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2014
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
1
North Coast NSW Medicare Local
acknowledges that Aboriginal and
Torres Strait Islander peoples are
the first people of Australia.
We acknowledge the traditional
custodians of the land upon which
we work, including Bundjalung,
Arakwal, Gumbaynggirr, Dunghutti,
Yeagl, Ngarabal, Nganyaywana
and Birpai Aboriginal Nations,
and pay respect to Elders, both
past and present.
COPYRIGHT
North Coast NSW Medicare Local
(NCNSWML) 2014
All intellectual property and copyright
reserved.
Apart from any fair dealing for the purposes
of private study, criticism or review, as
permitted under the Copyright Act 1968,
no part of this report may be reproduced,
transmitted, stored in a retrieval system or
adapted in any form or by any means
(electronic, mechanical, photocopying,
recording or otherwise) without written
permission of NCNSWML.
Enquiries should be addressed to Manager,
Strategic Development and Program Design,
NCNSWML by emailing [email protected]
DISCLAIMER
North Coast NSW Medicare Local
(NCNSWML) takes reasonable steps to
ensure the information contained in this 2014
Comprehensive Needs Assessment is
accurate and up-to-date. However, the
content is provide by NCNSWML on an
‘as is, as available’ basis. NCNSWML is not
responsible for any errors or omissions in the
content and reserves the right to revise or
add to the content at any time without notice
to you. Readers of this document should
access the relevant primary sources as
referenced for the most up-to-date
information.
2
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Contents
EXECUTIVE SUMMARY
6
INTRODUCTION
METHODS
9
9
RESULTS
11
1. NORTH
11
11
15
15
15
16
16
19
19
21
24
25
25
27
28
29
30
COAST NSW – THE LOCATION AND PEOPLE
1.1
LOCATION
1.1.1 Geographic Diversity and Remoteness
1.1.2Climate
1.1.3
Economic Activity
1.2
THE PEOPLE
1.2.1
Current Population and Projected Growth
1.2.2 Ageing Population
1.2.3
Aboriginal Population
1.3
CULTURAL AND SOCIAL INFLUENCES
1.3.1
Index of Relative Socioeconomic Disadvantage
1.3.2
Family Type
1.3.3
Housing and Transport
1.3.4Education
1.3.5
Income Support
1.3.6
Labour Force
1.3.7
Other Social and Cultural Factors
2. HEALTH OF NORTH COAST NSW COMMUNITIES AND RESIDENTS
2.1
KEY HEALTH INDICATORS AND BEHAVIOURS
2.1.1
Adult Smoking
2.1.2Alcohol
2.1.3
Fruit and Vegetable Consumption
2.1.4
Physical Activity
2.1.5
Overweight and Obesity
2.2 HEALTH EQUITY
2.2.1
Aboriginal People - Closing the Gap
2.3
MORBIDITY
2.3.1
Chronic Disease
2.3.2
Other Health Conditions impacting the Community in NCNSW
2.4 HOSPITALISATIONS AND AVOIDABLE MORTALITY
33
35
36
36
37
38
38
39
39
41
41
54
64
3. HEALTH SERVICES AVAILABLE TO THE COMMUNITY69
3.1.
PRIMARY HEALTH SERVICES
70
3.1.1.
General Practice
70
3.1.2.
Aboriginal Medical Services
73
3.1.3
Allied Health
74
3.1.4
Mental Health Services
75
3.2.
LOCAL HEALTH DISTRICT SERVICES
76
3.2.1.
Northern NSW Local Health District
76
3.2.2.
Mid North Coast NSW Local Health District
78
3.3.
PRIVATE FACILITIES
79
3.3.1.
Private Hospitals
79
3.3.2.
Day Surgeries
79
3.4.
RESIDENTIAL AGED CARE FACILITIES (RACF)
80
3.5.
EHEALTH AND TELEHEALTH UTILISATION
81
3.5.1.eHealth
81
3.5.2.Telehealth
81
3.6.
Health Promotion
81
3.7.
Community experiences with access to health care
82
4. DISCUSSION
4.1 SUMMARY OF CHALLENGES
4.1.1
Regional Factors that Influence Health
4.1.2
Healthcare Availability and Accessibility
4.2
PRIORITIES FOR ACTION
83
83
83
84
86
102
REFERENCES
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
3
LIST OF TABLES
Table 1
Table 2 Table 3
Table 4
Table 5
Table 6
Table 7
Table 8
Table 9
Table 10
Table 11
Table 12
Table 13
Table 14
Table 15 Table 16
Table 17
Table 18 Table 19
Table 20
Table 21
Table 22
Table 23
Table 24
Table 25
Table 26
Table 27
Reporting Regions used for Needs Assessment
10
Population by LGA
12
Local Aboriginal Land Councils
13
Rurality Classification for Key Towns in North Coast NSW (3)14
Estimated Residential Population 2012 (2)16
Population Projections 2011-2031 (5)16
Age Dependency Ratio Comparison 2011-2031 (5)17
Aboriginal Population as a percentage of total population (6)20
Comparison of Aboriginal and Non Aboriginal Population by Age (6)21
Social Determinants of Health North Coast NSW compared to NSW Average (2)22
Social Determinants of Health - North Coast LGAs compared to the regional average (2)23
Health Indicators - LGAs in NCNSW compared to the NSW Average (2) (19)34
Selected Health Behaviours (21)35
NCNSW selected Cancers- Incidence and Mortality compared to NSW Average
42
Coronary Heart Disease Hospitalisations by LGA 2009-10 to 2010-11 (22)47
North Coast of NSW Local Government Area Dementia Prevalence Rates (43)53
Status of Fluoridation of Reticulated Water Supply (40)58
NCNSW Male Hospitalisation by Cause 2012-2013 (22)65
NCNSW Female Hospitalisation by Cause (22)66
Leading cause of Hospitalisation for NCNSW Aboriginal Population 2011/12 (Rate/100 000) (22)66
Potentially Preventable Hospitalisations by LGA 2010-2011/12 (21)67
Number of NCNSW General Practitioners
70
NCNSWML General Practice Survey (March 2014)
71
Current numbers of Selected Health Providers in NCNSW 2013 (50)73
Services Provided by Aboriginal Medical Services in NCNSW
74
Residential Aged Care Facilities per LGA
80
Comparison of GP Readiness for eHealth NCNSWML
81
LIST OF FIGURES
Figure 1
North Coast NSW Primary Health Network Region
11
Figure 2
Map of Aboriginal Nations
14
Figure 3
Percentage of Population Growth by LGA 2011-2031 (5)17
Figure 4 Population Growth by LGA 2011-2031 (5)18
Figure 5
Percentage of Population >65 years by LGA (5)19
Figure 6
Aboriginal Population as a percentage of LGA (6)19
Figure 7
Age Distribution of NCNSW Aboriginal and Non-Aboriginal Populations as a percentage
of 0-5 yr Age Range (6)20
Figure 8
Index of Relative Social Disadvantage by LGA 2011 (2)24
Figure 9
Percentage of Single Parent Families by LGA (2)25
Figure 10
Percentage of Low Income Welfare Dependant Families with Children (2)25
Figure 11
Number of persons in N NSW living in Marginal Housing 2011 (10)26
Figure 12
Number of Persons in MNC NSW Living in Marginal Housing 2011 (10)26
Figure 13 Index of Education and Occupation by LGA. 2011 (2)27
Figure 14
Percentage of Age Pensioners by LGA, 2012 (2)28
Figure 15
Percentage of Disability Support Pensioners by LGA 2012 (2)28
Figure 16
Percentage of People on Long Term Unemployment Benefits 2012
29
Figure 17
Percentage of People Unemployed by LGA
29
Figure 18
Percentage of people in LGA participating in Voluntary Work, 2011 (2)30
Figure 19
Incidents of Domestic Violence Reported to Police, 2013 (19)31
Figure 20 10 year trend of the highest incidents of domestic violence reported to police 2004-2013 (19)32
Figure 21
Current Smoking -2012 (22)35
Figure 22
Smoking Hospitalisations by LGA 2010/11-2011/12
36
Figure 23
Smoking During Pregnancy 2008-2010 (22)36
Figure 24 Percentage of People older than 16yrs consuming more than two standard drinks on
a day when drinking (22)37
Figure 25
Alcohol related hospitalisations (22)37
Figure 26
Incidents of liquor offences in selected LGAs from October 2011-September 2013 (19)38
Figure 27
Key Health Indicators (21)38
Figure 28
NSW Child Mortality (26)39
Figure 29
First Antenatal Visit before 14 weeks by Aboriginality 1996-2011(22)40
Figure 30
Preterm Births by Mothers Aboriginality (22)40
Figure 31
Low Birth Weights by Mothers Aboriginality (22)40
Figure 32
Hospitalisations for Respiratory Disease (22)42
4
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Figure 33
Figure 34
Figure 35
Figure 36
Figure 37
Figure 38 Figure 39
Figure 40 Figure 41
Figure 42
Figure 43
Figure 44
Figure 45
Figure 46
Figure 47 Figure 48
Figure 49
Figure 50
Figure 51
Figure 52
Figure 53
Figure 54
Figure 55
Figure 56
Figure 57
Figure 58
Figure 59
Figure 60
Figure 61
Figure 62
Figure 63
Figure 64
Figure 65
Figure 66
Figure 67
Figure 68
Figure 69
Figure 70
Figure 71
Figure 72 Overall N NSW Cancer Incidence and Mortality trend for Males and Females 1972-2008 (32)43
Overall MNC NSW Cancer Incidence and Mortality trend for Males and Females 1972-2008 (32)43
Overall NSW Cancer Incidence and Mortality trend for Males and Females 1972-2008 (32)44
Prostate Cancer Incidence and Mortality N NSW, MNC NSW and NSW 2004-2008 (32)44
Colon Cancer Incidence & Mortality N NSW, MNC NSW and NSW 2004-2008 (32)45
Breast Cancer Incidence & Mortality N NSW, MNC NSW and NSW 2004-2008 (32)45
Melanoma Incidence & Mortality N NSW, MNC NSW, NSW 2004-2008 (32)46
Coronary Heart Disease Hospitalisations 2010-11 (22)46
Cardiovascular Disease Hospitalisation Ratio (to NSW) by Disease Type 2011-12 (22)47
Cardiovascular Disease Procedures 2011-12 (22)48
Cardiovascular Disease Procedures Ration 2011-12 (22)48
Diabetes Registrations/100,000 by LGA 2013 (33)
49
Diabetes Hospitalisations by LGA 2009/10 - 2010/11 (22)50
Diabetes Hospitalisations by Aboriginality 2010/11 (22)50
Hospitalisations for Intentional Self Harm 2012-13 (21)51
Suicide Trend NCNSW 1988-2011 (21)51
NSW Hotspots of Prevalence of Dementia (42)52
2011-2050 Growth in Dementia Cases by Region (43)53
Mean Number of 5-6 Year Old Children with Decayed, Missing and Filled Teeth (22)54
Percentage of 5-6 Year Old Children that are Free of Dental Caries (22)55
Mean Number of 11-12 Year Old Children with Decayed, Missing and Filled Teeth (22)55
Percentage of 11-12 Year Old Children that are Free of Dental Caries (22)56
Mean Number of Children Aged 5-6 Years with Decayed, Missing and Filled Teeth by
Socioeconomic Status (22)56
Mean Number of Children Aged 11-12 Years with Decayed, Missing and Filled Teeth by
Socio Economic Status (22)57
Percentage of Children Fully Immunized 2012-2013 (24)59
NCNSW Immunisation Rates- Highlighting the areas with the highest disparity compared to
NCNSW Regional and National Rates (24)59
Age Adjusted Chlamydia Notification Rate January 2007 - September 2013 (44)60
Age Adjusted Gonorrhoea Notifictaion Rate January 2007 - September 2013 (44)61
Age Adjusted Syphilis Notification Rate January 2007- September 2013 (44)61
Percentage of HIV Notifications for Selected Areas 2007 - September 2013 (45)62
Hepatitis B Notifications for Selected Areas 1998 – 2012 (21)62
Hepatitis B Prevalence by LGA 2011 (46)63
Hepatitis C Notifications 1998-2012 (21)63
N NSWLHD Palliative Care Inpatient Separations (48)64
NCNSW Hospitalisation Trend 2006/07-2011/12 (22)64
Hospitalisations by LGA 2009/10-2010/11 (22)65
Trend for Potentially Preventable Hospitalisations 2001-2012 (21)67
Avoidable Mortality 2006-2010 (2)68
N NSW GP Workforce (Number of FTE GPs/100 000 for each N NSW LGA compared to NSW)
72
MNC GP Workforce (Number of FTE GPs/100,000 for each MNC NSW LGA compared to NSW
72
APPENDICES
Appendix 1
Appendix 2
Appendix 3
Appendix 4
Appendix 5
Appendix 6
Appendix 7
Appendix 8
Acronyms
Glossary
Cultural and Language Diversity
Local Aboriginal Land Council Contacts
Targeted Communities – Areas of Need
Audit of Service Across NCNSWML
National, State, Regional and Local Health Promotion Programs Across NCNSWML 2013
Data Summary of Key Focus Areas
90
91
92
93
95
96
98
99
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
5
Executive
Summary
This Needs Assessment captures the known issues facing the North Coast NSW (NCNSW) region in 2014.
It is a key document that will inform organisational strategy and activity for the North Coast Primary Health
Network moving forward.
A broad view of health and wellbeing has been taken, and as a result a wide range of data sources and
informants have been consulted. Published data was supplemented with information provided by the
Local Health Districts (LHDs) as well as Community and Social Service Agencies and Non Government
Organisations (NGOs). Key regional partners participated in the Strategic Development and Service Design
Committee which provided oversight to the development and findings of the document. Both quantitative
and qualitative data about the health of the population have been included. The report examines regional
issues related to National Health Priorities and identifies those at risk of poor health outcomes, as well as
mapping service distribution across the whole geographical area.
NCNSW is a disadvantaged community and the social determinants of health are overall poorer than the
NSW average. The community experiences health outcomes that are equal or below the state average for
chronic disease, both risk factors and prevalence. Consequently there are high rates of potentially
preventable hospitalisations and avoidable deaths.
There is significant variation in the health and wellbeing of the population according to geographical
location. Wherever possible, data has been provided at a Local Government Area (LGA) level to allow
greater understanding of this variation. Over time, local consultation will further refine this understanding
and provide greater clarity about factors effecting communities within each LGA.
6
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Characteristics of the region
The NCNSW region covers a large geographical area (35,570 square kilometres) which is home to an estimated 497,730 (2012) people spread across the region in diverse locations. Population projections predict
that in 2015, the population will rise to 512,000 people.
The 2014 Needs Assessment has highlighted a range of population factors that need to be considered
when planning and delivering health services in NCNSW. These include:
• Geography: A large geographical area exhibiting with settlement patterns from metropolitan to rural and
remote.
• Population: 497,730 (2012) residents with a projected growth rate faster than the state over the next
five and 20 years (projection for 2015 of 512 000). Substantial increase of those over 65 years of age,
having significant impact on demand for a range of health services.
• Socio-economic disadvantage: High rates of disadvantage on a range of indicators – ageing, Aboriginality, disability, remoteness, unemployment and income support. All LGAs scored below the state average in the Index of Relative Socio-Economic Disadvantage (IRSD). LGAs with Aboriginal populations
higher than 5% have the lowest scores.
• Aboriginality: 4% average (nearly double the state average), unevenly distributed with a number of districts and LGAs up to 10%.
• Ageing population
Health challenges facing the people of the region
• Lifestyle and social determinants of health: The region has high rates of smoking (especially smoking
during pregnancy) and alcohol consumption. The rate of potentially preventable hospitalisations is high
and immunisation rates are very low.
• Chronic disease: There is a high prevalence of chronic health conditions and chronic disease is a key
issue for the region, particularly in the context of the ageing population
Inequitable access to health services
• Access to primary care provision: Most GPs and other primary care services are located in larger
regional towns, or in townships on the coastal corridor.
• Fragmentation and lack of coordination of services: Health care services are unevenly distributed
across the region, for both clinical services and those providing health promotion and disease prevention services. Patient intake and record systems are unconnected. This impedes access to coordinated
and integrated care. Those with a chronic disease or mental illness requiring care over a long period of
time are most effected.
• Distribution of health workforce: The primary health workforce is ageing and unevenly distributed and
shortages are reported in locations across the region. Clinicians report difficulty recruiting and retaining
health care professionals. Many small towns reliant on limited GP services are vulnerable.
• Disjointed system to promote health and improve health literacy: A myriad of agencies provide the
community with access to health promotion and disease prevention information. The services are not
well coordinated and this can lead to duplication and can make it confusing for community members to
access the information they need.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
7
Priorities for Action
A key theme throughout this report is that of general disadvantage compared to the rest of NSW together
with considerable variation within the region.
The challenges identified in this report are complex and require innovative local solutions.
Six key priorities have been identified for action in NCNSW. These are within the scope of influence of the
primary health sector but sustained efforts are required and these must be integrated with the wider health
sector including Local Health Districts, Aboriginal Medical Services, Specialist Medical Services and
Private Hospitals as well as the wider social and community sector.
1.
2.
3.
4.
5.
6.
Coordinating care and reducing fragmentation
Partnerships to improve health care
Improving access to care
Keeping people healthy and out of hospital
Reducing disadvantage and health disparity
Innovation and local solutions.
By addressing these priorities, the people of the region will be better able to access the care that they
need to improve and maintain their health and avoid, wherever possible, the need to access acute
services. This will guide the work of the primary health network into the future.
8
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Introduction
The purpose of this Needs Assessment is to provide a key document that will inform organisational
strategy and activity for the North Coast Primary Health Network.
This document captures and documents the known health needs of the North Coast NSW Community
in 2014. It focuses on those aspects of health that can be influenced by the Primary Health sector but
recognises the interdependencies with both the acute health sector and the wider social service
landscape. It was developed by consulting a wide range of data sources as well as building upon the
knowledge and experience of local health districts, clinicians, community members and other regional
stakeholders.
Methods
Data
This document assesses the health needs of the North Coast NSW Community using both qualitative and
quantitative data sources.
Considerable assessment of need has already been undertaken by other regional stakeholder
organisations, including the two Local Health Districts (LHDs). This has resulted in the collection of
significant amounts of information about the needs of the population. This Needs Assessment draws on
this work and adds to it by focusing on the health of the population from a Primary Health perspective.
Information sources consulted included:
• Australian Bureau of Statistics
• NSW Health
• Local Health Districts
• National Health Performance Authority
• Australian Medicare Local Alliance Medical Local Planning Tool
• Other third party reports
• Local intelligence
• NCNSWML program utilisation information
This assessment collates the information obtained from these sources to present a comprehensive range
of information about the region, the health of its people and access to services. The breadth of the data
presented is wide reaching, with a specific aim of creating a repository of information that can be utilised
by local stakeholders, including NGOs to support their own work.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
9
Collaborative relationships with regional stakeholders were drawn upon to confirm the assessment presented in this document via North Coast NSW Medicare Local’s Strategic Development and Service
Design Committee.
Reporting Regions
Data used within this report has been collected from a variety of sources relative to a number of catchments.
Throughout this Needs Assessment, these catchments are referred to consistently as follows:
• NSW State (NSW)
• North Coast NSW (NCNSW) correlating to the North Coast Primary Health Network region
• LHD Aligned sub regions (Figure 1)
- Mid North Coast NSW (MNCNSW) which aligns with Mid North Coast Local Health District
(MNCLHD). This sub region extends from the southern boundary of Clarence Valley LGA to the
southern boundary of Port Macquarie- Hastings Council. (see Table 1 and see Figure 1)
- Northern NSW (NNSW), which aligns to the Northern NSW Local Health District (NNSWLHD).
This sub region extends from the southern Boundary of the Clarence Valley LGA to the Northern
Boundary of the Tweed LGA.
• Twelve Local Government Areas (LGAs). Where possible, analysis is presented at LGA level for consistent
interpretability. Additionally, this also offers the opportunity to integrate planning services and strategies
with the local government bodies. Note: A small portion of the Tenterfield LGA falls within the service
region (incorporating the Urbanville locality), however the population in this area is sparse
Designated areas within NCNSW
for purpose of this Report
Known as
Referred to within
Report
Aligns with
Northern portion of NCNSW
Northern NSW
N NSW
N NSWLHD
Southern portion of NCNSW
Mid North Coast NSW
MNC NSW
MNCLHD
12 Local Governments
Local Government Areas
LGA
LGA boundaries
Table 1 Reporting Regions used for Needs Assessment
Some data is also benchmarked against other comparable/like regions that exhibit similar qualities to
NCNSW in a range of factors including locality, geography, socio-economic condition and proportion of
population identifying as Aboriginal. These have been identified by using the National Health Performance
Authority Peer groupings of Medicare Locals. NCNSW is included in the Regional 2 peer grouping.
Comparisons are made within this report to other organisations in this grouping including: Southern and
Murrumbidgee Medicare Locals (Regional 2), Hunter and Illawarra-Shoalhaven Medicare Locals (Regional 1).
Data Presentation
Where possible, bar graphs use color to indicate rates relative to the NSW rate. Red and green bars
indicate NCNSW data that is significantly different to NSW data. • Statistically positive results are shown in green
• Statistically negative results are shown in red.
Aboriginal Health Indicators
This Needs Assessment compares the differences between Aboriginal people and the wider community
on numerous health indicators (1). Where possible, data relating to the Aboriginal population is presented
alongside that of the whole population throughout this report.
Health data specifically for Aboriginal people is very limited at a Local Government level and is collated at
LHD level.
For the purposes of this report, Aboriginal and Torres Strait Islander populations will be
referred to as Aboriginal people.
10
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Results
1
North Coast NSW – The location and
people
TWEED
BYRON
KYOGLE
LISMORE
BALLINA
RICHMOND VALLEY
CLARENCE
COFFS HARBOUR
1.1Location
The North Coast NSW primary health network
region covers a large geographical area (35,570
square kilometres). Along its eastern boundary
is the coast and to the west, the New England
Tablelands escarpment covered by a line of
State forests and National parks. The northern
boundary is the NSW/Queensland border and
the southern boundary extends beyond
Port Macquarie.
Population centres are naturally located on the
major river systems that divide the coast, with
the inland areas being much more sparsely
populated. The total population of the region is
estimated to be 497,730 (2012) (2). By 2015, this
population is projected to rise to 512, 094 (3)
BELLINGEN
NAMBUCCA
KEMPSEY
PORT MACQUARIE HASTINGS
North Coast
Mid North Coast
Figure 1 North Coast NSW Primary Health Network Region
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
11
The population is spread unevenly between the Local Government areas in the region. The two biggest
LGAs are Tweed at the northernmost tip of the region (18% population) and Port Macquarie-Hastings at
the southernmost point (15% population). The smallest LGAs are Kyogle (2%) and Bellingen (3%).
LGA
% of Total Population
Ballina
8%
Bellingen
3%
Byron
6%
Clarence Valley
10%
Coffs Harbour
14%
Kempsey
6%
Kyogle
2%
Lismore
9%
Nambucca
Port Macquarie-Hastings
Richmond Valley
Tweed
4%
15%
5%
18%
Table 2 Population by LGA (2011)
The Pacific Highway extends the length of the region, hugging the coastline and connecting the population
centres. The majority of the region’s population can be found close to the highway. A program of upgrades
to the Pacific Highway has impacted greatly on the safety of the road and the patterns of travel of the
residents as they seek medical care and other services. This is particularly evident in the north of the region
where travel time to Tweed Heads and the services in Queensland have been greatly reduced over the
past decade.
