1,000 persons * vs Inner West Sydney and state comparators, to Source: NSW Health Centre for Epidemiology and Evidence (2011); Note: * The prevalence estimates reported relate to the entire Sydney City LGA, which includes the SLAs of Sydney Inner, South, East and West. Data was not available at the SLA level for this indicator; Rates reported are indirectly standardised by age and gender. 5.4 HOME AND COMMUNITY CARE Figure 17 shows the profile of Home and Community Care (HACC) clients in Canterbury, compared to the total Inner West Sydney catchment, and NSW. Figure 17 shows that the proportion of Indigenous population that use HACC services (3.3%) within Canterbury is lower than the proportion within both the total catchment and NSW. However, consistent with the highly diverse cultural profile of the Canterbury LGA, the proportion of non-english speaking clients (41.0%) is significantly higher than the proportion across both the catchment (35.6%) and NSW (10.6%). The proportion of non-english speaking clients is also the highest of any LGA in the catchment 27. The level of cultural diversity in Canterbury may also be a factor underpinning the lower proportion of residents living alone, and the correspondingly higher proportion of clients with a carer. Figure 17: HACC client profile vs Inner West Sydney and state comparators, Australian Bureau of Statistics (2011) Inner West Sydney Medicare Local and Sydney Local Health District Page 27

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