The North Coast NSW region encompasses:
• 20 Statistical Local Areas (SLAs)
• 12 Local Government Areas (LGAs – General purpose Councils) plus the Urbenville State
Suburb which is part of the Tenterfield LGA (see Figure 1 )
• Two NSW Local Health Districts (LHDs) - Northern (NNSWLHD) and Mid North Coast (MNCLHD) • Four General Practice Networks (GPNs)
• Two Regional Development Australia (RDA) Areas • North Coast GP training
• Eight Aboriginal Medical Services (AMS)
• Seven Aboriginal nations
• 19 Local Aboriginal Land Councils (LALCs)
There are a number of external influences on the region. Proximity to the Gold Coast and the wider
South East Queensland region (one of the fastest growing areas in Australia) brings with it, a range of
complexities. South East Queensland provides access to a variety of services especially for those living
in NNSW, however there are a range of cross-border issues that need to be managed by both the LHD
and primary health care providers in this area, particularly related to referral patterns and processes.
Tourism impacts on many of the coastal towns, particularly during holiday periods. Populations can swell
at these times and local medical services can have difficulty meeting any extra demand for services.
The NCNSW has seven Aboriginal Nations including Bundjalung, Arakwal, Githabul, Yeagl, Gumgayngirr,
Dunghutti and Birpai
12
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
The cultural richness is reflected in the number of Local Aboriginal Land Councils (LALCs)
N
Map of Aboriginal Nations
Local Aboriginal Land
Councils
Locality
THUNGUTTI
BELLBROOK
BIRPAI
PORT MACQUARIE
NAMBUCCA HEADS
NAMBUCCA HEADS
DUNGHUTTI
KEMPSEY
BOWRAVILLE
BOWRAVILLE
YAEGAL
MACLEAN
COFFS HARBOUR
COFFS HARBOUR
DORRIGO PLATEAU
DORRIGO
GUGIN GUDDUBA
KYOGLE
JALI
BALLINA
JANA NGALEE
GRAFTON
JUBULLUM
TABULAM
BOGAL
CORAKI
MULI MULI
WOODENBONG
BIRRIGAN GARGLE
YAMBA
NGULINGAH
LISMORE
GRAFTON NGERRIE
SOUTH GRAFTON
CASINO-BOOLANGLE
CASINO
BARYULGIL SQUARE MALABUGILMAH
BARYULGIL VIA
GRAFTON
Table 3 Local Aboriginal Land Councils
Appendix 4 provides full contact details for each of the 19 LALCs in the NCNSW region.
1.1.1 Geographic Diversity and Remoteness
The largest concentration of people in the region can be found clustered along the coastline in regional
centres with largely urban facilities.
The larger centres of NCNSW are mostly located along the coastal strip and are divided between
• Major Cities (Tweed Heads and immediate surrounds)
• Inner Regional (Byron Bay, Ballina, Lismore, Grafton, Coffs Harbour and Port Macquarie and surrounds)
• The remainder of NCNSW is classified as Outer Regional (4)
Table 4 lists rurality classifications for key towns in NCNSW. The Australian Standard Geographical
Classification (ASGC) Remoteness Area (RA) classification does not reflect the demands of delivering
health care in Rural Australia. As a result, Medicare Australia continues to use Rural, Remote and
Metropolitan Area (RMMA) classifications.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
13
Towns
RRMA
ASGC RA
Tweed Heads
2
1
Tweed Coast
2/5
1
Murwillumbah
5
2
Byron Bay
5
2
Ballina
4
2
Lismore
3
2
Casino
4
2
Maclean
5
2
Grafton
4
2
Coffs Harbour
4
2
NambuccaMacksville
5
3
Kempsey
5
2
Port Macquarie
3
2
Table 4 Rurality Classification for Key Towns in
North Coast NSW (3)
The RRMA classification is used is used to calculate
rurality of towns and provide Department of Health
practice incentive payments to General Practices.
Calculation of the RRMA is informed by out-dated census
data and results in some discrepancies in representing
rurality of towns and communities in the region.
• For example, areas such as Murwillumbah and
Pottsville that are now closer to large population
centres still receive the highest rural loading and some
towns technically classified as RRMA 5 (Rural Centers
with an urban centre population under 10,000) actually
function as rural/remote places being within LGAs
with limited infrastructure, few services, very limited
transport options and a significant number of distant
and thinly populated villages and small settlements.
The newer RA classification under the ASGC is an
alternative measure of remoteness in the region. This
classification is also problematic because it does not
acknowledge differences between some of the larger
coastal centres (such as Port Macquarie, Coffs Harbour
and Ballina) and smaller more rural centres (such as
Casino and Maclean).
Local Rural Classification Approach
Locality Profile Modelling has been undertaken to address the rural / remoteness classification anomalies
that exist across the NCNSW. This has included analysis of the population and local accessibility to
existing services.
Locality Profile Modelling categorises localities based on the following attributes:
• Population (2011 Census) or forecasted population where available
• Socio Economic Indexes for Areas ( SEIFA )
• General Practitioners – full time equivalent (FTE)
• Services proximity
-Hospital
-Pharmacy
-Ambulance
- Pathology/Radiology services
- Community Health facilities
• Availability of after hours Pharmacy
• Availability of Pathology/ Radiology services
This categorisation enables identification of target communities of need.
Category A: Communities referred to as Outer Regional Rural & Remote communities have
• no, or very limited, after hours services and limited choices of service at a distance
• nil to limited or shortage in FTE clinical workforce (solo GP or low GP to population ratio)
• limited access or multiple service gaps or distant proximity (> 30mins) to services (Ambulance,
Emergency Department Pharmacy, Pathology, Radiology)
• limited or restricted emergency services
• socioeconomic disadvantage (SEIFA score - 875-900)
• population < 2000
Category A communities include: Bellbrook, Bowraville, Bonalbo, Comboyne, Coraki,
Coramba/Nana Glen/Bucca, Crescent Head and Urbenville
14
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Category B: Communities referred to as Coastal and Rural communities have
• limited after hours service choices
• limited workforce availability in after hours
• gaps in services access (Ambulance, Emergency Department, Pharmacy, Pathology, radiology),
or distance proximity to District Hospital (<30mins)
• socioeconomic disadvantage (SEIFA score < 925)
• population <5000
Category B communities ooli-Minnie Waters and experience service gaps, low socio-economic status
and other disadvantages. (see Appendix 5 for complete listing of categories and towns)
1.1.2 Climate
The Climate of NCNSW is broadly characterised as subtropical. In general, the coastal strip experiences
more rainfall than the inland towns. In the wetter summer months the area is regularly prone to flooding,
although periods of drought occur, particularly effecting farms and grazing pastures inland.
Climate change and variability is impacting the natural, economic and social systems that support good
health. It has the potential to be the cause of more injuries, disease and deaths impacting on the burden
of human ill-health (5). Expected continuing impacts include increased population at risk of vector borne
diseases, increase in floods and storms and social and economic impact on coastal communities, subject
to sea level rising, such as those of the NCNSW.
Other potential risks include injuries and fatalities related to heatwaves and other severe weather events;
spread of some infectious diseases from rising temperatures and changes in rainfall; exacerbated
respiratory allergies from increased allergens (pollens and spores) in the air; mental health problems in
those experiencing physical and economic impacts of variable weather conditions; health consequences
of population dislocation as some regions become uninhabitable (5).
1.1.3 Economic Activity
The economic base of the region is dominated by tourism, agriculture, education, health and training.
Major infrastructure developments such as the Pacific Highway up-grades can stimulate wider economic
activity across the communities as labour is imported to complete the projects.
Tourism contributes to demand for primary care services including after hours services in NCNSW,
particularly during holiday times in coastal towns.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
15
1.2 The People
1.2.1 Current Population and Projected Growth
The current NCNSW population is 497,730 people consisting of 253,362 females (50.9%) and 244,368
males (49.1%) (Table 5).
Locality
Male
Female
Total
N NSW
142,226
147,161
289,387
MNC NSW
102,142
106,201
208,343
NCNSW
244,368
253,362
497,730
3,624,791
3,676,343
7,301,134
NSW
Table 5 Estimated Residential Population 2012 (2)
The population is projected to grow more slowly than the state average over the next 20 years from 2011
(15.9% versus 27.8%). (Table 6)
Locality
Population Projections*
% of Population Growth
2011
2011 - 2031
2011 - 2031
N NSW
287,869
331,651
15.2%
MNC NSW
207,490
242,822
17%
NCNSW
495,359
574,474
16%
7,218,528
9,228,362
27.8%
NSW
Table 6 Population Projections 2011-2031 (6)
* Population projections are population estimates calculated and released by NSW Department
of Planning and Infrastructure based on the estimated residential populations taken from the 2011
migration and are not precise predictions of the demographic future. Whilst the latest data is used
in conjunction with expertise on fertility, mortality and migration, these variables are subject to a wide
variety of social, economic and political factors which cannot be foreseen. Some projections may not
add up to the total population due to rounding of figures.
No LGA is expected to reach the expected NSW growth rate of 27.8%. The predicted population growth
for NCNSW is not expected to be uniform with variations from 24% in Coffs Harbour and Tweed, down
to -1% for Bellingen. (see Figure 3)
16
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
NORTH COAST NSW – THE LOCATION AND PEOPLE
Figure 3 Percentage of Population Growth by LGA 2011-­‐2031 (5)
% Population Growth 2011 - 2031
30%
25%
24%
20%
15%
10%
5%
18%
0%
-5%
13%
10%
10%
24%
21%
5%
11%
7%
0%
0%
-1%
NCNSWML
NSW
Figure 3 Percentage of Population Growth by LGA 2011-2031 (5)
Projected Growth by Age
Projected Growth by Age
Over
20 all
years,
allinLGAs
in NCNSW
willa have
a decline
in the population
aged
Over the
nextthe
20next
years,
LGAs
NCNSW
will have
decline
in the population
aged between
15 and
between 15 and 65 years. The importance of this lies within the ratio of active workers
65 years.
The
importance
of
this
lies
within
the
ratio
of
active
workers
(aged
15-65
years)
compared
to
(aged 15-65 years) compared to inactive workers (0-14 and >65 years). This is referred to
inactiveasworkers
(0-14
and
>65
years).
This
is
referred
to
as
the
age
dependency
ratio.
As
the
ratio
the age dependency ratio. As the ratio increases there is a subsequent increased burden
increases
there isand
a subsequent
increased
burden
on health and
social
services.
Monitoring
dependency
on health
social services.
Monitoring
dependency
ratios
enables
adequate
planning
for
changesadequate
in social and
economic
development
as and
well economic
as demonstrating
broad as
trends
ratios enables
planning
for changes
in social
development
wellinas
social support.
demonstrating
broad trends in social support.
7 illustrates
the increase
in the
age dependency
ratio across
NCNSW
and
the
Table 7Table
illustrates
the increase
in the age
dependency
ratio across
NCNSW
and the
differences
between
differences
between
the
NNSW
and
MNCNSW.
the N NSW and MNC NSW.
Table 7 Age Dependency Ratio Comparison 2011-­‐2031 (5) Age Dependency Ratio
N NSW
MNC NSW
NCNSWN NSW
NSW
2011
0.61
2031
0.66
0.90
0.63
0.86
0.50
NCNSW
0.84
20110.66
0.610.63
MNC NSW
2031
0.84
0.90
0.86
0.63
Table 7 Age
Dependency Ratio Comparison 2011-2031 (5)
NSW
•
•
•
•
0.50
0.63
As the 0-14 year age group remains a relatively stable proportion of the population, the increase in the
• As the 0-14 year age group remains a relatively stable proportion of the population, the
dependency
ratio
due
to an increase
population
andageing
the subsequent
increase
in isthe
dependency
ratio in
is the
dueageing
to an increase
in the
population reduction
and the of the
population
within
the
15-64
year
group.
subsequent reduction of the population within the 15-64 year group.
The proportion
of the population
aged
65 and
years
andinover
in was
2011greater
was greater
in NCNSW
The•proportion
of the population
aged 65
years
over
2011
in NCNSW
compared to
compared
the state
average
(20.1% versus 14.5%).
the state
average to
(20.1%
versus
14.5%).
This difference
is projected
to increase
by(29.2%
2031 (29.2%
20.1%).
This• difference
is projected
to increase
further further
by 2031
versusversus
20.1%). It is estimated that 18.6% of the current NCNSW population is aged 14 years or younger and this is
projected
to slightly
to 17.1%
2031.
The Health
Needs decrease
of North Coast
NSW- by
2014
Page 19 of 122
The inactive working population aged 0-14 years has slight decreases in the majority of the LGAs and the
over 65 year age group increases by up to 13% of the population across the LGAs in NCNSW. This results
in a decrease in the working population of up to 11% in the 15-64 year age groups in all LGAs.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
17
•
It is estimated that 18.6% of the current NCNSW population is aged 14 years or younger
and this is projected to slightly decrease to 17.1% by 2031.
Figure 4 Population Growth by LGA 2011-­‐2031 (5)
Urbenville
Tweed
Port
Richmond Macquarie
Valley -Hastings Nambucca Lismore
Kyogle
Kempsey
Coffs
Harbour
Clarence
Valley
Byron
Bellingen
Ballina
% Population Growth by LGA
2011 - 2031
2011
18%
2031
17%
30%
53%
19%
61%
19%
2011
21%
61%
31%
51%
2031
17%
2011
18%
2031
18%
60%
22%
2011
19%
60%
21%
2011
19%
2031
18%
2011
20%
2031
18%
2011
19%
2031
19%
2011
20%
33%
51%
17%
2031
13%
68%
18%
63%
26%
56%
19%
61%
31%
51%
17%
64%
28%
53%
14%
66%
2031
18%
59%
24%
2011
18%
58%
24%
2011
18%
2031
16%
37%
48%
16%
2031
33%
51%
2031
19%
2011
18%
2031
16%
0%
10%
23%
60%
30%
54%
18%
63%
31%
54%
15%
2031
30%
51%
18%
2011
19%
60%
21%
2011
24%
58%
20%
30%
40%
<15
50%
15-64
60%
70%
80%
90%
100%
65+
The Health
NeedsGrowth
of North
NSW- 2014
(5)
Figure
4 Population
by Coast
LGA 2011-2031
18
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Page 20 of 123
LGAs and the over 65 year age group increases by up to 13% of the population across the
LGAs in NCNSW. This results in a decrease in the working population of up to 11% in the
15-64 year age groups in all LGAs.
1.2.2
Ageing Population
NORTH COAST NSW – THE LOCATION AND PEOPLE
1.2.2The
Ageing
Population
North Coast
is a popular place for retirement with these migrating retirees now known
as “sea
changers”
and place
“tree changers”.
The North
Coast
is a popular
for retirement with these migrating retirees now known as “sea
1.2.3
Aboriginal
Population
changers” and “tree changers”.
11 out of the 12 LGAs (+Urbenville) in NCNSW have a higher proportion of >65 year old
population
compared
to NSW.
The LGAs
of Nambucca
and Port
Macquarie-Hasting
have
11 outThe
of the
12 LGAs
in NCNSW
a higher proportion
>65 year
old population
proportion
of(+Urbenville)
NCNSW
residents
thathave
are
Aboriginal
(4.1%)
is of
around
double
that of
NSW
24%
of
their
population
aged
>65
years,
followed
closely
by
Tweed
at
23%.
(see
Figure
5)
(2.3%).
compared
to NSW. The LGAs of Nambucca and Port Macquarie-Hasting have 24% of their population
aged >65 years, followed closely by Tweed at 23%. (see Figure 5)
Figure Table 8 5 Percentage of Population years by oLf GA (5)population (6) Aboriginal Population as a >p65 ercentage total Aboriginal Population
30%
25%
Bellingen
20%
Byron
Total Population
% of Population1,207
> 65 Years 2011
Ballina
369
21%
15% Valley
Clarence
21%
19%
18%
13%
Coffs
Harbour
10%
551
19%
2,639
2,692
Kempsey
Kyogle
3.0%
12,886
24%
51,252
14%
2.9%
24%
30,823
17%
2,985
5%
% of Total Population
40,755
23%
19%
1.8%
18%
5.1%
70,933
3.8%
29,188
10.2%
615
9,537
6.4%
Lismore
1,809
44,282
4.1%
Nambucca
1,189
19,286
6.2%
Port Macquarie-Hastings
2,039
74,949
2.7%
Richmond Valley
1,389
22,697
6.2%
2,769
88,463
3.1%
0%
Tweed
NCNSWML
NSW
N NSW
11,023
288,307
3.8% MNC
9,274(5)
207,242
4.5%
Figure 5 Percentage of Population >65 years by LGA
The rate of increase of the population over 65 years is set to increase substantially across
NCNSW
20,297
495,549
4.1%
NCNSW and is predicted to have a greater impact in Tweed, Port Macquarie-Hastings,
The rate
of
increase
of
the
population
over
65
years
is
set
to
increase
substantially
across
NCNSW
NSW
2.3%and is
Nambucca
and Richmond Valley LGAs.165,916
These LGAs will be 7,211,468
faced with substantial
predicted
to
have
a
greater
impact
in
Tweed,
Port
Macquarie-Hastings,
Nambucca
and
Richmond
Valley
increases in the population of people over 65 years within the next 20 years, placing
LGAs.pressure
These LGAs
be faced
with substantial
increases in the population of people over 65 years
on allwill
types
of infrastructure
.
except
have
percentages
of Aboriginal
population above the state average,
withinAll
theLGAs,
next 20
years,Byron,
placing
pressure
on all types
of infrastructure.
however the distribution is not even across NCNSW, with a number of LGAs having a
greater proportional representation. In particular, Kempsey has an Aboriginal population
1.2.3representing
Aboriginal
Population
10.2%
of its total population. (see Table 8 and Figure 6)
The proportion
of NCNSW
residents that are Aboriginal (4.1%) is around double that of NSW (2.3%).
Figure 6 Aboriginal Population as a percentage of LGA (6)
12 Percentage 10 Aboriginal PopulaUon as % of LGA 8 6 4 The Health Needs of North Coast NSW- 2014
2 3% 2.9% 1.8% 5.1% 3.8% 10.2% 6.4% 0 NSW Page 21 of 123
4.1% 6.2% 2.7% 6.2% 3.1% NCNSWML Figure 6 Aboriginal Population as a percentage of LGA (6)
The Health Needs of North Coast NSW- 2014
Page 22 of 123
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
19
All LGAs, except Byron, have percentages of Aboriginal population above the state average, however
the distribution is not even across NCNSW, with a number of LGAs having a greater proportional
representation. In particular, Kempsey has an Aboriginal population representing 10.2% of its total
population. (see Table 8 and Figure 6)
Aboriginal Population
Total Population
% of Total Population
Ballina
1,207
40,755
3.0%
Bellingen
369
12,886
2.9%
Byron
551
30,823
1.8%
Clarence Valley
2,639
51,252
5.1%
Coffs Harbour
2,692
70,933
3.8%
Kempsey
2,985
29,188
10.2%
615
9,537
6.4%
Lismore
1,809
44,282
4.1%
Nambucca
1,189
19,286
6.2%
Port Macquarie-Hastings
2,039
74,949
2.7%
Richmond Valley
1,389
22,697
6.2%
Kyogle
Tweed
2,769
88,463
3.1%
N NSW
11,023
288,307
3.8%
9,274
207,242
4.5%
20,297
495,549
4.1%
165,916
7,211,468
2.3%
MNC NSW
NCNSW
NSW
Table 8 Aboriginal Population as a percentage of total population (6)
The Aboriginal community has a higher proportion of children and young people and lower numbers of
older people compared with non-Aboriginal communities of NCNSW. Aboriginal people aged less than
24 years account for 55% of the NCNSW Aboriginal population while non-Aboriginal people aged under
24 years account for 29% of the total population.
Figure 7 Age Distribution of NCNSW Aboriginal and Non-Aboriginal Populations as a percentage of
0-5 yr Age Range (6)
20
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
NCNSW Aboriginal
NCNSW Non-Aboriginal
Number
%
Cumulative %
Number
%
Cumulative %
0-4
1,963
10%
10%
26,918
6%
6%
5-9
2,393
12%
21%
27,514
6%
11%
10-14
2,538
13%
34%
30,122
6%
18%
15-19
2,361
12%
46%
29,325
6%
24%
20-24
1,965
10%
55%
21,779
5%
29%
25-29
1,421
7%
62%
20,739
4%
33%
30-34
1,163
6%
68%
21,982
5%
38%
35-39
1,210
6%
74%
27,108
6%
43%
40-44
1,212
6%
80%
30,143
6%
50%
45-49
1,081
5%
85%
33,690
7%
57%
50-54
930
5%
90%
37,268
8%
65%
55-59
764
4%
94%
35,640
7%
72%
60-64
503
2%
96%
34,530
7%
79%
65-69
330
2%
98%
28,289
6%
85%
70-74
235
1%
99%
23,043
5%
90%
75+
227
1%
100%
47,161
10%
100%
Total
20,297
475,252
Table 9 Comparison of Aboriginal and Non Aboriginal Population by Age (6)
1.3 Cultural and Social Influences
NCNSW is a socially disadvantaged region, scoring below the NSW average across a range of Social
Economic Indexes.
For the purposes of creating a visual map of the social determinants in the region (Table 10 and Table 11),
various indicators have been compared to the state average and assigned colours as follows:
Indicators where there is a more negative outcome for the community than the state average
Indicators where the outcome for the community is similar to the state average
Indicators where there is a more positive outcome for the community than the state average
Table 10 demonstrates the socioeconomic disadvantage that characterises the region compared to the
rest of the state. This table illustrates that across a range of indicators of the Social Determinants of
Health, LGAs within the region are more disadvantaged that the state average overall.
Within the NCNSW region, there is variation in the level of social disadvantage between LGAs. This can
be seen in Table 11, where the analysis demonstrates that overall, the LGAs of Kempsey, Nambucca,
Richmond, Clarence and Nambucca experience more negative social determinant outcomes for the
community than the average for the NCNSW, while Port Macquarie and Ballina are relatively less
disadvantaged.
These differences are important to consider when assessing health needs and planning services. The
North Coast region cannot be considered as a single community. Detailed local level assessment of need
and service planning must consider these local differences in order to most effectively target programs
and services.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
21
NORTH COAST NSW – THE LOCATION AND PEOPLE
Port Macquarie-Hastings
Kempsey
Nambucca
Bellingen
Coffs Harbour
Clarence Valley
Richmond Valley
Ballina
Lismore
Kyogle
Byron
Tweed
Social Determinants of Health North Coast NSW compared to NSW Average (2) NCNSW
Table 10 SEIFA
SEIFA IRSD
Minimum Score
Maximum Score
Families (2011)
Single parent with children < 15 years
Jobless families with children < 15 years
Children < 15 years in jobless families
Housing/Transport (2011)
Rent assistance from Centrelink
Housing authority dwellings being rented
Housing stress - mortgage holders
Housing stress - renters
Housing stress-mortgage holders & renters
No motor vehicle
Education
Secondary school (2011)
Higher education (2013)
Early school leavers (2011)
Learning or earning (2011)
Income support (2012)
Age pensions
Disability support pensioners
Female sole parent pensioners
Unemployment beneficiaries
Long-term unemployment beneficiaries
Youth unemployment beneficiaries
Low income families (with children)
Children in low income families
Health care card holders
Pensioner concession cards
Total concession card holders
Labour Force
Unemployment (2013)
Labour force participation (2012)
Female labour force participation (2011)
Personal and Financial Stressors
Households that could raise $2,000 within a
week (2010)
Households that had at least one cash flow
problem in the last 12 months
Govt support as main source of income in the
last 2 years
Govt support as main source of income, for 12
months or more, within the past 24 months
Table 10 Social Determinants of Health North Coast NSW compared to NSW Average (2)
The Health Needs of North Coast NSW- 2014
22
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Page 25 of 123
NORTH COAST NSW – THE LOCATION AND PEOPLE
Port Macq-Hastings
Kempsey
Nambucca
Bellingen
Coffs Harbour
Clarence Valley
Richmond Valley
Ballina
Lismore
Kyogle
Byron
Social Determinants of Health -­‐ North Coast LGAs compared to the regional average (2) Tweed
Table 11 SEIFA
SEIFA IRSD
Minimum Score
Maximum Score
Rank within Medicare Local
Families (2011)
Single parent with children <15 years
Jobless families with children < 15 years
Children < 15 years in jobless families
Housing/Transport (2011)
Rent assistance from Centrelink
Housing authority dwellings being rented
Housing stress - mortgage holders
Housing stress - renters
Housing stress - mortgage holders & renters
No motor vehicle
Education
Secondary school (2011)
Higher education (2013)
Early school leavers (2011)
Learning or earning (2011)
Income support (2012)
Age pensions
Disability support pensioners
Female sole parent pensioners
Unemployment beneficiaries
Long-term unemployment beneficiaries
Youth unemployment beneficiaries
Low income families (with children)
Children in low income families
Health care card holders
Pensioner concession cards
Total concession card holders
Labour Force
Unemployment (2013)
Labour force participation (2012)
Female labour force participation (2011)
Personal and Financial Stressors
Households that could raise $2,000 within a
week (2010)
Households that had at least one cash flow
problem in the last 12 months
Government support as main source of
income in the last 2 years
Government support as main source of
income, for 12 months or more, within the
past 24 months
Table 11 Social Determinants of Health - North Coast LGAs compared to the regional average (2)
The Health Needs of North Coast NSW- 2014
Page 26 of 123
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
23
NORTH COAST NSW – THE LOCATION AND PEOPLE
1.3.1
Index of Relative Socioeconomic Disadvantage
1.3.1 Index of Relative Socioeconomic Disadvantage
The Australian Bureau of Statistics (ABS) has developed the Socio-Economic Indexes for
Areas (SEIFA)
ofof
Local
Government
(LGA).
The Index
of Relative Socio-Economic
The Australian
Bureau
Statistics
(ABS) has
developed
the Socio-Economic
Indexes for Areas (SEIFA)
Disadvantage
that indicate relative
disadvantage.
index
of Local
Government(IRSD)
(LGA).summarises
The Index ofvariables
Relative Socio-Economic
Disadvantage
(IRSD)This
summarises
ranks
areas
on
a
continuum
from
most
disadvantaged
to
least
disadvantaged.
A
low
score
variables that indicate relative disadvantage. This index ranks areas on a continuum from most
on this index indicates a high proportion of relatively disadvantaged people in an area.
disadvantaged to least disadvantaged. A low score on this index indicates a high proportion of relatively
disadvantaged
people
area. scored below the state average of 1000. This emphasises the
In 2011, all
LGAsininan
NCNSW
relative
socioeconomic
disadvantage
across
In 2011,
all LGAs
in NCNSW scored
below the
stateNCNSW.
average of 1000. This emphasises the relative
socioeconomic disadvantage across NCNSW.
The LGAs are ranked into quintiles across NSW (see key below), showing lowest (1st
quintile)
highest
(5thNSW
quintile).
Clarence
Valley,
Kempsey,
Kyogle,
The LGAs
are to
ranked
intodisadvantage
quintiles across
(see key
below),
showing
lowest (1st
quintile) to highest
th
Nambucca
and
Richmond
Valley
LGAs
are
in
the
5
and
most
disadvantaged
quintile.
disadvantage (5th quintile). Clarence Valley, Kempsey, Kyogle, Nambucca and Richmond
Valley LGAs are
in the 5th and most disadvantaged quintile.
LGAs (with Aboriginal populations higher than 5%) had the lowest scores (Figure 8).
LGAs (with Aboriginal populations higher than 5%) had the lowest scores (Figure 8).
Figure 8 Index of Relative Social Disadvantage by LGA 2011 (2) Index of RelaUve Social Disadvantage by LGA 1000 980 960 940 920 900 880 860 840 820 Figure 8 Index of Relative Social Disadvantage by LGA 2011 (2)
The Health Needs of North Coast NSW- 2014
24
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Page 27 of 122
NORTH COAST NSW – THE LOCATION AND PEOPLE
1.3.2
Family Type
NCNSW
has more
single
1.3.2
Family
Typeparent families with children under 15 years of age - 30.7%
1.3.2
Family
Type
(14,375) compared to the NSW state average of 21.2% (151,157).
NCNSW
hassingle
moreparent
single families
parent families
with children
under
15 of
years
age - 30.7%
NCNSW
has more
with children
under 15
years
age of
- 30.7%
(14,375) compared to
(14,375)
compared
to
the
NSW
state
average
of
21.2%
(151,157).
•
LGAs
with
the
highest
rate
of
single
parent
families
with
children
under
15 years of
the NSW state average of 21.2% (151,157).
age are Kempsey (39.1%), Richmond Valley (31.4%) and Nambucca (35.7%) (see
• the
LGAs
with the
rateparent
of single
parent
families
withunder
children
underof
15age
years
• LGAsFigure with
ratehighest
of single
families
with
children
15 years
areofKempsey
9). highest
age are Kempsey
(39.1%),
Valley
(31.4%)
Nambucca
(35.7%) (see
(39.1%), Richmond
Valley (31.4%)
andRichmond
Nambucca
(35.7%)
(seeand
Figure
9).
Figure 9). of Single Parent Families by LGA (2)
Figure 9 Percentage Figure 9 Percentage of Single Parent Families by LGA (2)
Single Parent Families
Single Parent Families
40
30
20
10
0
50
Percentage
Percentage
50
40
30
20
10
0
NSW
NSW
Children
Low
Income
Welfare
Dependent
Families
with
In 2012,
more
families
in NCNSW
were low
income
or Children
welfare dependant (14.1%) compared
Low
Income
Welfare
Dependent
Families
with
Children
2012,average
more families
in NCNSW
low income
or welfare
to NSWInState
(10%).
All LGAswere
had rates
that were
higherdependant
than NSW(14.1%)
with thecompared
In 2012,tomore
in NCNSW
were low
income
or welfare
dependant
(14.1%)
compared
NSWfamilies
State average
(10%).
had
rates
that Macquarie-Hastings
were
higher than
NSW
with the to NSW state
highest being
Kempsey
(19.6%)
andAll
theLGAs
lowest
being
Port
(10.7%).
averagehighest
(10%). All
had rates
thatand
were
higher
than
NSW
the highest being(10.7%).
Kempsey (19.6%)
beingLGAs
Kempsey
(19.6%)
the
lowest
being
Portwith
Macquarie-Hastings
Figure 10 lowest being
Percentage Low Income Welfare Dependant Families with Children (2) and
the
Portof Macquarie-Hastings
(10.7%).
(2)
Figure
9 Percentage
of Single
Parent Families
by LGAwith
Low Income
Welfare
Dependent
Families
Figure 10 % Low Income Welfare Dependant Families With Children
% Low Income Welfare Dependant Families With Children
15
10
5
0
25
Percentages
Percentages
25
20
Percentage of Low Income Welfare Dependant Families with Children (2) 20
15
10
5
0
NCNSWML NSW NSW
NCNSWML
Figure 10 Percentage of Low Income Welfare Dependant Families with Children (2)
The Needs
Health Needs
of Coast
North Coast
The Health
of North
NSW-NSW2014 2014
1.3.3 Housing and Transport
of 123
PagePage
28 of28123
Housing The residents of NCNSW experience housing stress which is above the NSW average for both mortgage
holders as well as renters and higher than the NSW average for people receiving rent assistance from
Centrelink. Across the region there are higher numbers of households with no motor vehicle than the NSW
average (see Table 11).
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
25
The residents of NCNSW experience housing stress which is above the NSW average for
both mortgage holders as well as renters and higher than the NSW average for people
receiving rent assistance from Centrelink. Across the region there are higher numbers of
households with no motor vehicle than the NSW average (see Table 11).
Homelessness
Homelessness
The ABS defines homelessness as
The ABS “When
definesahomelessness
as have suitable accommodation alternatives they are considered
person does not
if their
current
living accommodation
arrangement alternatives they are considered homeless if their
“When a homeless
person does
not have
suitable
• arrangement
is in a dwelling that is inadequate or
current living
• has no
tenure,
or if theirorinitial tenure is short and not extendable
• is in a dwelling
that
is inadequate
•
does
not
allow
them
to have
control
of,not
andextendable
access to space for social relations” (7).
• has no tenure, or if their initial tenure
is short
and
• does not allow them to have control of, and access to space for social relations” (7).
In 2011, the ABS reported there to be 2,188 people who are experiencing homelessness in
NCNSW.
can be
broken
1,374 experiencing
in NNSW andhomelessness
814 in MNCNSW.
As well
as can
In 2011,
the ABSThis
reported
there
to bedown
2,188topeople
in NCNSW.
This
this
group
there
are
a
number
of
people
living
in
accommodation
that
is
temporary,
be broken down to 1,374 in N NSW and 814 in MNC NSW. As well as this group there are a number of
overcrowded, improvised or supported. (see Figure 11 and Figure 12)
people living in accommodation that is temporary, overcrowded, improvised or supported. (see Figure
11 andFigure Figure
11 12)
Number of persons in NNSW living in Marginal Housing 2011 (8)
Number of persons in NNSW in marginal housing 2011 801 Persons who are marginally housed in caravan parks 96 Persons in other improvised dwellings 486 Persons living in other crowded dwellings 196 Persons living in 'severely' crowded dwellings 24 Persons in other temporary lodging 227 Persons staying in boarding houses 319 Persons staying temporarily with other households 260 Persons in supported accommodaLon for the homeless Persons who are in improvised dwellings, tents or sleeping out 351 NORTH
COAST NSW – THE
LOCATION AND PEOPLE
0 100 200 300 400 500 600 700 800 900 (8)
Figure
of persons
in N NSW
in LMarginal
Figure 111
2 NumberNumber of Persons in Mliving
NCNSW iving in MHousing
arginal H2011
ousing 2011 (8)
Number of Persons in MNC NSW in marginal housing 2011 563 Persons who are marginally housed in caravan parks 61 Persons in other improvised dwellings 362 Persons living in other crowded dwellings 162 Persons living in 'severely' crowded dwellings 10 Persons in other temporary lodging 39 Persons staying in boarding houses 233 Persons staying temporarily with other households 268 Persons in supported accommodaLon for the homeless 73 Persons who are in improvised dwellings, tents or sleeping out The Health Needs of North Coast NSW- 2014
0 100 Page 29 of 123
200 300 400 500 600 (8)
Figure
12 NumberRental
of Persons
in MNC NSW
Living in Marginal
The Anglicare
Affordability
Snapshot
(2014) Housing
reports2011
there
has been a decline in the
number of properties which are affordable and available to people on low incomes in
The Anglicare
NCNSWRental
(9). Affordability Snapshot (2014) reports there has been a decline in the number of
properties which are affordable and available to people on low incomes in NCNSW (9).
Client data, collected between July and September 2013 by St Vincent de Paul Society
Client data, collected between July and September 2013 by St Vincent de Paul Society highlights that
highlights that the Society has provided 31% of its total services expenditure for people in
the Society has provided 31% of its total services expenditure for people in homeless or temporary
homeless or temporary accommodation in the Lismore Catholic Diocese (which shares the
accommodation in the Lismore Catholic Diocese (which shares the NCNSW footprint). This expenditure
NCNSW footprint). This expenditure of in the Lismore Diocese far exceeds the next closest
of in the Lismore Diocese far exceeds the next closest expenditure for homelessness by a Diocese for
expenditure for homelessness by a Diocese for the same services (12.75%). (10).
the same services (12.75%). (10).
26
Transport
People living in NCNSW are transport disadvantaged. The Pacific Highway provides the
major north/south transport route. Many rural residents have to drive to a neighbouring town
for health services. Drives of up to 30 minutes are not uncommon.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Lack of transport is a major barrier to health care access, particularly for vulnerable and
marginalised people such as Aboriginal and older people of which numbers are high in
Transport
People living in NCNSW are transport disadvantaged. The Pacific Highway provides the major north/south
transport route. Many rural residents have to drive to a neighbouring town for health services. Drives of up
to 30 minutes are not uncommon.
Lack of transport is a major barrier to health care access, particularly for vulnerable and marginalised
people such as Aboriginal and older people of which numbers are high in NCNSW.
• Public transport, where it exists, is limited to bus services which run infrequently in all but the larger
regional centres. There is a high reliance on private motor vehicles, particularly in the out of business
hours period.
Limited availability of public transport presents a significant barrier to accessing services including primary
care. The growing ageing population experiences greater physical impediments to driving so health care
and other services becomes particularly difficult.
The inland villages are characterised by small populations and most are relatively remote. People living in
these communities face the additional barrier of difficult driving conditions, particularly at night and during
periods of bad weather.
NORTH
COAST
NSW – that
THE impact
LOCATION
ANDaccessibility
PEOPLE
Some community transport options exist however
there
are barriers
on the
of
these services including:
• Limited knowledge and understanding of the program
• Strict and rigid eligibility criteria
• Restrictions
on traversing the state border (to access many specialists)
1.3.4 Education
of Education and Occupation
1.3.4Index
Education
In 2011, the education and occupation status of LGAs in NCNSW, as measured by the Index
Indexof
ofEducation
Educationand
andOccupation,
Occupationshowed significant variation. All LGAs scored below the state
In 2011,
the education
occupation
status
LGAs(1,029).
in NCNSW,
aswith
measured
by the
Index of Education
average
of 1,000,and
with
the exception
of of
Byron
LGAs
Aboriginal
populations
and Occupation,
significant
All scores,
LGAs scored
below
the state
of 1,000,
with the
higher thanshowed
5% tended
to havevariation.
the lowest
with the
exception
of average
Kyogle (2)
.
exception
of Byron (1,029). LGAs with Aboriginal populations higher than 5% tended to have the lowest
scores,
with13 the
ofEducation Kyoglea(2)
Figure exception
Index of nd .Occupation by LGA. 2011 (2) 1050 EducaUon & OccupaUon 1000 950 900 850 800 Figure 13 Index of Education and Occupation by LGA. 2011 (2)
1.3.5
Income Support
NCNSW has a high number of households with an income of less than $500 per week
(17.2% N NSW; 19.0% MNC NSW) compared to NSW (12.1%). These rates are amongst
the highest in NSW.
The region also has the lowest rate of households with an income of greater than $2000 per
week in NSW (8.8% N NSW; 7.9% MNC NSW) compared to NSW 21.7% (6) .
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Age Pension
In 2012 there were more eligible residents in NCNSW receiving age pensions (75.2%) than
the NSW state average (69.7%). The LGA with the highest rate of age pensioners was
27
1.3.5 Income Support
NCNSW has a high number of households with an income of less than $500 per week (17.2% N NSW;
19.0% MNC NSW) compared to NSW (12.1%). These rates are amongst the highest in NSW.
The region also has the lowest rate of households with an income of greater than $2000 per week in NSW
(8.8% N NSW; 7.9% MNC NSW) compared to NSW 21.7% (6).
Percentages
Age Pension
In 2012 there were more eligible residents in NCNSW receiving age pensions (75.2%) than the NSW state
average (69.7%). The LGA with the highest rate of age pensioners was Nambucca at 80.8% and the
lowest was Byron at 65.8%. (see Figure 14) (2)NORTH COAST NSW – THE LOCATION AND PEOPLE
Age Pensioners
90
80
70
60
50
40
30
20
10
0
NCNSWML
NSW
Figure 14 Percentage of Age Pensioners by LGA, 2012
(2)
Disability
Support
Pension
Disability
Support
Pension
In 2012
were eligible
more eligible
residents
receiving
the disability
in (10.9%)
In 2012
there there
were more
residents
receiving
the disability
supportsupport
pensionpension
in NCNSW
NCNSW
(10.9%)
than
NSW
(5.7%).
The
LGAs
with
the
highest
percentage
of
disability
than NSW (5.7%). The LGAs with the highestNORTH
percentage
disability
pensioners
were Kempsey
COASTofNSW
– THEsupport
LOCATION
AND PEOPLE
support
pensioners(15.1%).
were Kempsey
Nambucca
(15.1%).
The LGA
with the
(2)
(15.7%)
and Nambucca
The LGA(15.7%)
with theand
lowest
percentage
was Ballina
at 8.6%
.
lowest percentage was Ballina at 8.6% (2).
Figure 15 Percentage of Disability Support Pensioners by LGA 2012 (2) Age Pensioners
90
80
70
18
60
16
50
14
40
12
30
10
20
8
10
6
40
2
0
Percentages
Percentages
% Disability Support Pensioners
NCNSWML
NCNSWML
NSW
NSW
Figure 15 Percentage of Disability Support Pensioners by LGA 2012 (2)
28
Disability Support Pension
InPeople
2012 there
were more
eligible residents
receiving
the disability support pension in
Receiving
an Unemployment
Benefit
Long-term
NCNSW
(10.9%)
than
NSW
(5.7%).
The
LGAs
with
the highest
percentage
of than
disability
In 2012, more NCNSW residents were eligible and receiving
long-term
(more
180 days)
support
pensioners
were
Kempsey
(15.7%)
and
Nambucca
(15.1%).
The
LGA
with
unemployment benefit (6.3%) than across NSW (3.2%). LGAs with the highest ratethe
of longlowest
percentage was
Ballina
at 8.6% were
(2). Nambucca and Kyogle (8.6%) and the lowest
term unemployment
benefit
recipients
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
rate was in Ballina (4.7%) (2).
Percentage of Disability Support Pensioners by LGA 2012 (2) Figure 15 Figure 16 Percentage of People on Long Term Unemployment Benefits 2012 Percentage
Percentage
People Receiving an Unemployment Benefit Long-term
In 2012, more NCNSW residents were eligible and receiving long-term (more than 180 days)
unemployment benefit (6.3%) than across NSW (3.2%). LGAs with the highest rate of long-term
NORTH
– THE
AND
PEOPLE
and COAST
KyogleNSW
(8.6%)
andLOCATION
the lowest
rate
was in
unemployment benefit recipients were Nambucca
NORTH COAST NSW – THE LOCATION AND PEOPLE
(2)
Ballina (4.7%) .
% on Long Term Unemployment Benefit
% on Long Term Unemployment Benefit
10
10
8
8
6
6
4
4
2
2
0
0
NCNSWML
NCNSWML
NSW
NSW
1.3.6 16
Labour
Force
Figure
Percentage
of People on Long Term Unemployment Benefits 2012
1.3.6
Labour Force
Unemployment
1.3.6 Labour
Force
Unemployment rates have been higher for NCNSW than the state average and other regions
Unemployment
Unemployment
across NSW for many decades. The pleasant climatic conditions and community
Unemployment
rates
have
been
forthan
NCNSW
than
the state
average
and
other
regions
Unemployment
rateswithin
have
been
higher
forhigher
NCNSW
the state
average
and
other regions
across
NSW
acceptance
the
region
have
encouraged
long-term
unemployed
people
to
migrate
to
NSW
forpleasant
many
decades.
The pleasant
conditions
and community
the
North
Coast.
This influx
of population,
coupled
with limited
employment
opportunities
for manyacross
decades.
The
climatic
conditions
andclimatic
community
acceptance
within
the region have
acceptance
within
the region
have encouraged
long-term
unemployed
people to migrate
and long-term
constrained
business
activity,
contributed
to consistently
high unemployment
rates to
encouraged
unemployed
peoplehas
to migrate
to the
North Coast. This
influx of population,
the
Coast.
This influx of
and North
long-term
unemployment
(2).population, coupled with limited employment opportunities
coupled and
with constrained
limited employment
constrained
business activity,
has contributed
to
businessopportunities
activity, has and
contributed
to consistently
high unemployment
rates
(2)
consistently
high
unemployment
rates
and
long-term
unemployment
.
and
long-term
unemployment
In 2013,
the unemployment
rate(2).
for NCNSW was 6.6% compared to NSW 5.2%. The
highest unemployment rate for the region was in Byron and Nambucca at 8.8% whilst Ballina
In 2013, the unemployment rate for NCNSW was 6.6% compared to NSW 5.2%. The highest
was
the only
LGA in the region
with
rate lowerwas
than6.6%
NSWcompared
(4.9% compared
5.5% )(see
In
2013,
the unemployment
rate
fora NCNSW
to NSWto5.2%.
The
unemployment
rate for the region was in Byron and Nambucca at 8.8% whilst Ballina was the only LGA
Figure 17).
highest
unemployment rate for the region was in Byron and Nambucca at 8.8% whilst Ballina
in the region
a rate
lower
thanregion
NSW.with
(4.9%
compared
to 5.5%
) (see
Figure
17). to 5.5% )(see
was with
the only
LGA
in the
a rate
lower than
NSW
(4.9%
compared
Figure 1
7 Percentage o
f P
eople U
nemployed b
y L
GA Figure 17).
Figure 17 Percentage
Percentage
10
Unemployment
Percentage of People U
nemployed by LGA 8
10
6
48
Unemployment
26
04
2
0
NCNSWML
NSW
Figure
17 Percentage of People Unemployed by LGA
Volunteerism
NCNSWML
NSW
Volunteer rates can provide an indication of community connectedness. The percentage of
people volunteering in each LGA on NCNSW is higher than the NSW average (Figure 18).
Volunteerism
Volunteer
rates can
provide
indication
The Health Needs
of North
Coastan
NSW2014 of community connectedness. The percentage
Page 33 of 123of
people volunteering in each LGA on NCNSW is higher than the NSW average (Figure 18).
The Health Needs of North Coast NSW- 2014
Page 33 of 123
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
29
NORTH COAST NSW – THE LOCATION AND PEOPLE
Volunteerism
This shows a high level of engagement in supporting community activities but not why this
Volunteer rates can provide an indication of community connectedness. The percentage of people
rate is high. Possible attributions include:
volunteering in each LGA on NCNSW is higher than the NSW average (Figure 18). This shows a high
level of•engagement
in supporting
activities
but nottowhy
this rate
is high.
Possible
Older people
may havecommunity
available time
to dedicate
informal
work
situations
andattributions
the
include: region has a high percentage of older people
• people
The portion
of population
of ‘sea’
and ‘tree’
who situations
volunteer and
in the
of has a high
• Older
may have
available time
to dedicate
to changers
informal work
thehope
region
securing
employment
or as an avenue to meet people. The ‘sea’ and ‘tree’ changers
percentage
of older
people
alsoof
bring
with them
manyand
tertiary
whichwho
canvolunteer
be utilised
• The portion
population
of ‘sea’
‘tree’skills
changers
in by
thecommunity
hope of securing employorganisations
ment or as an avenue to meet people. The ‘sea’ and ‘tree’ changers also bring with them many tertiary
skills
which
utilised by
Figure 18 can bePercentage of pcommunity
eople in LGA porganisations
articipating in Voluntary Work, 2011 (2)
Volunteerism
35
Percentage
30
25
20
15
10
5
0
NCNSWML
NSW
Figure 18 Percentage of people in LGA participating in Voluntary Work, 2011
(2)
Northern Rivers Social Development Council (NRSDC) undertook a Community Wellbeing
Survey to measure how people felt about their quality of life and to highlight current social
Northern Rivers Social Development Council (NRSDC) undertook a Community Wellbeing Survey to
conditions. Forty one percent of people reported they volunteered with a local group (36%
measure
how people
felt four
about
their quality
of life
and to highlight
currentby
social
conditions.
one
nationally).
Forty
percent
of survey
respondents
felt valued
society
and 90%Forty
felt that
percentthey
of people
reported
they
volunteered
with
a
local
group
(36%
nationally).
Forty
four
percent
of
could get help from family and friends if needed (11).
survey respondents felt valued by society and 90% felt that they could get help from family and friends
(11) are many examples of widespread community engagement within NCNSW and
There
if needed
.
regardless of the underlying reasons for this engaged and willing community, it provides an
There are
many examples
of widespread
community engagement within NCNSW and regardless of the
opportunity
for innovation
and activity.
underlying reasons for this engaged and willing community, it provides an opportunity for innovation
and activity.
1.3.7 Other Social and Cultural Factors
1.3.7 Other Social and Cultural Factors
Culturally
and Linguistically
Population
Culturally
and Linguistically
Diverse Diverse
Population
NCNSW
hasculturally
fewer culturally
residents
NSW of
average
18.6%,
NCNSW
has fewer
diverse diverse
residents
than thethan
NSWthe
average
18.6%,ofwith
only with
4.1%only
of the
4.1%born
of the
population
born overseas
in non-English
speaking
(NES)
countries
(19,783)
(see
population
overseas
in non-English
speaking
(NES) countries
(19,783)
(see
Appendix
3 for LGA
Appendix
3
for
LGA
level
detail).
The
highest
proportions
of
overseas-born
residents
were
level detail). The highest proportions of overseas-born residents were living in the coastal LGAs of
living in the coastal LGAs of Byron (7.2%), Coffs Harbour (5.9%) and Tweed (4.6%).
Byron (7.2%), Coffs Harbour (5.9%) and Tweed (4.6%).
of(1,264)
0.3% (1,264)
of all overseas
born NCNSW
theyspeak
did not
A total Aoftotal
0.3%
of all overseas
born NCNSW
residentsresidents
reported reported
that theythat
did not
English
speak
English
well,
or
at
all.
Rates
of
limited
English
language
fluency
were
highest
in
the(0.8%),
well, or at all. Rates of limited English language fluency were highest in the LGAs of Coffs Harbour
(2)
Byron and Tweed (both 0.3%) . These rates are low compared to state averages.
The Health Needs of North Coast NSW- 2014
Page 34 of 123
Refugees
Australia accepts 13,500 people per year as part of its Refugee and Humanitarian Program and most have
been selected for resettlement from overseas along with a small number of asylum seekers. In NSW,
metropolitan Sydney locations receive the majority of arrivals.
30
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
• MNC NSW had 2.2% (571) of all NSW humanitarian arrivals between 2005-2011 which is in the high
range for all other regional NSW
• N NSW had 0.4% of arrivals which is higher than the Central Coast and Western LHDs (12).
The country of origin and past experiences can increase the health risks of refugees including
psychological disorders, physical pain due to torture or unfit living conditions, under-immunisation or
undetected chronic diseases.
Children at significant risk of harm
As of March 2014 over 48,000 vulnerable children in NSW were waiting to be seen by caseworkers from
the NSW Department of Family and Community Services (FACS). The potential for young people to suffer
sexual and physical abuse while in the care of the state is high. This is an increase of almost 4,000 children
from the same period last year (13) .
Across NSW, 28% (17,981) of children and young people at Risk of Significant Harm reports received a
face-to-face assessment by a community services caseworker in 2012/13, whilst 30% of the reported
children and young people from the Northern District of FACS received face-to-face assessment. This
number, however, does not capture the children and young people assessed and receiving support
services from caseworkers in non-government organisations.
In 2012-13 the Northern District of FACS reporting area had funding for 320 FTE positions with the actual
FTE employment being 278 (a vacancy of 42 positions). There were 51 funded vacancies in the April-June
2013 quarter, approximately 16% of funded positions, slightly higher than the state percentage (14) .
Crimes and Domestic Violence
In 2010, the NSW Domestic and Family Violence Action Plan reported that one in three women will be
physically assaulted in their lifetime and that 42% of homicides are a result of domestic or family
violence (15).This could be significant when considering the potential for substantial under-reporting of
domestic violence. In 2013, there were 28,291 incidents of domestic violence in NSW that were reported
to police of which 2,261 took place in NCNSW (16).
The LGAs in NCNSW with the highest incidence
of domestic
were
KempseyAND
(754/100,000),
Coffs
NORTH
COASTassaults
NSW – THE
LOCATION
PEOPLE
Harbour (604.2/100,000) and Richmond Valley (579.7/100,000) which are all much higher than the NSW
rate (391.2/100,000). These LGAs all show no indication of improvement with rates higher than the NSW
NCNSW
apprehended
orders20).
(AVOs) issued in 2013 which was 10% of
average
for the had
past 2,404
10 years
(see Figure violence
19 and Figure
all AVOs in NSW. Given NCNSW has less than 7% of the state’s population, the amount of
AVOs
disproportionate.
NCNSW
had is
2,404
apprehended violence orders (AVOs) issued in 2013 which was 10% of all AVOs in
NSW. Given NCNSW has less than 7% of the state’s population, the amount of AVOs is disproportionate.
Figure 19 Incidents of Domestic Violence Reported to Police, 2013 (16).
Rate/100,000 Incidents of DomesUc Assault Reported to Police 2013 800 700 600 500 400 300 200 100 0 Figure 19 Incidents of Domestic Violence Reported to Police, 2013 (16).
Figure 20 10 year trend of the highest incidents of domestic violence reported to police 2004-­‐2013 (16)
10 Year trend of the highest Incidents of DomesUc Violence Reported to Police in LGAs 2004-­‐2013 THE HEALTH NEEDS OF NORTH COAST NSW - 2014
1200 1000 31
Figure 20 10 year trend of the highest incidents of domestic violence reported to police 2004-­‐2013 (16)
10 Year trend of the highest Incidents of DomesUc Violence Reported to Police in LGAs 2004-­‐2013 1200 Rate/100,000 1000 800 600 400 200 0 2004 2005 2006 Coffs Harbour 2007 2008 Kempsey 2009 2010 Richmond Valley 2011 2012 2013 NSW (16)
Figure
20 10 Aboriginal
year trend of women
the highest
incidents
of domestic
reported
to police
Nationally,
suffer
higher
rates ofviolence
serious
violence
than2004-2013
non-Aboriginal
women, with Aboriginal women nearly six times as likely to be victims of domestic violencerelatedAboriginal
assault. women
In the past
12higher
months,
20%
Aboriginal
women
reported physical
Nationally,
suffer
rates
of of
serious
violence
than have
non-Aboriginal
women, with
violence
compared
to
7%
of
non-Aboriginal
women.
Of
all
the
victims
of
these
assaults
Aboriginal women nearly six times as likely to be victims of domestic violence-related assault. that
In the
require hospitalisation, 50% are due to family related violence. This equates to an Aboriginal
past 12 months, 20% of Aboriginal women have reported physical violence compared to 7% of nonwoman being 35 times more likely to be hospitalised due to family related violence
Aboriginal
women.
all the victimswomen.
of these assaults
that
require
hospitalisation,
50% are
due to family
compared
to aOf
non-Aboriginal
Aboriginal
women
also
have been found
to be
related
violence.
This
equates
to
an
Aboriginal
woman
being
35
times
more
likely
to
be
hospitalised
due
homicide victims up to ten times more often than non-Aboriginal women.
to family related violence compared to a non-Aboriginal women. Aboriginal women also have been found
to be homicide victims up to ten times more often than non-Aboriginal women.
The Health Needs of North Coast NSW- 2014
“
Page 36 of 123
In 2013, the unemployment rate for NCNSW was
6.6% compared to NSW 5.2%. The highest
unemployment rate for the region was in Byron
and Nambucca at 8.8% whilst Ballina was the only
LGA in the region with a rate lower than NSW.
32
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
2
Health of North
Coast NSW
Communities
and Residents
This section of the report examines the health of North Coast Communities including
• Health Indicators and behaviors - examining the behaviors and factors that contribute to ill health,
particularly chronic disease
• Health equity- the particular challenges faced by some groups in the community because of factors
they cannot change
• The morbidity related to diseases in North Coast NSW populations
• The impact these diseases have on the community in terms of hospitalisations and mortality
Health indicators and behaviours together contribute to regional performance in the nine national health
priority areas (17) which are:
• arthritis and musculoskeletal conditions
• asthma
• cancer control
• cardiovascular health
• diabetes mellitus
• mental health
• obesity
• injury prevention and control
• dementia
These priority areas contribute significantly to the burden of illness and injury and will be the subject of
considerable focus across the whole health sector, particularly primary health care.
There is significant variation in the health of the people who reside on the North Coast and these are
heavily influenced by the factors outlined in the previous chapter. Table 12 summarises LGA level
information regarding
• Pregnancy and Early Childhood
• Chronic Disease Risk Factors
• Chronic Disease Prevalence
• Cancer
• Hospitalisations
• Mortality
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
33
For the purposes of creating this visual map of indicators, the health of the various populations in the
region (Table 12) have been compared to the state average and assigned colours as follows:
HEALTH OF NORTH COAST NSW COMMUNITIES AND
Indicators where there is a more negative
outcome for the community than the average
RESIDENTS
Indicators where the outcome for the community is similar to the average
Indicators where there is a more positive outcome for the community than the average
Pregnancy and Early Childhood
Children fully immunised 1 year of age
(2011/12)
Children fully immunised 2 years of age
(2011/12)
Children fully immunised 5 years of age
(2011/12)
Fertility Rate (2011)
Low Birth Weight (2008)
Smoking During Pregnancy (2008-2010)
Infant Death Rate (2006-2010)
Chronic Disease Risk Factors
Smoking (2007/08)
Alcohol consumption at risky levels
(2007/08)
Physical Inactivity (2007/08)
Overweight (not obese) (2007/08)
Obese (2007/08)
People with at least 1 of 4 of above risk
factors
Usual Daily Intake of Two or More Serves
of Fruit
Chronic Disease Prevalence
Type 2 Diabetes (2007/08)
High Cholesterol (2007/08)
Circulatory System Diseases (2007/08)
Hypertensive Disease (2007-08)
Respiratory System Diseases (2007/08)
Asthma (2007/08)
COPD (2007/08)
Musculoskeletal System Diseases
(2007/08)
Arthritis (2007/08)
Osteoarthritis (2007/08)
##
Cancer
All Cancer Incidence
Melanoma Incidence
Prostate Cancer Incidence
Hospitalisations
Hospitalisations for all Causes (2012/13)
Alcohol Attributable Hospitalisations
Alcohol Attributable Injury Hospitalisations
Smoking Attributable Hospitalisations
COPD Hospitalisations
Coronary Heart Disease Hospitalisations
Stroke Hospitalisations
Diabetes Hospitalisations
High Body Mass Hospitalisations
Fall Related Hospitalisation
Potentially Preventable Hospitalisations
Mortality
Deaths From All Causes
Potentially Avoidable Deaths
##
##
NCNSW
Port Mac-Hastings
Kempsey
Nambucca
Bellingen
Coffs Harbour
Clarence Valley
Richmond Valley
Kyogle
Byron
Tweed
Health Indicator
Ballina
Health Indicators -­‐ LGAs in NCNSW compared to the NSW Average (2) (18) Lismore
Table 12 ##
##
##
##
##
##
##
##
Table 12 Health Indicators ­‐ LGAs in NCNSW compared to the NSW Average (2) (18)
## Available data imcomplete
34
The Health Needs of North Coast NSW- 2014
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Page 38 of 123
2.1 Key Health Indicators and Behaviours
Health and wellbeing are affected by many risk factors.
The top seven preventable risk factors that influence burden of disease in Australia are (19)
1. Adults smoking
2. Blood pressure (risk factors include overweight and obesity, physical inactivity, smoking and poor diet)
3. Overweight and obesity
4. Physical inactivity
5. Blood cholesterol ( risk factors include smoking, overweight and obesity, poor diet and physical
inactivity)
6.Alcohol
7. Low intake of fruit and vegetables
Table 13 compares these risk factors against the state average and highlights a number of issues likely to
impose pressure on the health of the community.
Risk Factor
N NSW
MNC NSW
NCNSW
NSW
%
%
Adults Smoking (2012)
19.5
17.8
19.7
16.0
31.6
Smoking During Pregnancy (2011)
17.1
19.3
Not Available
11.1
52.2
Overweight/Obesity (2012)
48.7
56.1
52.3
50.5
56.5
Adequate Physical Activity (2012)
57.6
46.0
53.5
54.5
56.6
Alcohol (Risk Drinking) (2012)
33.8
32.6
33.0
27.9
30.6
Recommended Fruit Intake (2012)
52.8
53.0
52.7
51.6
52.4
Recommended Vegetable intake
(2012)
14.5
12.5
13.3
9.1
9.1
%
NSW
Aboriginal %
Table 13 Selected Health Behaviours (20)
Risk factors are presented individually, however in practise they do not operate in isolation. They often
coexist and interact with one another.
2.1.1 Adult Smoking
HEALTH OF NORTH COAST NSW COMMUNITIES AND
In 2012, 19.6% of adults in NCNSW smoked, RESIDENTS
which is higher than the NSW level of 16%.
Data is not available for the rate of smoking among the Aboriginal population of NCNSW, however 32% of
Figure 21 Current Smoking -­‐2012 (18)
Aboriginal people in NSW smoked which is significantly higher than for the rate for the whole of NSW (18).
Current Smoking 2012 45 40 Percentage 35 30 25 20 15 10 5 0 NCNSWML NSW NSW Aboriginal Figure 21 Current Smoking -2012 (18)
In 2011/12, NCNSW had a significantly higher rate of smoking related hospitalisations
(631/100,000), compared to NSW (565/100,000). Rates vary across LGAs.
• Byron and Tweed have significantly lower rates of smoking attributable hospitalisations
compared to NSW.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
• Kyogle, Richmond Valley, Clarence Valley, Coffs Harbour, Bellingen and Nambucca all
have rates that are significantly higher than NSW (18). (Figure 22)
35
NCNSWML NSW NSW Aboriginal In 2011/12, NCNSW had a significantly higher rate of smoking related hospitalisations
(631/100,000), compared to NSW (565/100,000). Rates vary across LGAs.
• Byron and Tweed have significantly lower rates of smoking attributable hospitalisations
In 2011/12,compared
NCNSW had
a significantly higher rate of smoking related hospitalisations (631/100,000),
to NSW.
compared
NSW (565/100,000).
RatesClarence
vary across
LGAs.
• to
Kyogle,
Richmond Valley,
Valley,
Coffs Harbour, Bellingen and Nambucca all
• Byron and
Tweed
have
significantly
lower
rates
of
attributable
hospitalisations
compared to NSW
have rates that are significantly highersmoking
than NSW
(18). (Figure
22)
Richmond
Valley,
Clarence
Valley,
Coffs
Harbour,
Bellingen
and
Nambucca
all
have rates that
• Kyogle,
Figure 22 Smoking Hospitalisations by LGA 22)
2010/11-­‐2011/12 are significantly
higher
than
NSW (18) (Figure
Age Standardised Rate/100,000
Smoking Hospitalisations by LGA
2010/11 - 2011/12
1000
800
600
400
200
0
NCNSWML
NSW
HEALTH OF NORTH COAST NSW COMMUNITIES AND
Figure 22 Smoking Hospitalisations by LGA 2010/11-2011/12
RESIDENTS
There are significantly greater numbers of mothers who smoke during their pregnancy across NCNSW
(with the
exception
of Smoking Byron LGA).
There
greater
numbers
of (mothers
who smoke during their pregnancy
Figure 23 are significantly
During Pregnancy 2008-­‐2010 18)
across NCNSW (with the exception of Byron LGA).
Smoking During Pregnancy 2008-­‐2010 Standardised Prevalence RaUo 350 300 The Health
250 Needs of North Coast NSW- 2014
200 150 100 50 0 Page 40 of 123
NSW Figure 23 Smoking During Pregnancy 2008-2010 (18)
Smoking during pregnancy inhibits the growth of the baby, contributing to lower birth weights. It
also increases the chance of other complications such as premature birth, still birth and can lead to
Smoking
during pregnancy
the growth
of the
contributing
to lower birthofweights.
infant mortality.
It can also inhibits
lead to health
problems
for baby,
the unborn
child as development
the
It also
increases
chance
of other complications such as premature birth, still birth and can lead
babies
lungs isthe
inhibited
(56)
2.1.2 Alcohol
to infant mortality. It can also lead to health problems for the unborn child as development of the
babies lungs is inhibited.
Excessive use of alcohol can result in a number of adverse health impacts, but also
importantly, negative social consequences including domestic and interpersonal violence. In
2.1.22012,
Alcohol
NCNSW had higher rates of the consumption of more than two standard alcoholic
drinks each occasion of drinking among persons aged 16 years (33%) compared to the state
Excessive use of alcohol can result in a number of adverse health impacts, but also importantly, negative
average (27.9%) (19).
social consequences including domestic and interpersonal violence. In 2012, NCNSW had higher rates
of the consumption
ofPercentage more than
standard
drinks
each
of ddrinking
among
Figure 24 of Ptwo
eople older than alcoholic
16yrs consuming more than occasion
two standard rinks on a d
ay when persons
drinking aged 16
years(18)
(33%) compared to the state average (27.9%). (19)
36
Consumes more than two standard drinks on a day when drinking
(2012)
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
50
ars
2012, NCNSW had higher rates of the consumption of more than two standard alcoholic
drinks each occasion of drinking among persons aged 16 years (33%) compared to the state
average (27.9%) (19).
Figure 24 drinking (18)
Percentage of People older than 16yrs consuming more than two standard drinks on a day when Consumes more than two standard drinks on a day when drinking
(2012)
Percent Aged >16 years
50
40
30
20
10
0
Figure 24
N NSW
MNC NSW HEALTH
NCNSWML
NSW NSW COMMUNITIES
NSW Aboriginal AND
OF NORTH COAST
RESIDENTS
Percentage of People older than 16yrs consuming more than two standard drinks on a day when drinking (18)
NCNSW has significantly higher rates of alcohol attributable hospitalisations compared to
over-represented
in
alcohol
attributable
hospitalisations
compared
theand
nonare
Aboriginal
NSW.
The Aboriginal
population
the region
has significantly
higher to
rates
highly The
NCNSW
has significantly
higher
rates
of in
alcohol
attributable
hospitalisations
compared
to
NSW.
population.
Aboriginal population in the region has significantly higher rates and are highly over-represented in
alcoholFigure attributable
hospitalisations
to(18)
the non Aboriginal population.
25 Alcohol related hcompared
ospitalisations The Health Needs of North Coast NSW- 2014
Page 41 of 123
Age Standardised Rate/100,000
Alcohol Related Hospitalisations 2011-12
3000
2500
2000
1500
1000
500
0
N NSW
MNC NSW
NCNSWML
Non-Aboriginal
NSW
Aboriginal
Figure 25 Alcohol related hospitalisations (18)
The social impact of higher alcohol use among NCNSW residents is reflected in alcoholrelated
crime
statistics.
Theuse
township
Byron residents
Bay is particularly
notable,
with high rates
The social
impact
of higher
alcohol
among of
NCNSW
is reflected
in alcohol-related
crimeof
alcohol
related violence
unwanted National
interest
( alcohol related violence
statistics.
The township
of Byrongaining
Bay is particularly
notable, media
with high
rates of
Figure
26)
gaining unwanted National media interest (Figure 26).
500
New South Wales
(Stable)
Incidents of liquor offences in selected LGAs from October 2011-­‐September 2013 (16) Ballina (Stable)
Bellingen (Stable)
375
Incidents of Liquor offences in selected LGAs from October 2011 to September 2013
Byron (Stable)
Clarence Valley
(Stable)
Coffs Harbour
(Stable)
NSW (Stable)
Kempsey
Lismore (Stable)
Nambucca BALLINA (Stable)
Port Macquarie
BELLINGEN
(Stable)
Richmond Valley
250
Rate per 100,000 population
Rate per 100,00 population
Figure 26 125
0
1
01
t2
Oc
1
01
c2
De
2
01
b2
Fe
2
01
r2
Ap
2
01
n2
Ju
2
01
g2
Au
2
01
t2
Oc
2
01
c2
De
2
01
b2
Fe
2
01
r2
Ap
2
01
n2
Ju
2
01
g2
Au
BYRON (Stable)
CLARENCE
VALLEY (Stable)
COFFS
(16)
Figure 26 Incidents of Liquor offences in selected local Government Areas, from Octover 2011 to September
HARBOUR 2013
(Stable)
KEMPSEY
LISMORE
THE HEALTH NEEDS OF NORTH COAST
NSW - 2014
(Stable)
NAMBUCCA
PORT
MACQUARIE
37
In 2013 there was a rate of 1,247.8/100,000 of incidents of liquor offences recorded in Byron compared
to NSW 197.6/100,000. This is largely influenced by the influx of tourists and the lure of the area as a
party location. This behaviour places much stress on the already limited services within this community,
including health services and especially after hours care.
2.1.3 Fruit and Vegetable Consumption
A healthy diet, indicated by consuming recommended quantities of fruits and vegetables, can assist in the
prevention of developing a chronic disease and maintaining general well-being and healthy weight.
In 2012 NCNSW had
• similar rates of recommended fruit consumption among persons aged 16 years and over (52.7%)
compared to the state average (51.6%)
• significantly higher rates of recommended vegetable consumption among persons aged 16 years
(13.3%) compared to the state average (9.1%) (see Figure 27) (19)
2.1.4 Physical Activity
Leading an active lifestyle, indicated by undertaking adequate amounts of physical activity, can assist in
the prevention of developing a chronic disease, maintaining good bone health and healthy weight, and
improving mental health. In 2012, NCNSW had similar rates of adequate physical activity among persons
aged 16 years and over (53.5%) compared to the state average (54.5%). (see Figure 27) (19)
2.1.5 Overweight and Obesity
In 2012, Overweight (32.9%) and Obesity (19.3%) rates for residents aged 16 years and over in NCNSW
HEALTH OF NORTH COAST NSW COMMUNITIES
AND
were similar to the state average (31.4% overweight
and 19.1% obesity) (see Figure 27) (19).
RESIDENTS
Key Health Indicators 2012 70 Percentage 60 50 40 30 20 10 0 Vegetable Fruit NCNSWML Physical AcLvity NSW overweight obese NSW Aboriginal Figure 27 Key Health Indicators (19)
2.2
HEALTH EQUITY
Equity in health aims to give everyone a fair opportunity to attain their full potential and that
no-one is disadvantaged in achieving this (20).
Consideration of indicators of health equity and service accessibility highlights a number of
areas of inequity and identifies areas of limited access to health services in NCNSW. Whilst
not all health differences can be eliminated it is possible to work to reduce avoidable or
unfair factors, creating opportunities for health and bringing health differentials down to the
lowest possible levels.
38
2.2.1 Aboriginal People- Closing the Gap
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Health data for Aboriginal people in NCNSW is very limited, particularly in more detail than
LHD level. Understanding the National context provides some perspective of health
inequities. The Council of Australian Governments has set six targets addressing the
2.2 Health Equity
Equity in health aims to give everyone a fair opportunity to attain their full potential and that no-one is
disadvantaged in achieving this (20).
Consideration of indicators of health equity and service accessibility highlights a number of areas of
inequity and identifies areas of limited access to health services in NCNSW. Whilst not all health
differences can be eliminated it is possible to work to reduce avoidable or unfair factors, creating
opportunities for health and bringing health differentials down to the lowest possible levels.
2.2.1 Aboriginal People- Closing the Gap
Health data for Aboriginal people in NCNSW is very limited, particularly in more detail than LHD level.
Understanding the National context provides some perspective of health inequities. The Council of
Australian Governments has set six targets addressing the disadvantage faced by Aboriginal Australians
in life expectancy, child mortality, education and employment.
There are two that are specifically health related.
Closing the gap in life expectancy within a generation (by 2031)
There has been a small improvement in life expectancy for the Aboriginal population, however there still
HEALTH
COAST
NSW2010
COMMUNITIES
needs considerable progress to close the gap by
2031. OF
ForNORTH
Australia,
between
and 2012,AND
the
RESIDENTS
estimated Aboriginal life expectancy was 69.1 years for males and 73.7 years for females. This equates
to 10.6 years less than non-Aboriginal males and 9.5 years less than non-Aboriginal females (21).
From 2005-2007
the NSW
Aboriginal
life expectancy
washealth
slightlyconditions
better at 69.9
for males
Many data,
Aboriginal
deaths
have been
due to chronic
that years
have developed
through
of health
inequalities
disadvantage,
contributing
to less
the disparity
(8.6 years less
than decades
non-Aboriginal
NSW
males) andand
75.0
years for females
(7.4 years
than non-in
life expectancy.
Aboriginal NSW
women) (18). Improvement in the prevention and management of these chronic
diseases is expected to improve life expectancy further (22).
Many Aboriginal deaths have been due to chronic health conditions that have developed through decades
Halving the
in mortality
rates for Aboriginal
children
five by
2018
of health inequalities
andgap
disadvantage,
contributing
to the disparity
in life under
expectancy.
Improvement
in the
There
have been of
vast
improvements
in Aboriginal
childto
mortality
since the further (22).
prevention and
management
these
chronic diseases
is expected
improverates
life expectancy
implementation of the targets. In 2006-2008 for NSW, the Aboriginal infant mortality rate
Halving the gap in mortality rates for Aboriginal children under five by 2018
of 6.2 deaths/1,000 births has shown continual improvement up to 2010-2012 rate of
There have been vast improvements in Aboriginal child mortality rates since the implementation of the
3.8/1,000 births as seen in Figure 28. (23)
targets. In 2006-2008 for NSW, the Aboriginal infant mortality rate of 6.2 deaths/1,000 births has shown
continual
improvement
up Cto
2010-2012
rate of 3.8/1,000 births as seen in Figure 28. (23)
Figure 28 NSW hild Mortality (23) NSW Child Mortality 2006 -­‐ 2012 Rate/1,000 Births 7 6 5 4 3 2 1 0 Aboriginal Non-­‐Aboriginal Closing the Gap is a long-term, ambitious framework that acknowledges that improving
Closingopportunities
the Gap is a for
long-term,
ambitious
framework
that
acknowledges
that improving
opportunities
Aboriginal
Australians
requires
intensive
and sustained
effort from
all levels for
of government,
as well as
the private
and not-for-profit
sectors,
communities
and individuals.
Aboriginal
Australians requires
intensive
and sustained
effort from
all levels
of government,
as well as the
purposes of
this report,
data hasand
been
collated on
and maternal
privateFor
andthe
not-for-profit
sectors,
communities
individuals.
Forinfant
the purposes
of thishealth
report,indata has
particular (24).
been collated on infant and maternal health in particular (24).
Figure 28 NSW Child Mortality (23)
Infant and Maternal Health
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Fewer Aboriginal mothers
in NCNSW had their first antenatal
visit before 14 weeks gestation
compared to the region’s non-Aboriginal mothers (Figure 29). This is consistent across both
NNSWLHD and MNCLHD.
39
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
FirstHealth
Antenatal Visit Before 14 Weeks by Aboriginality 1996 Infant and Maternal
2011antenatal visit before 14 weeks gestation compared to
Fewer Aboriginal mothers in NCNSW had their first
HEALTH OF NORTH COAST NSW COMMUNITIES AND
the region’s non-Aboriginal mothers (Figure 29). RESIDENTS
This is consistent across both N NSWLHD and MNCLHD.
% of Confinements
% of Confinements
100
N NSW Aboriginal
80
First Antenatal Visit Before 14 Weeks by Aboriginality
1996
MNC NSW
Aboriginal
2011
60
N NSW Non-Aboriginal
40
100
20
80
0
60
N NSW Aboriginal
MNC NSW NonAboriginal
MNC NSW Aboriginal
N NSW Non-Aboriginal
40
Poorer20infant and maternal health outcomes, may be partly explained
by Nonlater presentation
MNC NSW
for antenatal intervention. Aboriginal mothers in both NNSW and
MNCNSW
have higher
Aboriginal
rates of0low birth weight and preterm births compared to the region’s non-Aboriginal
population (see
Figure2930 and
Figure 31).
Figure
First Antenatal
Visit before 14 weeks by Aboriginality 1996-2011 (18)
Poorer infant and maternal health outcomes, may be partly explained by later presentation
for antenatal
intervention.
Aboriginalmay
mothers
in both
NNSW by
and
MNCNSW
havefor
higher
Poorer infant
and maternal
health outcomes,
be partly
explained
later
presentation
antenatal
rates of low birth weight and preterm births compared to the region’s non-Aboriginal
intervention. Aboriginal mothers in both N NSW and MNC NSW have higher rates of low birth weight and
population (see
30 compared
Preterm Births by Mothers Aboriginality (18) pretermFigure births
to the
region’s
non-Aboriginal
population (see Figure 30 and Figure 31).
Figure 30 and Figure 31).
Preterm Births by Mother's Aboriginality
2010-11
Preterm Births by Mothers Aboriginality (18) 15
10
20
5
15
0
10
% of Births
% of Births
Figure 320
0 16.9
Preterm Births by Mother's Aboriginality
2010-11
13
12.1
8.2
5.9
16.9
13N NSW
MNC NSW
Aboriginal
5
7.2
5.9
12.1NSW
Non-Aboriginal
8.2
7.2
HEALTH OF NORTH COAST NSW COMMUNITIES AND
(18)
RESIDENTS
Figure 30 Preterm Births by Mothers Aboriginality
Figure 31 0
Low Birth Weights by Mothers Aboriginality (18) N NSW
MNC NSW
NSW
Low Birth Weight By Mother's Aboriginality 2010-11
% of Births
Aboriginal
Non-Aboriginal
16
14
Figure 31 Low Birth Weights by Mothers A15.2
boriginality (18) 12
10
10
8
6
6.8
4
5
2
The Health Needs of North Coast NSW- 2014
0
N NSW
MNC NSW
Aboriginal
40
2.3
MORBIDITY
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
2.3.1
Chronic Disease
5.9
Page 46 of 123
NSW
Non-Aboriginal
The Health
Needs
of NorthbyCoast
NSW2014 (18)
Figure
31 Low
Birth Weights
Mothers
Aboriginality
11.8
Page 46 of 123
2.3 Morbidity
2.3.1 Chronic Disease
Chronic diseases are leading causes of death and disability in Australia. They are also associated with
high use of health care services, contributing to major funding pressures in Australian health care that are
expected to rise over coming decades as prevalence increases.
Chronic disease has been defined as illness that is prolonged in duration, does not often resolve
spontaneously, and is rarely cured completely. Chronic diseases are complex and varied in terms of
their nature, how they are caused and the extent of their impact on the community. While some chronic
diseases make large contributions to premature death, others contribute more to disability. Features
common to most chronic diseases include:
• complex causality, with multiple factors leading to their onset
• a long development period, for which there may be no symptoms
• a prolonged course of illness, perhaps leading to other health complications
• associated functional impairment or disability
Chronic Diseases considered in this report are
• Arthritis and musculoskeletal conditions
• Asthma and Respiratory conditions
• Cancer
• Cardiovascular health
• Diabetes
• Mental health
• Obesity
• Injury and Poisoning
• Dementia
It is estimated that 50% of GP consultations are related to chronic disease management (25). This is
difficult to substantiate because Medical Benefits Scheme (MBS) item number usage of chronic disease
management items can only provide an indication of the chronic disease burden on the primary health
care sector. Item numbers are underutilised for a number of reasons. GPs report that use of MBS items is
limited for chronic disease and chronic disease management/team care plans, because they are hard to
co-ordinate, particularly in smaller practices (25) .
Arthritis and musculoskeletal conditions
Data collection related to the incidence of these conditions in NCNSW is difficult to obtain at this time.
Nationally
• 28% of Australians have arthritis and other musculoskeletal conditions
• 14% have back problems
• 8% have osteoarthritis
• 3% have osteoporosis
• People with arthritis and other musculoskeletal problems self reported fair or poor health twice as often
as those without these conditions (26).
Asthma and Respiratory Diseases
The hospitalisation rate for asthma across NCNSW is similar to that for NSW (196/100,000 compared to
181/100,000 NSW). There are significantly higher rates for chronic obstructive pulmonary disease (COPD),
influenza and pneumonia and for other acute respiratory infections (Figure 32).
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
41
The hospitalisation rate for asthma across NCNSW is similar to that for NSW (196/100,000
compared to 181/100,000 NSW). There are significantly higher rates for chronic obstructive
pulmonary disease (COPD), influenza and pneumonia and for other acute respiratory
infections (Figure 32).
Figure 32 Hospitalisations for Respiratory Disease (18) Ags Standardised
Hospitalisations/100,000
Respiratory Diseases 2011-2012
600
500
400
300
200
100
0
Asthma
NCNSWML
Chronic
Obstructive
Pulmonary
Disease
NSW
Influenza &
pneumonia
Other acute resp
infections
Figure 32 Hospitalisations for Respiratory Disease (18)
Cancer Cancer
Incidence
and Mortality
Incidence
and Mortality
Incidence
refersrefers
to thetonumber
of new
cases
detected
within
a aset
mortality
Incidence
the number
of new
cases
detected
within
setperiod
periodof
oftime
time and
and mortality
the number
of deaths
occur
within
a set
periodofoftime.
time.Mortality refers to the number
refers refers
to the to
number
of deaths
that that
occur
within
a set
period
Mortality
referswithin
to the a
number
of deaths
that occur within a set period of time.
of deaths
that occur
set period
of time.
• In 2009, within NCNSWs population of 487,333 there was an overall cancer incidence of 3,624. This
translates to a crude incident rate of 7.4/1,000 persons.
• The overall cancer mortality for NCNSW in 2008 was 1,159 within a population of 482,056 which
The Health Needs of North Coast NSW- 2014
Page 48 of 123
translates to a crude mortality rate of 2.4/1,000 persons.
Table 14 is a graphical account of the different cancers in NCNSW, their incidence and mortality compared
to that for the whole of NSW.
Clinical Groups
Incidence
Mortality
Bowel
Breast
Cancer Unknown Primary
Gynaecological
Head & Neck
Lymphohaematropietic
Myelodysplasia
Neurological
Respiratory
Skin
Thyroid & Other Endocrine
Upper Gastrointestinal
Urogenital
Significantly above NSW
Significantly below NSW
Table 14 NCNSW selected Cancers- Incidence and Mortality compared to NSW Average
Note: The indirect method of age-standardisation was used to compare rates.
42
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
In 2004-2008, NCNSW had significantly higher rates of cancer diagnosis per 100,000 (528.3 N NSW and
506.7 MNC NSW) compared to the state average (483.2). In 2011, the number of new diagnoses of cancer
in NCNSW represented a 3% growth per annum. (27)
An increase in testing due to better public awareness and increased use of diagnostic tools (PSA for
prostate, mammograms for breast, colonoscopy for colon and skin clinics for skin cancer) has contributed
to a steady increase in cancer diagnosis since 1972.
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
OF NORTH
NSW as a whole is showing a downward mortalityHEALTH
trend greater
thanCOAST
N NSWNSW
and COMMUNITIES
MNC NSW andAND
overall
RESIDENTS
NCNSW mortality rates show a stable or slightly decreasing
trend. (see Figure 33, Figure 34, Figure 35)
(27)
Figure34 33
N NSWMCancer
and Mortality
trend for
Males
and
Females
1972-2008
Figure Overall Overall NCNSW Incidence
Cancer Incidence and Mortality trend for M
ales and Females 1972-­‐2008 (27) Figure 34 Overall MNCNSW Cancer Incidence and Mortality trend for Males and Females 1972-­‐2008 (27) Figure 34 Overall MNC NSW Cancer Incidence and Mortality trend for Males and Females 1972-2008 (27)
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
The Health Needs of North Coast NSW- 2014
Page 50 of 123
The Health Needs of North Coast NSW- 2014
Page 50 of 123
43
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
Figure 35 Overall NSW Cancer Incidence and Mortality trend for Males and Females 1972-­‐2008 (27) Figure 35 Overall NSW Cancer Incidence and Mortality trend for Males and Females 1972-2008 (27)
ProstateProstate
Cancer Cancer
Incidence:
NNSW
MNCNSW
have
similar incidence
rates forcancer
prostate
cancer
and
Incidence:
N NSW and
MNCand
NSW
have similar
incidence
rates for prostate
(88.4
and (88.4
84.4/100,000
84.4/100,000
compared to NSW 84.4/100,000).
compared
to NSW 84.4/100,000).
Mortality: The mortality rates in both NNSW (14.9/100,000, 95% (Confidence Interval * 13.3,
Mortality: The
mortality
rates in(16.2/100,000,
both N NSW (14.9/100,000,
(Confidence
Interval
* 13.3, 16.7)
16.7) and
MNCNSW
95% CI* 14.2,95%
18.3),
however are
significantly
higher
that
of NSW (12.8/100,000,
95%
CI* however
12.4, 13.1)
and MNCthan
NSW
(16.2/100,000,
95% CI* 14.2,
18.3),
are significantly higher than that of NSW
(12.8/100,000, 95% CI* 12.4, 13.1)
* CI Confidence Interval (see Glossary)
HEALTH OF NORTH COAST NSW COMMUNITIES AND
* CI Confidence Interval (see Glossary)
Age Standardised Rate/100,000
Figure 36 RESIDENTS
Prostate Cancer Incidence and Mortality NNSW, MNCNSW and NSW 2004-­‐2008 (27) Prostate Cancer 2004-2008
100
80
60
40
20
0
Incidence
N NSW
Mortality
MNC NSW
NSW
Figure
Prostate Cancer Incidence and Mortality N NSW, MNC NSW and NSW 2004-2008 (27)
Colon36
Cancer
The Health Needs of North Coast NSW- 2014
Page 51 of 123
Incidence: NNSW has a significantly higher incidence rate of colon cancer (44.9/100,000,
95% CI 41.9, 48) compared to NSW (40.6/100,000, 95% CI 39.9 41.2). The incidence rate
for MNCNSW, however is similar to NSW.
Mortality: The mortality rates for colon cancer in both NNSW and MNCNSW are similar to
NSW rate (20.7 and 13/100,000 compared to NSW 14.6/100,000).
Figure 37 44
Colon Cancer 2004-2008
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
,000
Colon Cancer Incidence & Mortality NNSW, MNCNSW and NSW 2004-­‐2008 (27) 60
50
Age S
0
Incidence
N NSW
Mortality
MNC NSW
NSW
Colon Cancer
Incidence:
NNSW has a significantly higher incidence rate of colon cancer (44.9/100,000,
Colon
Cancer
95%
CI
41.9,
48) compared
to NSW (40.6/100,000,
incidence rate
Incidence: N NSW
has a significantly
higher incidence95%
rateCI
of 39.9
colon41.2).
cancerThe
(44.9/100,000,
95% CI 41.9,
for
MNCNSW,
however
is
similar
to
NSW.
48) compared to NSW (40.6/100,000, 95% CI 39.9 41.2). The incidence rate for MNC NSW, however is
Mortality: The mortality rates for colon cancer in both NNSW and MNCNSW are similar to
similar to NSW.
NSW rate (20.7 and 13/100,000 compared to NSW 14.6/100,000).
Mortality:
The mortality rates for colon cancer in both N NSW and MNC NSW are similar to NSW rate
(20.7
and
13/100,000
compared
to&NSW
14.6/100,000).
Figure 37 Colon Cancer Incidence Mortality NNSW, MNCNSW and NSW 2004-­‐2008 (27) Age Standardised Rate/100,000
Colon Cancer 2004-2008
60
50
40
30
20
10
0
Incidence
N NSW
Mortality
MNC NSW
NSW
Figure 37 Colon Cancer Incidence & Mortality N NSW, MNC NSW and NSW 2004-2008 (27)
Breast Cancer
Incidence: Both NNSW and MNCNSW have similar incidence rates of breast cancer to that
Breast
of NSWCancer
(60.7 & 54.6/100,000 NSW 58.2/100,000).
Incidence:
Bothmortality
N NSW and
NSW have
similar
incidence
of breast cancer
to that
Mortality: The
ratesMNC
for breast
cancer
in both
N NSWrates
(10.5/100,000
95% C.I.
9.1 of NSW
(60.7
54.6/100,000
58.2/100,000).
12.1)&and
MNCNSWNSW
(10.2/100,000,
95% CI 8.6, 12.1) are significantly lower than the NSW
rate (12.6/100,000, 95% CI 12.3, 13).
Mortality: The mortality rates for breast cancer in both N NSW (10.5/100,000 95% C.I. 9.1 12.1) and MNC
NSW
95%
CI C8.6,
12.1)
are
significantly
lower
than athe
rate (12.6/100,000,
HEALTH
OF NNORTH
COAST
NSW
COMMUNITIES
Figure 3(10.2/100,000,
8 Breast ancer Incidence &
Mortality NSW, MNCNSW nd NNSW
SW 2004-­‐2008 (27) AND
RESIDENTS
95% CI 12.3, 13).
Age Standardised Rate/100,000
Breast
The Health Needs of North Coast
NSW- Cancer
2014
2004-2008
Page 52 of 123
70
60
50
40
30
20
10
0
Incidence
N NSW
Mortality
MNC NSW
NSW
Figure 38 Breast Cancer Incidence & Mortality N NSW, MNC NSW and NSW 2004-2008 (27)
Melanoma
Incidence: The incidence rate for melanoma is significantly higher in both N NSW
(80.8/100,000, 95% CI 76.4 85.3) and MNCNSW (64.7/100,000, 95% CI 60.2 69.4)
compared to the incidence rate for NSW (48.8/100,000, 95% CI 48.1 49.5) with N NSW
having an incidence rate that is 166% higher than NSW.
Mortality NNSW mortality rate (8.2/100,000 95% CI 6.9 9.6) for melanoma is also
significantly higher than NSW (6.2/100,000, 95% CI 6 6.5), whilst the mortality rate for
MNCNSW (6.5/100,000) is similar to NSW (6.2/100,000).
Figure 39 Melanoma Incidence & Mortality NNSW, MNCNSW, NSW 2004-­‐2008 (27) 0
Melanoma 2004-2008
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
45
Ag
Incidence
Mortality
N NSW
MNC NSW
NSW
Melanoma
Incidence: The incidence rate for melanoma is significantly higher in both N NSW
Melanoma
(80.8/100,000, 95% CI 76.4 85.3) and MNCNSW (64.7/100,000, 95% CI 60.2 69.4)
Incidence:
The incidence
rate for melanoma
is significantly
higher in
bothCIN48.1
NSW49.5)
(80.8/100,000,
95% CI
compared
to the incidence
rate for NSW
(48.8/100,000,
95%
with N NSW
76.4 85.3)
and
MNC
NSW
(64.7/100,000,
95%
CI
60.2
69.4)
compared
to
the
incidence
rate
for
NSW
having an incidence rate that is 166% higher than NSW.
(48.8/100,000,
CI 48.1
49.5) with
NSW having an
incidence
is 166% higher
than NSW.
Mortality95%
NNSW
mortality
rateN(8.2/100,000
95%
CI 6.9 rate
9.6) that
for melanoma
is also
significantly
higher than
NSW (6.2/100,000,
95%
CIfor
6 6.5),
whilstisthe
ratehigher
for than
Mortality: N
NSW mortality
rate (8.2/100,000
95% CI 6.9
9.6)
melanoma
alsomortality
significantly
MNCNSW (6.5/100,000) is similar to NSW (6.2/100,000).
NSW (6.2/100,000, 95% CI 6 6.5), whilst the mortality rate for MNC NSW (6.5/100,000) is similar to NSW
(6.2/100,000).
Figure 39 Melanoma Incidence & Mortality NNSW, MNCNSW, NSW 2004-­‐2008 (27) Age Standardised Rate/100,000
Melanoma 2004-2008
100
80
60
40
20
0
Incidence
N NSW
Mortality
MNC NSW
NSW
Figure 39 Melanoma Incidence & Mortality N NSW, MNC NSW, NSW 2004-2008 (27)
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
Cardiovascular
Cardiovascular
DiseaseDisease
N NSWNNSW
has significantly
lower rates
of hospitalisations
for coronary
disease
for both
males
has significantly
lower
rates of hospitalisations
forheart
coronary
heart
disease
forand
both
males
and females
compared
NSW. MNCNSW
however,
significantly
higher
for
females
compared
to NSW. MNC
NSWtohowever,
has significantly
higherhas
rates
for both males
andrates
females. both
males
and
females.
Females
have
a
rate
of
145%
higher
than
NSW
(543.3/100,000
Females
have
145%Hhigher
thanHospitalisations NSW (543.3/100,000
Figure 40 a rate of
Coronary eart Disease 2010-­‐11 (18) compared to 374/100,000).
compared to 374/100,000).
Coronary Heart Disease Hospitalisations 2010/11
Age Standardised Rate/100,000
1200
The Health Needs of North Coast NSW- 2014
Page 53 of 123
1000
800
600
400
200
0
Males
Females
N NSW
Males
Females
Males
MNC NSW
Females
NSW
Figure 40 Coronary
Heart Disease Hospitalisations
2010-11
(*Note, hospitalisations
are measured from
place(18)
of residence not from place of treatment)
*Note: Hospitalisations
measuredheart
from place
of residence
not from place
of treatment
There
is variation inare
coronary
disease
hospitalisations
between
LGAs across NCNSW
with Port Macquarie-Hastings having the highest rate. This is more than 50% higher than the
NSW average. Tweed has a similar percentage of people aged over 65 years (23%)
compared to Port Macquarie-Hastings (24%) but has a hospitalisation rate for coronary heart
disease, which is 30% less. (Table 15)
Table 15 46
Coronary Heart Disease Hospitalisations by LGA 2009-­‐10 to 2010-­‐11 (18) Local Government Area
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Tweed
Byron
Rate/100,000
Significance to NSW
488.9
↓↓ 464.1
↓↓ There is variation in coronary heart disease hospitalisations between LGAs across NCNSW with Port
Macquarie-Hastings having the highest rate. This is more than 50% higher than the NSW average.
Tweed has a similar percentage of people aged over 65 years (23%) compared to Port Macquarie-Hastings
(24%) but has a hospitalisation rate for coronary heart disease, which is 30% less. (Table 15)
Local Government Area
Rate/100,000
Tweed
488.9
Byron
464.1
Lismore
576.1
Kyogle
629
Ballina
618.4
Richmond Valley
971.7
Clarence Valley
730.7
Coffs Harbour
792.4
Bellingen
646.7
Nambucca
812.3
Kempsey
915.6
Port Macquarie-Hastings
Significance to NSW
Same
Same
Same
1,074.50
Table 15 Coronary Heart Disease Hospitalisations by LGA 2009-10 to 2010-11 (18)
Age Standardised Hospitalisation
Ratio to NSW
Data for hospitalisation is based on the patient’s place of residence and not location of hospital. This is
a significant point as this anomaly may otherwise
be attributed to Tweed’s proximity to health services
HEALTH OF NORTH COAST NSW COMMUNITIES AND
in Queensland.
RESIDENTS
Cardiovascular Disease Hospitalisation by Disease Type
2011/12
1.4
1.2
1
0.8
0.6
0.4
0.2
0
CHD
HF
PVD
N NSW
Stroke
MNC NSW
TIA
AF
All CVD
NSW
Figure 41 Cardiovascular Disease Hospitalisation Ratio (to NSW) by Disease Type 2011-12 (18)
KEY KEY
CHD CHD
Coronary
HeartDisease
Disease
Coronary
Heart
TIA
TIA
HF
Heart Failure
AF
Peripheral
Vascular Disease
Sudden neurologic
impairment due to
All CVD
PVD
HF
PVD
Stroke
Stroke
Heart Failure
Peripheral Vascular Disease
cerebrovascular disorder
AF
Trans Ischemic
Attack Attack
Trans Ischemic
Atrial Fibrillation
All CVD
All Cardiovascular Disease
Atrial Fibrillation
All Cardiovascular Disease
Sudden neurologic impairment due to
cerebrovascular disorder
In 2011-12, NNSW had 8% less hospitalisations (1795.8/100,000) for all CVDs compared to
NSW (1949.6/100,000), whilst MNCNSW had 16% higher rate of CVD hospitalisations
(2273.9/100,000) (Figure 41).
The disease with the largest disparity in hospitalisations between the two areas was in
coronary heart disease where NNSW had 16% lower hospitalisation (448.1/100,000)
compared to NSW (579/100,000).
MNCNSW had 28% higher
hospitalisations
THE HEALTH
NEEDS OF NORTH COAST NSW - 2014
(742.1/100,000) than NSW.
Both NNSW and MNCNSW had lower rates of heart failure at 20% lower for N NSW
47
In 2011-12, N NSW had 8% less hospitalisations (1795.8/100,000) for all CVDs compared to NSW
(1949.6/100,000), whilst MNC NSW had 16% higher rate of CVD hospitalisations (2273.9/100,000)
(Figure 41).
The disease with the largest disparity in hospitalisations between the two areas was in coronary heart
disease where N NSW had 16% lower hospitalisation (448.1/100,000) compared to NSW (579/100,000).
MNC NSW had 28% higher hospitalisations (742.1/100,000) than NSW.
Both N NSW and MNC NSW had lower rates of heart failure at 20% lower for N NSW (145.3/100,000) and
14% lower for MNC NSW (156.1/100,000) compared to NSW (181.4/100,000). In contrast both areas had
higher rates of hospitalisations for trans ischemic
attacks
N NSW
being
23%
higher (78.8/100,000)
HEALTH
OF with
NORTH
COAST
NSW
COMMUNITIES
AND
(18) COMMUNITIES AND
HEALTH
OF
NORTH
COAST
NSW
RESIDENTS
and MNC NSW being 31% higher (84.2/100,000) than NSW (64.1/100,000) .
RESIDENTS
Age
Standardised
Rate/100,000
Age
Standardised
Rate/100,000
Cardiovascular Disease Procedures 2011-12
Cardiovascular Disease Procedures 2011-12
400
400
350
350
300
300
250
250
200
200
150
150
100
100
50
50
0
0
Males
Males
Females
Females
N NSW
N NSW
Males
Females
Males
Females
MNC NSW
MNC NSW
Males
Males
Females
Females
NSW
NSW
(18)
Figure
42 Cardiovascular Disease Procedures 2011-12
2011-12,
In
cardiovascular procedures occurred 65% less for males and females living in
In 2011-12,
cardiovascular
occurred
less for
and females
living in
NNSW
compared
to NSW. procedures
MNCNSW males
had65%
a similar
ratemales
of procedures
as males
in
In 2011-12,
cardiovascular
procedures
occurred
65%had
lessa However,
for
males
and
livingas
in males
N NSW
NNSW(232.9/100,000
compared to NSW.
MNCNSW
males
similar
rate
offemales
procedures
in
NSW
compared
to
305.5/100,000).
MNCNSW
females
had
141%
NSW
(232.9/100,000
compared
to
305.5/100,000).
However,
MNCNSW
females
had
141%
compared
to
NSW.
MNC
NSW
males
had
a
similar
rate
of
procedures
as
males
in
NSW
(232.9/100,000
more cardiovascular procedures (123.8/100,000 compared to 88/100,000 (Figure 42).
moretocardiovascular
procedures
(123.8/100,000
compared
to 88/100,000
(Figure 42).
compared
305.5/100,000).
However, MNC
NSW females
had 141%
more cardiovascular
procedures
Figure 43 Cardiovascular Disease Procedures Ration 2011-­‐12 (18) (123.8/100,000 compared to 88/100,000 (Figure 42).
Age
Standardised
Procedure
Ratio
Age
Standardised
Procedure
Ratio
Figure 43 48
2.5
2.5
2
2
1.5
1.5
1
1
0.5
0.5
0
0
Cardiovascular Disease Procedures Ration 2011-­‐12 (18) Cardiovascular Disease procedures Ratio 2011-12
Cardiovascular Disease procedures Ratio 2011-12
Male
Male
CABG
CABG
Female
Persons
Female
Persons
N NSW
N NSW
Angioplasty/Stent
Angioplasty/Stent
Male
Male
Female
Female
MNC NSW
MNC NSW
Carotid Endarterectomy
Carotid Endarterectomy
Persons
Persons
NSW
NSW
(18) bypass graph procedures
People
living
in NNSWDisease
have Procedures
84% less Ration
coronary
artery
Figure 43
Cardiovascular
2011-12
People living in
NNSW have
84%(45.7/100,000).
less coronary artery
bypass
(7.5/100,000)
compared
to NSW
Whilst
peoplegraph
livingprocedures
in MNCNSW have 7%
(7.5/100,000)
to NSW
(45.7/100,000).
Whilst peoplecompared
living in MNCNSW
more
coronarycompared
artery bypass
graph
procedures (49.2/100,000)
to NSW have 7%
more coronary artery bypass graph procedures (49.2/100,000) compared to NSW
(45.7/100,000).
(45.7/100,000).
People living in NNSW had 63% less angioplasty/stent insertion procedures (51.1/100,000)
THE HEALTH
NEEDS
OF
COAST
NSW63%
- 2014less
People
living
in NNSW
had
angioplasty/stent
insertion procedures
(51.1/100,000)
compared
to NORTH
NSW
(137/100,000).
Whilst
people from MNCLHD
had 15% more
of the same
compared to(157.6/100,000)
NSW (137/100,000).
Whilst
people(137/100,000).
from MNCLHD had 15% more of the same
procedures
compared
to NSW
procedures (157.6/100,000) compared to NSW (137/100,000).
People living in N NSW have 84% less coronary artery bypass graph procedures (7.5/100,000) compared
HEALTH
OFhave
NORTH
NSW COMMUNITIES
AND
to NSW (45.7/100,000). Whilst people living in MNC
NSW
7%COAST
more coronary
artery bypass
graph
RESIDENTS
procedures (49.2/100,000) compared to NSW (45.7/100,000).
in NNSW
had
11%
less carotid endarterectomy
procedures
(8.7/100,000)
People People
living inliving
N NSW
had 63%
less
angioplasty/stent
insertion procedures
(51.1/100,000)
compared to
compared
to
NSW
(9.8/100,000).
In
contrast,
people
on
the
MNCNSW
had
40% more
NSW (137/100,000). Whilst people from MNCLHD had 15% more of the same procedures
(157.6/100,000)
procedures
(13.8/100,000) (MNCNSW female had 107% more endarterectomies
compared
to NSW (137/100,000).
(10.8/100,000) compared to NSW females (5.2/100,000) (18) .
People living in N NSW had 11% less carotid endarterectomy procedures (8.7/100,000) compared to NSW
(9.8/100,000). In contrast, people on the MNC NSW had 40% more procedures (13.8/100,000) (MNC NSW
Diabetes
female had 107% more endarterectomies (10.8/100,000) compared to NSW females (5.2/100,000) (18).
In 2013, the National Diabetes Service Scheme for diabetes and type 2 diabetes, reported
higher rates of registrations for NCNSW than the NSW average , particularly within
Diabetes
Valley,
Kempsey,
Nambucca,
Port
Macquarie-Hastings
and Richmond
In 2013,Clarence
the National
Diabetes
Service
Scheme for
diabetes
and type 2 diabetes,
reportedValley.
higher rates of
Bellingen, Byron, Coffs Harbour, Lismore and Tweed registrations are less than the NSW
registrations for NC NSW than the NSW average , particularly within Clarence Valley, Kempsey, Nambucca,
average. (Figure 44)
Port Macquarie-Hastings and Richmond Valley. Bellingen, Byron, Coffs Harbour, Lismore and Tweed
registrations
less than
thesome
NSWindication
average. (Figure
44)
Theseare
numbers
give
of prevalence
but may not capture all incidence of
diabetes
and
type
2
diabetes
(28).
These numbers give some indication of prevalence but may not capture all incidence of diabetes and type
(28)
2 diabetes.
Figure 44 Diabetes Registrations/100,000 by LGA 2013 (28) Diabetes by LGA 2013 8000 Rate/100,000 7000 6000 5000 4000 3000 2000 1000 0 LGA Prevalence LGA Type 2 NSW Prevalence NSW Type 2 Figure 44 Diabetes Registrations/100,000 by LGA 2013 (28)
Figure 45 Hospitalisations by LGA 2009/10 -­‐ 2010/11 (18) Between
2009-10 and Diabetes 2010-11,
NCNSW had
• significantly higher rates of diabetes related hospitalisations for Clarence Valley, Coffs Harbour and
Kempsey. • significantly lower rates of diabetes hospitalisation for Ballina, Byron, Port Macquarie-Hastings and
Tweed. (Figure 45) (18)
The Aboriginal population has significantly higher rates for diabetes hospitalisations throughout the
NCNSW and NSW as a whole (Figure 46). Hospitalisation rates are four times higher for Aboriginal people
compared to non-Aboriginal people within both N NSW and NSW and approximately 3.5 times higher for
those in MNC NSW.
The Health Needs of North Coast NSW- 2014
Page 57 of 123
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
49
Indirectly Age Standardised Indirectly Age Standardise
Standardised Separation RatioStandardised Separation Ra
180
160
140
120
100
80
60
40
20
Diabetes
0
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
Hospitalisations By LGA 2009/10 - 2010/11
180
160
140
NSW
120
100
80
Between 2009-10
and 2010-11, NCNSW had
60
significantly
40 higher rates of diabetes related hospitalisations for Clarence Valley, Coffs
Harbour20
and Kempsey.
significantly
0 lower rates of diabetes hospitalisation for Ballina, Byron, Port Macquarie•
•
Hastings and Tweed. (Figure 45) (18)
The Aboriginal population has significantly higher rates for diabetes hospitalisations
throughout the NCNSW and NSW as a whole (Figure 46). Hospitalisation rates are four
times higher for Aboriginal people compared to non-Aboriginal people within both NNSW
NSW
and NSW and approximately
3.5 times higher for those in MNCNSW.
Figure 45 Diabetes Hospitalisations by LGA 2009/10 - 2010/11 (18)
Figure 46 2009-10
Diabetes ospitalisations by Aboriginality Between
andH2010-11,
NCNSW
had 2010/11 (18) •
significantly higher rates of diabetes related hospitalisations for Clarence Valley, Coffs
Harbour andDiabetes
Kempsey.Hospitalisations by Aboriginality 2010/11
significantly lower rates of diabetes hospitalisation for Ballina, Byron, Port MacquarieHastings and Tweed. (Figure 45) (18)
Age Standardised Rate/100,000 Age Standardised Rate/100,000
•
800
700
The Aboriginal
population has significantly higher rates for diabetes hospitalisations
600 the NCNSW and NSW as a whole (Figure 46). Hospitalisation rates are four
throughout
500 for Aboriginal people compared to non-Aboriginal people within both NNSW
times higher
400and approximately 3.5 times higher for those in MNCNSW.
and NSW
300
200
Figure 46 100
0
Diabetes Hospitalisations by Aboriginality 2010/11 (18) Diabetes Hospitalisations by Aboriginality 2010/11
800
700
Figure 46600
Diabetes Hospitalisations by Aboriginality 2010/11 (18)
500
400
Mental Health 300
The
Health
North
Coast NSW2014
Page
58 of 123
Based on
extrapolation
National
Mental
Health survey, it is estimated that 20% of the
NCNSW
200Needsofofthe
(29)
100
population suffer from depression or anxiety. This equates to approximately 100,000 people .
• In 2011 rates of0 high or very high psychological distress in both adults and students, were the same
as that for NSW.
• In 2012-13 rates for hospitalisations for intentional self harm were significantly higher than those
recorded for the whole of NSW.
- Males aged 15- 24 years (290.5/100,000) had higher rates compared to NSW (182.8/100,000).
- Males of all ages (173.8/100,000) had higher rates compared to NSW (106.8/100,000).
- Females aged 15-24 year (665.4/100,000) had higher rates compared to NSW females
(465.8/100,000).
- Females of all ages had higher rates (293.4/100,000) compared to those for the whole of NSW
The Health Needs of North
Page 58 of 123
(182.8/100,000).(see
FigureCoast
47) NSW- 2014
50
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
o
o
Figure 47 Females aged 15-24 year (665.4/100,000) had higher rates compared to
NSW females (465.8/100,000).
Females of all ages had higher rates (293.4/100,000) compared to those for
the whole of NSW (182.8/100,000).(see Figure 47)
Hospitalisations for Intentional Self Harm 2012-­‐13 (19) Age Standardised Rate/100,000
Hospitalisations for Intentional Self Harm 2012-13
900
800
700
600
500
400
300
200
100
0
Male
Female
Male
NCNSWML
Female
NSW
15-24
All Ages
Figure 47 Hospitalisations for Intentional Self Harm 2012-13 (19)
The rate of recorded suicide in NCNSW was the same as for(19)NSW. (19) There has been a
The rate
of recorded
suicide
in NCNSW
was the
same
as to
for2011
NSW.(Figure
There
been
a fluctuating
fluctuating
trend
for suicide
in NCNSW
from
1988
48).has
The
linear
trend line trend
for suicide
NCNSW
from to
1988
to an
2011
(Figure
48). The
linear
lineofcould
be across
interpreted
to show an
couldinbe
interpreted
show
overall
steady
decline
in trend
the rate
suicide
NCNSW.
overallHowever,
steady decline
the rate
of suicide
across NCNSW.
However,
these results
be interpreted
these in
results
should
be interpreted
with caution,
especially
for theshould
years before
2007 after
which the
ABSyears
made
improvements
the quality
of made
deathimprovements
data collection.
with caution,
especially
for the
before
2007 after to
which
the ABS
to the quality
HEALTH OF NORTH COAST NSW COMMUNITIES AND
of death data collection.
RESIDENTS
Figure 48 Suicide Trend NCNSW 1988-­‐2011 (19) Suicide Trend NCNSW 1988-­‐2011 Age standardised rate/100,000 25 20 15 The Health Needs of North Coast NSW- 2014
Page 59 of 123
10 5 0 rate/100,000 Linear (rate/100,000) Figure 48 Suicide Trend NCNSW 1988-2011 (19)
Obesity
Obesity
From 2011 to 2013 North Coast NSW had a significantly higher rate of obesity 30.2/100
From(95%
2011C.I.
to 2013
NSW to
had
a significantly
higher
rate of 95%
obesity
(95%
C.I. 29.5,
29.5,North
30.9)Coast
compared
both
the NSW rate
(26.4/100
C.I.30.2/100
26.2, 26.6)
and
30.9)that
compared
to
both
the
NSW
rate
(26.4/100
95%
C.I.
26.2,
26.6)
and
that
for
the
whole
of
Australia
for the whole of Australia (27.5/100 95% C.I. 27.4, 27.6). This significantly higher rate is
(27.5/100
95% C.I. 27.4,
27.6). This
significantly
higher
rate isthe
predominantly
in the
predominantly
evident
in the female
population.
Within
North Coast evident
NSW the
ratefemale
of
population.
Within
the
North
Coast
NSW
the
rate
of
obesity
for
females
is
32.3/100
(95%
C.I.
obesity for females is 32.3/100 (95% C.I. 31.3, 33.2) compared to NSW 26.4/100 (95%31.3,
C.I. 33.2)
compared
to NSW
26.4/100
(95%
C.I. 26.1,
26.6)
Australia
27.5/100
27.3, 27.6),
whilst the
26.1, 26.6)
and
Australia
27.5/100
(95%
C.I.and
27.3,
27.6), whilst
the (95%
male C.I.
population
of North
maleCoast
population
of
North
Coast
NSW
had
similar
rates
to
both
NSW
and
Australia.
NSW had similar rates to both NSW and Australia.
Within North Coast NSW, 9 out of 12 LGA’s had female populations that had significantly
higher rates of obesity than both NSW and Australia, with Richmond Valley (35.7/100 (95%
C.I. 31.6, 39.9), Kempsey (35.8/100, 95% C.I. 31.3, 40.4) and Nambucca (35.7/100, 95%
C.I. 30.7, 40.7) LGA’s having the highest rates.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Dementia
There are more than 332,000 Australians living with dementia and in NSW, there are almost
112,000 which is expected to grow to 132,000 people by 2020. Currently, out of every ten
51
Within North Coast NSW, 9 out of 12 LGA’s had female populations that had significantly higher rates
of obesity than both NSW and Australia, with Richmond Valley (35.7/100 (95% C.I. 31.6, 39.9),
Kempsey (35.8/100, 95% C.I. 31.3, 40.4) and Nambucca (35.7/100, 95% C.I. 30.7, 40.7) LGA’s having
the highest rates.
Dementia
There are more than 332,000 Australians living with dementia and in NSW, there are almost 112,000 which
is expected to grow to 132,000 people by 2020. Currently, out of every ten people aged over 85 years,
there are three people suffering dementia. Almost one in ten people aged over 65 years have dementia
which is the single greatest cause of disability in older Australians (aged 65 years or older) and the third
leading cause of disability burden overall (30).
The numbers of people in rural areas with dementia are proportional to those in metropolitan areas yet
projected to increase by 2050 impacting 2.9% of NSW population (31). The Alzheimer’s Australia NSW report
demonstrates the incidences across NSW. The map clearly shows that NCNSW is a hotspot for dementia
especially for coastal areas such as Tweed Heads and Port Macquarie. (see Figure 49)
Figure 49 NSW Hotspots of Prevalence of Dementia (31)
Dementia prevalence rates “follow an exponential growth rate with age” (32). Figure 50 shows estimated
growth in dementia cases by region for 2011-2050. The potential impact for NCNSW due to its expanding
ageing population is significant.
The projected prevalence of dementia from 2013 to 2050, a 37 year span is extreme for the LGAs within
NCNSW. Predictions range from Nambucca with 321% increase to Clarence Valley up to a massive 550%.
(seeTable 16)
52
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Figure 50 2011-2050 Growth in Dementia Cases by Region (32)
Local Government Area
2013
2050
% Growth 2013-2050
1
Great Lakes Council
992
3651
368
2
Coffs Harbour City Council
966
3581
381
3
Taree City Council
897
2957
329
4
Ballina Shire Council
889
3107
349
5
Port Macquarie Hastings Council
676
2557
378
6
Kempsey Shire Council
508
1738
342
7
Nambucca Shire Council
428
1378
321
8
Byron Shire Council
376
1432
380
9
Tweed Shire Council
327
1306
399
10
Bellingen Shire Council
251
879
350
11
Richmond Shire Council
323
855
368
12
Kyogle Shire Council
141
458
324
13
Lismore City Council
128
623
486
14
Gloucester Shire Council
102
270
264
15
Clarence Valley Council
56
308
550
Table 16 North Coast of NSW Local Government Area Dementia Prevalence Rates (32)
Injury and Poisoning
In 2011/12, North Coast NSW had a rate of hospitalisation for injury and poisoning of 2987.3/100,000
(95% C.I. 2937.9, 3037.3) which is significantly higher than the NSW rate of 2371.4/100,000 (95% C.I.
2360.3, 2382.5).
The greatest difference between the rates for NCNSW and NSW lay with hospitalisations for
interpersonal violence where NCNSW had a rate of 153/100,000 (95% C.I. 140.7, 165.9) compared to
NSW 76.8/100,000 (95% C.I. 74.8, 78.9).
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
53
Other differences were with natural/environmental factors (NCNSW 110.9/100,000 compared to NSW
61.2/100,000) and Self Harm (NCNSW 161.7/100,000 compared to NSW 112.5/100,000).
Compared to Australia, NCNSW also had significantly higher injury and poisoning hospitalisation rates. In 2011/12, significantly higher rates were recorded in 8 of the 12 LGA’s within NCNSW compared to the
whole of Australia, with the worst rates in Kempsey, Bellingen and Clarence Valley LGA’s. However, Port
Macquarie LGA had a hospitalisation rate in 2011/12 that was significantly lower than that for the whole
of Australia.
2.3.2 Other Health Conditions impacting the Community in NCNSW
Kidney Disease
Hospitalisation rate for dialysis within NCNSW is significantly higher than NSW for males (5,502/100,000
compared to 5,339/100,000) and for females (4,425/100,000 compared to 3,454/100,000). (see Table 18
and Table 19)
The rate of dialysis hospitalisations for the NCNSW Aboriginal population (41,326/100,000) is nearly double
that for the NSW Aboriginal population (21,564/100,000) and more than 10 times higher than that of the
non-Aboriginal population within NCNSW (4,101/100,000) (see Table 20).
Overall NCNSW has significantly higher rates of hospitalisations for genitourinary diseases
(1,777.2/100,000) compared to NSW (1,706.2/100,000). The hospitalisation for genitourinary diseases is
significantly higher for NCNSW females (2,260.7/100,000) compared to NSW (2,066.8/100,000). Males
recorded rates that were significantly lower than that for NSW (1,278.3/100,000 compared to NSW
1,357.8/100,000) (19).
Oral Health
Oral health is a key community concern amongst residents of NCNSW. Lack of fluoridation in some areas,
ageing and socioeconomic factors all contribute to poor oral health outcomes.
Children
The oral health of children in the region is amongst the worst in NSW. While data is scarce an indicator of
oral health is the 2007 survey of NSW Child Dental Health (33) which identified
• MNCLHD was the only LHD in NSW with a statistically higher number of children aged 5-6 years with
decayed, missing and filled teeth (DMFT) than N NSWLHD. • N NSWLHD was also one of only two LHDsHEALTH
that levels
of children
whoNSW
wereCOMMUNITIES
free from oralAND
caries at age
OF NORTH
COAST
RESIDENTS
5-6 years that was significantly lower number
than the NSW state level. (see Figure 51 and Figure 52)
Decayed, Missing & Filled Teeth 2007
Mean Number DMFT
6
5
4
3
2
1
0
5-6 years
NSW
Figure 51 Mean Number of 5-6 Year Old Children with Decayed, Missing and Filled Teeth (18)
Figure 52 Percentage of 5-­‐6 Year Old Children that are Free of Dental Caries (18) 54
tal Caries
% 5-6 yr olds Free Of Dental Caries 2007
90
80
70
60
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
5-6 years
Figure 52 NSW
Percentage of 5-­‐6 Year Old Children that are Free of Dental Caries (18) % Free of Dental Caries
% 5-6 yr olds Free Of Dental Caries 2007
90
80
70
60
50
40
30
20
10
0
5-6 years
NSW
Figure 52 Percentage of 5-6 Year Old Children that are Free of Dental Caries (18)
For 11-12 year olds oral health was poor with the survey identifying that there are
• high
of decayed,
missing
and the
filled
teeth identifying
(DMFT), with
For 11-12
yearlevels
olds oral
health was
poor with
survey
that MNCLHD
there are highest in the
state
• high levels of decayed, missing and filled teeth (DMFT), with MNCLHD highest in the state
• low numbers of children who are free from dental caries compared to the rest of NSW,
• low numbers of children who are free fromHEALTH
dental caries
compared
to the rest of NSW, with
NORTH
COAST
with MNCLHD significantly lower than NSW OF
(see
Figure
53) NSW COMMUNITIES AND
RESIDENTS
MNCLHD
significantly lower than NSW (see
Figure 53)
Figure 53 Mean Number of 11-­‐12 Year Old Children with Decayed, Missing and Filled Teeth (18) Decayed, Missing & Filled Teeth 2007
11-12 yr old
Mean Number DMFT
1.8
1.6
1.4
1.2
1
The Health Needs of North Coast NSW- 2014
0.8
0.6
0.4
0.2
0
11-12 years
Page 64 of 123
NSW
Figure 53 Mean Number of 11-12 Year Old Children with Decayed, Missing and Filled Teeth (18)
Figure 54 Percentage of 11-­‐12 Year Old Children that are Free of Dental Caries (18) % Free of Dental Caries
% 11-12 yr olds Free of Dental Caries 2007
90
80
70
60
50
40
30
20
10
0
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
11-12 years
NSW
55
11-12 years
Figure 54 NSW
Percentage of 11-­‐12 Year Old Children that are Free of Dental Caries (18) % Free of Dental Caries
% 11-12 yr olds Free of Dental Caries 2007
90
80
70
60
50
40
30
20
10
0
11-12 years
NSW
Figure 54 Percentage of 11-12 Year Old Children that are Free of Dental Caries (18)
The highest number of children aged 5-6 years and 11-12 years with decayed, missing and
filled teeth
reside
in Clarence
Kempsey,
Kyogle,
andmissing
Richmond
The highest
number
of children
agedValley,
5-6 years
and 11-12
yearsNambucca
with decayed,
andValley
filled teeth
LGAs,
all
of
which
are
in
the
lowest
quintile
of
socioeconomic
status
nationally.
(see
Figure
reside in Clarence Valley, Kempsey, Kyogle, Nambucca and Richmond Valley LGAs, all of which
are in the
55
and
lowest quintile of socioeconomic status nationally. (see Figure 55 and Figure 56) These areas of high
HEALTH OF NORTH COAST NSW COMMUNITIES AND
socioeconomic disadvantage also have a highRESIDENTS
proportion of Aboriginal population of between 5% -10%.
Figure 56) These areas of high socioeconomic disadvantage also have a high proportion of
Aboriginal population of between 5% -10%.
Decayed, Missing & Filled Teeth by Socioeconomic Status 5-6 Years
Mean Number of Children Aged 5-­‐6 Years with Decayed, Missing and Filled Teeth by Socioeconomic Status (18) Mean Number DMFT
Figure 3 55 2.5
2
1.5
The Health Needs of North Coast NSW- 2014
1
Page 65 of 123
0.5
0
1st Quintile (Least
Disadvantaged)
2nd Quintile
th
3rd Quintile
4 Quintile
Ballina
Byron
Port Macquarie
– Hastings
Bellingen
Coffs Harbour
Lismore
Tweed
3rd Quintile
4th Quintile
5th Quintile (Most
Disadvantaged)
th
5 Quintile
Most disadvantaged
Clarence Valley
Kempsey
Kyogle
Nambucca
Richmond Valley
Figure 55 Mean Number of Children Aged 5-6 Years with Decayed, Missing and Filled Teeth by Socioeconomic Status (18)
Figure 56 Mean Number of Children Aged 11-­‐12 Years with Decayed, Missing and Filled Teeth by Socio Economic Status (18) 56
ber DMFT 11-12 years
Decayed, Missing & Filled Teeth by Socioeconomic Status 11-12 Years
1.2
1
0.8
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
0.6
0.4
Figure 56 Mean Number of Children Aged 11-­‐12 Years with Decayed, Missing and Filled Teeth by Socio Economic Status (18) Mean Number DMFT 11-12 years
Decayed, Missing & Filled Teeth by Socioeconomic Status 11-12 Years
1.2
1
0.8
0.6
0.4
0.2
0
1st Quintile
(Least
Disadvantaged)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (Most
Disadvantaged)
Figure 56 Mean Number of Children Aged 11-12 Years with Decayed, Missing and Filled Teeth by Socio Economic Status (18)
Older People
OlderLarger
Peoplenumbers of people are retaining their natural teeth into old age, including as they
Largerenter
numbers
of people are
retaining
naturalAsteeth
into old age,
including
as they
enter into
into supported
care
such astheir
RACFs.
the region’s
ageing
population
continues
to
increase,
demand
for ageing
oral health
services
specifically
for the older
supported
care this
suchcompounds
as RACFs. the
As the
region’s
population
continues
to increase,
this compounds
population
andhealth
thoseservices
with reduced
mobility. the older population and those with reduced mobility.
the demand
for oral
specifically for
Aboriginal
People
The Health
Needs of North Coast NSW- 2014
Page 66 of 123
Data to assess the oral health of Aboriginal people of NCNSW is limited. Reports from the local AMSs
indicate that this is an area of great need, consistent with the national trend.
Across Australia, Aboriginal people
• experience higher rates of untreated caries – Aboriginal 15 year olds have almost three times the
number of carious teeth as their counterparts
• aged 35-54 have up to five times the dental decay
• experience higher rates of periodontal disease, with poor periodontal health across all age groups
• are at greater risk of periodontal disease due to comorbidities such as diabetes, smoking, stress,
genetic and epigenetic inherited factors, poor education and nutrition, socio-economic status and
cardiovascular disease
• experience higher rates of tooth loss, trauma and edentulism (five times higher for 35-54 year olds)
• have less access to regular public or private dental services
As the rurality and remoteness of the Aboriginal child increases, so does the burden of disease.
Aboriginal children living in rural areas had the worst oral health with the highest dmft/DMFT scores,
followed by Aboriginal children in metropolitan areas (34) (35).
The national survey on adult oral health showed that Aboriginal people aged 17-20 years had 3.2 times
the prevalence of decayed teeth and 2.5 times the prevalence of missing teeth than their non-Aboriginal
counterparts. The severity of decayed teeth among Aboriginal adults aged 35-54 is five times higher than
their non-Aboriginal counterparts.
Aboriginal people have been highlighted as a group with disproportionate oral health issues and at high
risk of poor oral health outcomes by the North Coast Oral Health Opinion Leaders Forum which provides
an opportunity for private and public oral health providers to develop strategies to improve oral health and
to provide guidance at a local level.
Fluoridation
Fluoridation of drinking water is one of the most effective ways of reducing dental caries and maintaining
positive oral health. It has been shown to reduce tooth decay by around 50-70% and reduces the risk of
tooth loss by 40-60%. (36) Much of the reticulated water supply across the region is not fluoridated and
there is active opposition to fluoridation of the supply in some locations.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
57
LGA
Fluoridation
Status
Ballina
Comments
Council agreed Aug 2013 to seek directive
Bellingen
Byron
No current Council resolution to seek direction
Clarence Valley
Coffs Harbour
Kempsey
South West Rocks is already fluoridated. Council has
submitted a concept design to the NSW Office of Water.
Kyogle
Lismore
Gazetted to be commissioned. Council agreed Aug 2013
to seek directive. Nimbin supply will not be fluoridated.
Nambucca
Port Macquarie Hastings
Port Macquarie is a diluted supply.
Richmond Valley
Direction received 2007. Casino is already fluoridated.
Rocky creek system to be fluoridated. Plans to commence
fluoridation underway.
Tweed
Uki supply non fluoridated.
Rous Water (Regional Water Supply Authority)
Resolved to proceed with the construction and operation
of fluoridation plants.
Table 17 Status of Fluoridation of Reticulated Water Supply (37)
Childhood Immunisation
In 2012-13 NCNSW had the lowest rate of childhood immunisation nationally for one and two year olds,
and second lowest for the five year age group. (See Figure 57)
The low immunisation rates and high conscientious objector population in NCNSW may be partially
attributed to The Australian Vaccination Sceptics Network which is highly active in this region and
disseminates information that impedes the attainment of a higher immunisation rate. (38)
Aged One Year
NCNSW recorded the nation’s lowest rate of children fully immunised at one year of age (86.1%), along
with the largest cohort of conscientious objection recorded across Australia (176 people).
Out of a total of 1,485 postcodes across Australia, six NCNSW postcodes were listed in the lowest 10
areas of one year old children fully immunised. Towns such as Mullumbimby, have percentages as low as
44.1% (lowest region in Australia) and Bellingen 68% and Byron Bay 68.9%. (see Figure 58)
Aged Two Years
NCNSW recorded the nation’s lowest rate of children fully immunised at two years of age (89%), along
with the third largest cohort of conscientious objection (223 people) recorded across Australia.
Of the 10 postcodes with the lowest two year old immunisation rates, four are situated within NCNSW.
The lowest percentage in Australia was in Mullumbimby (54.5%), then Bangalow (4th lowest, 71.4%),
Byron Bay (7th lowest, 73.6%) and Brunswick Heads (10th lowest, 74.8%). (see Figure 58)
Aged Five Years
88% of children aged five years were fully immunised in the NCNSW. This was the second lowest in
Australia, with the highest number of conscientious objections recorded in the country (362).
Mullumbimby had the lowest percentage of fully immunised five year old children in Australia (46.8%)
along with Byron Bay (6th lowest, 66.7%), Brunswick Heads (7th lowest, 70.2%), and Bellingen (8th
lowest, 70.4%). (see Figure 58)
58
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
Aboriginal
Children
improvement
and at five years of age, Aboriginal children in the region have rates higher
Rates
of childhood
immunisation
amongst
within
areabove
low
forthat
one year age
than
the national
rate
(92.4%
NCNSW
comparedchildren
to 91.5%
and well
improvement
and
at five
years
of age,Aboriginal
Aboriginal
children
inNSW)
theNCNSW
region
have
rates
higher
recorded
rate
for the
whole
(88%).
group
(84.4%),
which
is
similar
toNCNSW
the
national
rate(Figure
for Aboriginal
butwell
wellabove
belowthat
the national rate
than
the national
rate
(92.4%
NCNSW
compared
to 57)
91.5% children,
NSW) and
recorded rate for
the whole
NCNSW (88%).
(Figurehas
57)seen an improvement and at five years of age,
strategies
in Aboriginal
communities
(91.2%). Targeted
Aboriginal children in the region have rates higher than the national rate (92.4% NCNSW compared to
Figure 57 Percentage of Children Fully Immunized 2012-­‐2013 (39) 91.5% NSW) and well above that recorded rate for the whole NCNSW (88%). (Figure 57)
Percentage of Children Fully Immunized 2012-­‐2013 (39) Figure 57 Percentage Percentage % of Children Fully Immunised 2012/13 % of Children Fully Immunised 2012/13 94 94 92 92 90 90 88 88 86 86 84 84 82 82 1 year 1 year NCNSWML NCNSWML NaLonal NaLonal 2 years 2 years 5 years 5 years NCNSWML Aboriginal PopulaLon NCNSWML Aboriginal PopulaLon Aboriginal
Population
NaLonal Aboriginal PopulaLon NaLonal Aboriginal PopulaLon Figure 58 NCNSW Immunisation Rates-­‐ Highlighting the areas with the highest disparity compared to NCNSW Figure 57 Percentage
of Children
Fully RImmunized
2012-2013 (39)
Regional National ates (39)H ighlighting Figure 58 NCNSW a nd Immunisation Rates-­‐ the areas with the highest disparity compared to NCNSW Regional and National Rates (39) Percentage Percentage NCNSWML ImmunisaUon Rates 2012/13 NCNSW
Immunisation Rates
2012/13
NCNSWML ImmunisaUon Rates 2012/13 100 100 90 90 80 80 70 70 60 60 50 50 40 1 year 40 Mullumbimby 1 year Mullumbimby Brunswick Heads Brunswick Heads Bangalow Bangalow Dorrigo Dorrigo 2 years 2 years Byron Bay Byron Bay NCNSWML NCNSWML 5 years 5 Bellingen years Bellingen NaLonal NaLonal Figure 58 NCNSW Immunisation Rates- Highlighting the areas with the highest disparity compared to NCNSW Regional
and National Rates (39)
Other Communicable Diseases
Other communicable disease patterns vary greatly across NSW, due to factors such as population age and
The Health Needs of North Coast NSW- 2014
Page 69 of 123
distribution, ethnicity, sexuality and injecting drug use. Due to a number of these factors, areas of Sydney
The Health Needs of North Coast NSW- 2014
Page 69 of 123
skew results and make comparisons at a state level meaningless. For this reason, LHDs that have similar
traits to N NSWLHD and MNCLHD have been chosen for comparative purposes.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
59
Chlamydia
Throughout NSW, Chlamydia notifications are more common in females and in older teenagers and young
adults. Most people with chlamydia are asymptomatic thus, notification rates are often dependant on
testing rates. In NSW there was an increase in chlamydia testing between April 2012 (90,668 tests) to April
2013 (98,031). However, for the same period, across NSW there was a decrease in positive tests (5.69% in
2012 to 5.19% in 2013) (40).
In comparison to other non-metropolitan LHDs, N NSW had higher rates of notifications for chlamydia with
a steady increase from 2007 until 2012 and a slight projected decrease in 2013. MNC NSW has had a
similar notification rate to other NSW LHDs, with steady notification rates from 2007 to 2012, again with a
slight projected decrease in 2013 (40).
Figure 59 Age Adjusted Chlamydia Notification Rate January 2007 - September 2013 (40)
Note: Adjusted for most recent year being incomplete.
Gonorrhoea
Gonorrhoeal notifications are predominately reported in males, notably between the ages of 25-35 years
and are thought to be mainly associated with male to male sex. Again, due to a number of asymptomatic
infections (especially in women), the number of notifications are dependant on the number of tests
performed. In NSW, there was an increase in gonorrhoeal testing between April 2012 (111,095 tests)
and April 2013 (121,316) and a decrease in positive tests (0.94% in 2012 to 0.85% in 2013) (40).
In comparison to similar LHDs, N NSW had similar rates of notifications for gonorrhoea with a steady
increase from 2007 until 2012 with a 50% projected increase in notifications for 2013. MNC NSW also
had similar notification rates comparative to NSW LHDs, with steady rates from 2007 to 2012 with a
slight projected decrease in 2013. (see Figure 60) (40)
Syphilis
Syphilis is a sexually transmitted infection that can have serious long-term complications or even death
if not treated correctly. Though notified numbers are low, the seriousness of the disease necessitates the
need for vigilance in surveillance. Due to the low number of notifications, the trends tend to be erratic
but still allow for interpretation of spikes in the community. N NSW had a downward trend in notifications
between 2007 and 2010.
Since 2010 there has been a steady increase in notifications with a projected increase of 66% between
2012 and 2013. MNC NSW had a steady syphilis notification rate between 2007 and 2012. Between 2012
and 2013 however, there is a projected increase in notifications of 200%. (see Figure 61 ) (40)
60
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Figure 60 Age Adjusted Gonorrhoea Notifictaion Rate January 2007 - September 2013 (40)
Figure 61 Age Adjusted Syphilis Notification Rate January 2007- September 2013 (40)
Note: Adjusted for most recent year being incomplete. Excludes Congenital infections.
The Human Immunodeficiency Virus (HIV)
In the first nine months of 2013 there were 271 people newly diagnosed with HIV in NSW. This compares
to 308 notifications for the same period in 2012. In 2012, a 24% increase in notifications in NSW
prompted an increase in testing, particularly of high risk groups (men who have sex with men, people
who inject drugs and sex workers) and priority populations (Aboriginal people) who access publicly funded
sexual health clinics. N NSW has the highest number of people, outside metropolitan Sydney living
with HIV.
With over 50% of notifications coming from two health districts, Sydney and South Western Sydney, trends
of notifications in other health districts tend to be erratic due to the small numbers of notifications. N NSW
saw a spike of notifications of HIV between 2010 and 2011 reaching 3.3% of NSW total new diagnoses. Since then there has been a steady decline to 0.7% in 2013. MNC NSW has been slightly more erratic
moving between 0.7% and 2.5% with the 2013 percentage being at 1.5% of NSW notifications. (see
Figure 62)
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
61
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
HEALTH OF NORTH COAST NSW COMMUNITIES AND
RESIDENTS
% of HIV Notifications 2007 - Sept 2013
% of HIV Notifications 2007 - Sept 2013
% ofNotifications
NSW Notifications
% of NSW
6
56
45
3
4
23
12
01
0
2007
2008
2009
2010
2011
Illawarra 2012 Murrumbidgee
2011
2013
N NSW
2007
MNC2008
NSW
Hunter
2009
Southern
2010
N NSW
MNC NSW
Hunter
Southern
2012
Illawarra
2013
Murrumbidgee
Hepatitis B
Figure 62 Percentage of HIV Notifications for Selected Areas 2007 - September 2013 (41)
NCNSW has significantly lower rates of hepatitis B notifications compared to those reported
for
NSW. B
Hepatitis
Hepatitis
B
NCNSW has significantly lower rates of hepatitis B notifications compared to those reported
NCNSW
has
significantly
of hepatitis
B notifications
to those reported
NSW. Figure 63
indicates lower
that inrates
relation
to comparable
regionscompared
(Hunter, Southern,
Illawarrafor
and
for NSW.
Medicare
Locals),
NCNSW regions
has similar
rate Southern,
of notification
of Hepatitis
B.
63 indicates that
in relation
to comparable
(Hunter,
Illawarra
and Murrumbidgee
FigureMurrumbidgee
Figure
63 indicates
that
insimilar
relation
to comparable
regions
(Hunter, Southern, Illawarra and
Medicare
Locals),
NCNSW
has
rate
notification
of –Hepatitis
Figure 63 Hepatitis B Notifications for of
Selected Areas 1998 2012 (19) B.
Murrumbidgee Medicare Locals), NCNSW has similar rate of notification of Hepatitis B.
Age-Standardised
Notification
Age-Standardised
Notification
Rate/ Rate/
100,000
100,000
Figure 63 Hepatitis B Notifications for Selected Areas 1998 – 2012 (19) Hep B Notifications 1998-2012
25
Hep B Notifications 1998-2012
20
25
15
20
10
15
5
10
0
5
0
Hunter
Illawarra
Murrumbidgee
Figure 63 Hepatitis
B Notifications
for Selected Areas
1998 – 2012 (19)
Hunter
Illawarra
Murrumbidgee
Southern
NCNSWML
Southern
NCNSWML
In 2011, there were 3,265 people living with chronic hepatitis B in NCNSW. Of those with chronic
The Health Needs of North Coast NSW- 2014
Page 73 of 123
hepatitis B, 24.4% were Aboriginal and a further 19.56% were born overseas. Throughout NCNSW,
Kempsey (0.88%) had the highest percentage of its population living with hepatitis B. Tweed Heads had
The Health Needs of North Coast NSW- 2014
Page 73 of 123
the greatest number of people with hepatitis B totalling 565 followed by Coffs Harbour with 503. (see
Figure 64) (42).
62
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Figure 64 Hepatitis B Prevalence by LGA 2011 (42)
Hepatitis C
NCNSW is a hotspot for hepatitis C (HCV) notifications with Australian Society for HIV Medicine NSW
(ASHM NSW) reporting that N NSW has the highest burden of HCV in NSW based on total notifications.
For the year 2011-12, NCNSW had 274 HCV notifications, the highest number outside Sydney. Since
1998-99 NCNSW has had significantly higher rates of notifications for HCV compared to NSW and higher
rates compared to similar ML areas as demonstrated in Figure 65. (19)
Figure 65 Hepatitis C Notifications 1998-2012 (19)
Palliative Care
In NSW the demand for palliative care is expected to increase by 4.6% annually.
• Seventy-four percent of Australians would like to die at home, however, the majority die in hospitals
with only 16% achieving their desired outcome of a death at home.
• Forty percent of people who die in hospital have no medical reason to do so (43)
This results in a potentially poorer quality of death and a high cost burden for the health system.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
63
•
Forty percent of people who die in hospital have no medical reason to do so (43)
This results in a potentially poorer quality of death and a high cost burden for the health
system.
In NNSW this is expected to be even higher as a result of the high burden of chronic disease
and the ageing population. It is an area for concern amongst North Coast residents.
In N Palliative
NSW this Care
is expected
to be even
higher
as a result
of the
high burden
of chronic
separations
in NNSW
shows
a 116%
increase
in palliative
care disease
inpatientand the
ageing
population.
is an area for
concern
amongst
Coast
residents. Palliative
Care separations
separations
in ItNNSWLHD
hospital
facilities
(43)North
between
2009-2012.
This demonstrates
in N this
NSWincreasing
shows a 116%
increase
in
palliative
care
inpatient
separations
in
N
NSWLHD
hospital facilities
demand for services, both in the community setting and inpatient facilities.
(43)
between 2009-2012. This demonstrates this increasing demand for services, both in the community
Figure 6 facilities.
NNSWLHD Palliative Care Inpatient Separations (43) setting
and6inpatient
NNSWLHD PalliaUve Care InpaUent SeparaUons 900 800 700 600 500 400 300 200 100 0 PaliaLve Care InpaLent SeparaLons 2009-­‐10 PalliaLve Care InpaLent SeparaLons 2010-­‐11 PalliaLve Care InpaLent SeparaLons 2011-­‐12 Figure 66 N NSWLHD Palliative Care Inpatient Separations (43)
2.4
HOSPITALISATIONS AND AVOIDABLE MORTALITY
2.4 Hospitilisation and Avoidable Mortality
Hospitalisations
Hospitalisations
The people of NCNSW are hospitalised at a rate that is significantly higher than NSW, a
The people
of NCNSW
are hospitalised
at a rate
that is significantly
higher than
a trend which
trend which
has been
consistent since
2007/08.
HEALTH
OF NORTH COAST
NSWNSW,
COMMUNITIES
ANDhas
RESIDENTS
been consistent since 2007/08.
Figure 67 NCNSW Hospitalisation Trend 2006/07-­‐2011/12 (18) Age Standardised HospitlaisaUon Rate/
100,000 NCNSW HospitalisaUons 2006/07 -­‐ 2011/12 37000 36000 35000 34000 The Health Needs of North Coast NSW- 2014
Page 75 of 123
33000 32000 31000 NCNSWML NSW Figure 67 NCNSW Hospitalisation Trend 2006/07-2011/12 (18)
In 2011-12 NCNSW had significantly higher rates of hospitalisations compared to the other
regions in NSW (36,435/100,000 compared to 36,015/100,000).
•
Between 2009-10 and 2010-11, the LGAs of Kyogle, Ballina, Richmond Valley, Lismore,
Clarence Valley and Kempsey all had significantly higher rates of hospitalisations than
the NSW average with Kempsey LGA having the highest rate of 49,260/100,000
hospitalisations.
Tweed, Byron, Coffs Harbour and Port Macquarie-Hastings LGAs all had significantly
lower rates of hospitalisations compared to NSW with Byron LGA having the lowest rate
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
of 27,361/100,000 (See Figure 68).
•
64
Figure 68 Hospitalisations by LGA 2009/10-­‐2010/11 (18) NCNSWML NSW In 2011-12 NCNSW had significantly higher rates of hospitalisations compared to the other
regions in NSW (36,435/100,000 compared to 36,015/100,000).
• NCNSW
Betweenhad
2009-10
and 2010-11,
the LGAs
of Kyogle, Ballina,
Richmond
Lismore,
In 2011-12
significantly
higher rates
of hospitalisations
compared
to the Valley,
other regions
in
Clarence
Valley
and
Kempsey
all
had
significantly
higher
rates
of
hospitalisations
than
NSW (36,435/100,000 compared to 36,015/100,000).
the NSW average with Kempsey LGA having the highest rate of 49,260/100,000
• Betweenhospitalisations.
2009-10 and 2010-11, the LGAs of Kyogle, Ballina, Richmond Valley, Lismore, Clarence
Valley and Kempsey all had significantly higher rates of hospitalisations than the NSW average with
• Tweed,
Byron,the
Coffs
Harbour
and
Port Macquarie-Hastings
LGAs all had significantly
Kempsey
LGA having
highest
rate of
49,260/100,000
hospitalisations.
lower
rates
of
hospitalisations
compared
to
NSW
with
Byron
LGA
having thelower
lowestrates
rateof
significantly
• Tweed, Byron, Coffs Harbour and Port Macquarie-Hastings LGAs all had
of 27,361/100,000 (See Figure 68).
hospitalisations compared to NSW with Byron LGA having the lowest rate of 27,361/100,000 (See
Figure
68).68 Figure Hospitalisations by LGA 2009/10-­‐2010/11 (18) Age Standardised SeparaUon RaUo HospitalisaUons by LGA 2009/2010 -­‐ 2010/11 140 120 100 80 60 40 20 0 NSW Figure 68 Hospitalisations by LGA 2009/10-2010/11 (18)
Causes of Hospitalisation
The top The
six causes
of male
include
18)
Health Needs
of hospitalisations
North Coast NSW2014 a mix of both chronic and acute conditions
Page(Table
76 of 123
and NCNSW has significantly higher rates than the NSW average for five of these conditions.
Males
NCNSW
Rate/100,000
NSW
Rate/100,000
Dialysis
5,502
5,339
Injury & Poisoning
5,458
4,804
Digestive System Diseases
3,606
3,446
Other Factors Influencing Health
3,342
4,475
Nervous & Sense Disorders
2,689
2,202
Symptoms & Abnormal Findings
2,656
2,318
Significance
Difference@ 95% CI
Table 18 NCNSW Male Hospitalisation by Cause 2012-2013 (18)
The top six causes of female hospitalisations (Table 19) include both chronic and acute conditions, and
for these conditions, NCNSW has significantly higher rates for five of these causes compared to the
NSW average.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
65
Females
NCNSW
Rate/100,000
NSW
Rate/100,000
Maternal, Neon. & Congenital
5,228
4,827
Dialysis
4,425
3,454
Injury & Poisoning
4,278
3,881
Other Factors Influencing Health
3,853
5,605
Digestive System Diseases
3,510
3,307
Nervous & Sense Disorders
2,653
2,205
Significance
Difference@ 95% CI
Table 19 NCNSW Female Hospitalisation by Cause (18)
The rates of hospitalisations amongst Aboriginal people illustrates the disparity in health between the
Aboriginal and non-Aboriginal population.
• Aboriginal people in NCNSW have significantly higher rates (compared to NSW Aboriginal people) of
hospitalisations for five out of six of the leading causes of hospitalisation. (See Table 20) • The largest disparity lies in the hospitalisation rates for dialysis. The Aboriginal population in NCNSW
has a hospitalisation rate that is nearly twice the rate for NSW Aboriginal people and more than
10 times that of the non-Aboriginal people in NCNSW.
Factors Influencing Health
Aboriginal
Non-Aboriginal
NSW Aboriginal
41,326
4,101
21,564
Injury & poisoning
8,922
4,570
6,828
Maternal, Neon. & Congenital
4,083
2764
3,800
Symptoms & Abnormal Findings
5,757
2,690
3,993
Respiratory Disease
4,642
1,666
3,924
Digestive System Diseases
4,893
3,603
3,872
Dialysis
Significance
Difference @ 95% CI
Same
Table 20 Leading cause of Hospitalisation for NCNSW Aboriginal Population 2011/12 (Rate/100 000) (18)
Potentially Preventable Hospitalisations
For the years 2010-11 and 2011-12, NCNSW had a significantly higher rate of Potentially Preventable
Hospitalisations (PPH) compared to NSW. This rate has been higher than NSW since 2001 (Figure 69).
There are notable regional variations (Table 21) however the factors that could be changed to prevent
these admissions is not well known or understood in the research literature.
Potentially Preventable Hospitalisations (PPH) are those conditions for which hospitalisation is
considered potentially avoidable through preventive care and early disease management, usually
delivered in an ambulatory setting, such as primary health care.
66
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Potentially Preventable Hospitalisations (PPH) are those conditions for which hospitalisation
is considered potentially avoidable through preventive care and early disease management,
usually delivered in an ambulatory setting, such as primary health care.
Figure 69 Trend for Potentially Preventable Hospitalisations 2001-­‐2012 (19) Age Standardised Rate/100,000 PotenUally Preventable HospitalisaUons 2001 -­‐ 2012 3200 3000 2800 2600 2400 2200 2000 Males NCNSWML Females NCNSWML NCNSWML Males NSW Females NSW NSW Figure 69 Trend for Potentially Preventable Hospitalisations 2001-2012 (19)
Table 21 Potentially Preventable Hospitalisations by LGA 2010-­‐2011/12 (19) Local Government
Local Area
Government Area
Rate/100,000 Rate/100,000
Significance to NSW
Significance to NSW
Tweed
Tweed
2,600.50
2,600.50
Same Byron
Byron
2,112.10
2,112.10
↓ 2,511.60
2,511.60
Same Kyogle
Kyogle
3,484.20
3,484.20
↑ Ballina
Ballina
2,483.20
Richmond Valley
3,550.30
2,483.20
Clarence Valley
3,095.60
Lismore Lismore
Richmond Valley
Clarence Valley
3,550.30
3,095.60
The Health Needs of North Coast NSW- 2014
Coffs Harbour
2,906.30
Bellingen
3,280.60
Nambucca
2,781.90
Kempsey
5,158.90
Port Macquarie-Hastings
2,390.70
Same
Same
Same Same
↑ ↑ Page 78 of 123
Table 21 Potentially Preventable Hospitalisations by LGA 2010-2011/12 (19)
Avoidable Mortality
For people born in the NCNSW region, the life expectancy of a male is 78.2 years and a female is 84 years.
This is similar to other comparable peer regions in Australia. (44)
Between the years 2006-2010, NCNSW had significantly higher rates of avoidable mortality
(258.8/100,000) compared to NSW (242.2/100,000). (2) In this period, three LGAs in the region had
significantly lower standardised mortality rates compared to NSW. (Figure 70)
Avoidable mortality counts are defined as deaths that occur before the age of 75 years that are
considered preventable or otherwise avoidable through better preventative health management or
interventions at the primary, secondary or tertiary levels of health care.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
67
Between the years 2006-2010, NCNSW had significantly higher rates of avoidable mortality
(258.8/100,000) compared to NSW (242.2/100,000) (2). In this period, three LGAs in the
region had significantly lower standardised mortality rates compared to NSW (Figure 70).
Avoidable Mortality 2006-­‐2010 (2) Figure 70 Indirectly Age Standardised Mortality RaUo Avoidable Mortality 2006-­‐2010 140 120 100 80 60 40 20 0 NSW NCNSWML Figure 70 Avoidable Mortality 2006-2010 (2)
Note: These figures are based on patients place of residence, not the place of treatment.
Note: These figures are based on patients place of residence, not the place of treatment.
Avoidable mortality counts are defined as deaths that occur before the age of 75 years that
are considered
preventable
or of
otherwise
through better preventative health
Summary
of Indicators
of the health
NCNSW avoidable
populations
or statistically
interventions
at the primary,
secondary
or tertiary
levels
of health
care. to the whole
Northmanagement
Coast NSW has
significantly
higher rates
of the following
health
indicators
compared
of NSW
Cancer
• Prostate cancer mortality
• Colon cancer incidence (N NSW)
• Melanoma incidence
• Melanoma mortality (N NSW)
Alcohol attributable hospitalisations
Avoidable Mortality
The Health Needs of North Coast NSW- 2014
Decayed, missing & filled teeth in children
Page 79 of 123
Coronary heart disease (MNC)
Hepatitis C notifications
Potentially preventable hospitalisations
Smoking attributable hospitalisations
Hospitalisation, particularly for the following health outcomes:
• Dialysis
• Digestive diseases
• Infectious diseases
* Nervous & sense disorders
* Cardiovascular diseases
* Respiratory diseases
• Skin diseases
• Intentional self-harm
• Genitourinary diseases
• Maternal, neonatal & congenital
• Symptoms & abnormal findings
• Injury & poisoning
Very low childhood immunisation rates and very high levels of conscientious objectors compared to the rest of Australia.
68
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
3
Health Services
available to
the community
The community of NCNSW has access to a comprehensive range of health services, delivered by a variety
of providers.
Service availability in the regional centres is good, with a comprehensive range of acute and primary health
services available. Away from these centres, access becomes more difficult with the range of services
limited and transport providing a significant barrier, particularly for those reliant upon public transport or
with limited mobility.
There is a cross border flow of patients in the northern part of the region who access specialist and tertiary
services in Southern Queensland. A cross border steering committee brings together primary and tertiary
services to monitor this flow and address issues that arise because of it.
Mapping of service availability, particularly in the primary health sector is challenging. The health
workforce is highly mobile, regularly changing where and when services are delivered. The workforce is
strongly influenced by lifestyle factors, with many service providers working in a part time capacity. As
the national health services directory evolves, this will provide the best opportunity to develop a
comprehensive understanding of where private services are located. This will be augmented by the
development of strong practitioner engagement via clinical councils and multidisciplinary learning
opportunities, allowing for development of localised service maps in response to particular health issues
as they arise.
Whilst there is seemingly a plethora of local services in the region, the diversity of service providers
present challenges to integration and effective care coordination. Patient intake and record systems are
unconnected which impedes access to coordinated and integrated care. Those with a chronic disease
or mental illness requiring care over a long period of time are most effected. There is considerable
opportunity to improve the patient journey by better linking these services.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
69
3.1. Primary Health Services
3.1.1. General Practice
General practitioners are the main providers of primary health care services in NCNSW.
A census of general practice undertaken by NCNSW during 2014 identified 173 normal practices. Of these,
47 reported irregular opening hours during typical business hours.
There are a range of service arrangements in typical business hours. Larger towns and regional centres are
serviced by an array of multi practitioner general practices. In the smaller towns and villages single
GP practices are more common.
There is a mixture of billing arrangements evident across the region. Twenty seven of the practices
reported they bulk billed all patients and a further 92 reported bulk billing specified patients (such as DVA,
pensioners, children or Indigenous patients). Sixty three of 152 practices (42%) reported they provide a
Saturday morning service.
Hospitals, Community Health and Multipurpose Centres augment the services provided by GPs across
the region, particularly in the smaller towns.
There are two dedicated residential aged care visiting GP services, despite a growing aged care
population.
Workforce
The General Practice workforce in NCNSW is regularly changing.
Three sources of data were consulted to develop an understanding of GP capacity.
• Health Workforce Australia (HWA)
• NSW Rural Doctors’ Network (RDN)
• NCNSW program information including the After Hours program
There is significant variation between these data sets so care must be taken to interpret them. (see Table 22)
NSW RDN (Dec 13)
HWA (2011/12)
NCNSW (Mar 2014)
502
514
723
GP numbers
Table 22 Number of NCNSW General Practitioners
Measurement of the GP workforce and its capacity is generally calculated by two means;
• the full-time workload equivalent (FWE) • the full-time equivalent (FTE)
Both measures are reported in this document and although every attempt has been made to
aggregate data as accurately as possible, there are discrepancies due to a number of factors such
as differences in methods of measure and underreporting and/or non-responders to GP surveys
conducted by NCNSW.
Full-time Workload Equivalent (FWE)
FWE is calculated by dividing each doctor’s Medicare billing by the average billing of full-time doctors
for the year. There is no cap on a doctor’s FWE, however there are a wide range of service provision
arrangements, both above and below the average (45).
• NCNSW has 538 Full-time Work Equivalent GPs within its catchment. This represents 104 FWE GPs
per 100,000, which compares well to the state average of 100 FWE GPs/100,000
• Across Australia the coastal regions are much better supplied with GPs than the inland communities. Inner Regional RA-2 (coastal) communities have a GP workforce of 96.5 FWE GPs/100,000 and Outer
regional RA-3(rural) have 81.9 FWE GPs/100,000
70
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Full-time Equivalent (FTE)
The FTE is calculated as the number of employed health professionals multiplied by the average number of
hours worked for that profession. For example, for a GP, the average number of hours worked in a week
is 40 so that 40 hours/week = 1.0 FTE. The FWE is a measure of medical workforce supply that takes into
account the differing working patterns of doctors.
• NCNSW has 480.6 FTE GPs practicing at 173 General Practices. (see Table 23)
Region
Sub-region
General
Practice
General
Practitioners
Registrars
GP FTE
N NSW
Tweed
25
102
7
86.3
Byron
16
58
12
46.85
Lismore
11
44
6
30.35
Kyogle
1
5
0
4.2
Urbenville
1
2
0
0.9
Ballina
14
62
9
47.15
Richmond Valley
10
25
2
19.8
Clarence Valley
14
51
8
45.9
92
349
44
281.45
21
97
8
62.2
5
19
6
14.95
Nambucca
11
26
1
19.2
Kempsey
13
31
8
30.3
Port Macquarie -Hastings
31
107
27
72.5
81
280
50
199.15
173
629
94
480.6
Sub-Total
MNC NSW
Coffs Harbour
Bellingen
Sub-Total
Total
NCNSWML
Table 23 NCNSWML General Practice Survey (March 2014)
NCNSW has 92.8 FTE/100,000. N NSW is slightly better supplied with 94.8 FTE/100,000 and MNC NSW
registering 99.7 FTE/100,000. The NSW average FTE for GPs is 103/100,000, making the region less well
supplied than the average for NSW.
Distribution of FTE general practitioners is uneven.
• LGAs with numbers of FTE GP positions that are higher than the NSW average.
- Byron (119.2 FTE/100,000)
- Ballina (152.1 FTE/100,000)
- Bellingen (110.9 FTE/100,000)
- Kempsey (105.9 FTE/100,000). • LGAs well below the state average - Urbenville (45 FTE/100,000)
- Kyogle (56.9 FTE/100,000).
- Coffs Harbour (94.3 FTE/100,000).
The number of GPs in a LGA can be misleading as the distribution is not evenly spread within the
LGA, significant fluctuations can occur. For example, Coffs Harbour LGA has a rate for the LGA
of 94.3/100,000 FTE, but in the regional centre of Coffs Harbour and its immediate locality, the
distribution is 164/100,000 FTE, making it the best supplied in the region.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
71
NNSW GP Workforce (Number of FTE GPs/100 000 for each NNSW LGA compared to NSW) Figure 71 NNSW GP Workforce (Number of FTE GPs/100 000 for each NNSW LGA compared to NSW) FTE/100,000
Population
FTE/100,000
Population
Figure 71 160.0
140.0
160.0
120.0
140.0
100.0
120.0
80.0
100.0
60.0
80.0
40.0
60.0
20.0
40.0
0.0
20.0
0.0
NNSW GP Work Force
NNSW GP Work Force
119.2
152.1
70.3
85.7
56.9
82.7
89.4
45.0
92.8
119.2
152.1
70.3
85.7
56.9
82.7
89.4
45.0
92.8
NSW
NSW
Figure 71 N NSW GP Workforce (Number of FTE GPs/100 000 for each N NSW LGA compared to NSW)
Figure 72 MNC GP Workforce (Number of FTE GPs/100,000 for each MNCNSW LGA compared to NSW Figure 72 MNC GP Workforce (Number of FTE GPs/100,000 for each MNCNSW LGA compared to NSW FTE/100,000
Population
FTE/100,000
Population
MNCNSW General Practitioner Work Force
MNCNSW General Practitioner Work Force
115.0
115.0
110.0
110.0
105.0
105.0
100.0
100.0
95.0
95.0
90.0
90.0
85.0
85.0
94.3
105.9
110.9
103.3
99.2
99.7
94.3
105.9
110.9
103.3
99.2
99.7
NSW
NSW
Figure 72 MNC GP Workforce (Number of FTE GPs/100,000 for each MNC NSW LGA compared to NSW
The reported number of GP vacancies provides an indication of the stresses on the GP
workforce.
Health
Workforce
(45) reports
low GPanvacancies
–ofMNCNSW
21; on
NNSW
15,
The
reported
number
of GP vacancies
provides
indication
the stresses
the GP
The reported
number
of GPreports
vacancies
provides
an indication
of the stresses
on the
GP workforce.
Health
however
anecdotal
from
GPs
indicate
thatvacancies
vacancies
are
under
reported.
Anecdotal
workforce.
Health
Workforce
(45)
reports
low
GP
–
MNCNSW
21;
NNSW
15,
Workforce (45) reports low GP vacancies – MNC NSW 21; N NSW 15, however anecdotal reports from GPs
however anecdotal reports from GPs indicate that vacancies are under reported. Anecdotal
Health
Needsare
of North
NSW-Anecdotal
2014
Page 84exist,
of 123 with
indicateThe
that
vacancies
underCoast
reported.
evidence suggests that over 50 vacancies
GPs avoiding
retirement
because
there
is
no
prospect
of
recruiting
a
replacement.
Practices
report
they
The Health Needs of North Coast NSW- 2014
Page 84 of 123
continue to have difficulties across the region in filling existing vacancies and so are not actively pursuing
additional staff to meet demand and utilise excess practice consultation room capacity.
A survey conducted by NCNSW gathered intelligence on FTE GP at a town and locality level and examined
availability of hospitals, ambulance, pharmacy, pharmacy after hours, and pathology/radiology of towns.
This can be viewed in Appendix 6 - Audit of Services.
The general practice workforce is part of a wider primary health workforce which includes practice nurses,
Pharmacists and Psychologists, which have been prioritised for attention by NCNSW.
72
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
General Practices
Practice Nurses
estimates Jan 2013
(Full time equivalent)
Pharmacists
Psychologists
(Full time equivalent)
N NSW
92
195
82
192
MNC NSW
81
199
60
120
TOTAL
173
349
142
312
Table 24 Current numbers of Selected Health Providers in NCNSW 2013 (46)
After Hours Medical Care
There is widespread misunderstanding in the community that the hospital emergency departments are
open 24 hours and can provide all sorts of medical services for free and a community perception that it is
very expensive to access after hours medical services away from hospitals. In the NCNSW region there is
considerable variability of gap payments charged by providers offering after hours services.
GPs report that the care they can provide in the community in the out of hours period is impacted by the
lack of after hours pharmacies to dispense medication and, to a lesser extent, pathology and radiology.
All of these services can be accessed via the local hospital network.
Dedicated after hours services exist in three locations. GP practices in the region report participation in
co-operative after hours rosters (27 practices) and using medical deputising services (19 practices) where
they exist. Fifty one practices reported that they would provide phone advice in the after hours period,
despite there being no MBS item to bill for this service. Twenty practices reported that they offered no after
hours services.
Hospital emergency departments (EDs) are important providers of free medical services at all hours of the
day. On occasions, this may contribute to congestion of the EDs as they deal with high volumes of triage
category four and five patients (those deemed less urgent) though the evidence for this is patchy and
generally not the major cause of delays in base hospital EDs.
3.1.2. Aboriginal Medical Services
There are 10 Aboriginal Medical Services (AMSs) dedicated to providing quality and culturally appropriate
care and services to Aboriginal people across NCNSW.
All centres provide GP services along with a range of associated services varying from practice nurse,
dental care, services for mums and bubs and smoking cessation. A list of services for each centre is
shown in Table 25.
“
There is widespread misunderstanding in the
community that the hospital emergency departments
are open 24 hours and can provide all sorts of medical
services for free and a community perception that it is
very expensive to access after hours medical services
away from hospitals.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
73
Name of Aboriginal
Medical Service
Locality
Description of services
Bugalwena General Practice
(NCML)
N NSW
Tweed Heads South
Bulk-billing medical practice for the Aboriginal
and Torres Strait Islander community and their
immediate families. The practice is open Monday
to Friday 8am to 4.30pm
Bugalwena Service (LHD)
N NSW Tweed Heads
Provides a variety of services to the Aboriginal and
Torres Strait Islander community and their families
Bullinah Aboriginal Health Service
N NSW Ballina
Bullinah is an Aboriginal Health Service established
for the Goori people in and around Ballina NSW
Casino Aboriginal Medical
Service
N NSW Casino
A specialist Aboriginal health service for the Casino
region
Lismore Aboriginal Medical
Service
N NSW Lismore
A specialist Aboriginal health service open five
days a week
Bulgarr Ngaru Medical Aboriginal
Corporation
N NSW Grafton (plus outreach
clinics to Baryulgil, Malabugilmah,
Yamba and Maclean
Home to the Grafton Aboriginal Medical Service
(AMS) established to provide health services to the
Aboriginal communities
Galambila Aboriginal Health
Service Incorporated
MNC NSW Coffs Harbour, Urunga,
Bellingen/Dorrigo, Woolgoolga,
Corindi and Ulung
Aims to be the peak provider of high quality,
culturally appropriate care to Aboriginal people
Durri Aboriginal Medical service
MNC NSW Kempsey
Provides a range of specialised aboriginal services
Werin Aboriginal Corporation
Medical Clinic
MNC NSW Port Macquarie
A specialist aboriginal medical clinics
Bawrunga Medical Centre
MNC NSW Nambucca Heads
Macksville
An Indigenous owned and managed not-for-profit
community organisation established in Bowraville
NSW in 1999, to address the need for affordable,
accessible, and high quality health and medical
services
Provides holistic primary health and related care
services
Table 25 Services Provided by Aboriginal Medical Services in NCNSW
3.1.3 Allied Health
Comprehensive data about the Allied Health workforce in NCNSW is not presently available. In time it is
hoped the National Health Services Directory will proved this in a dynamic way, however to date it is still
incomplete.
The establishment of the North Coast Allied Health Association is hoped to further aid in identifying allied
health providers in the region, providing the opportunity to better understand their distribution, identify
service gaps and professional needs. It is anticipated it will also provide a mechanism for effective
consultation.
In the period from September 2013 to January 2014, a survey was conducted by NCNSWML to assess
allied health professional support needs. The three highest ranked needs from the 100 respondents
related to
• ehealth
• accessing the National eHealth program, registering the practice and enrolling patients
• practice computerisation
• support to help consumers understand when they need to visit an Allied Health professional
• access to Medicare and health insurance rebates
• support to educate other health professionals on Allied Health expertise
74
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
3.1.4 Mental Health Services
Analysis of access to mental health services in the region has been undertaken by looking at the addresses
of the Psychology workforce obtained from the National Health Service Directory, in relation to the
population and their access to existing services. This is problematic because the National Health Service
Directory does not differentiate between services that are relatively available and those which are provided
only on an ad hoc basis.
Large areas of NCNSW experience levels of access to basic mental health services that are similar to
more remote locations.
Access to Allied Psychological Services (ATAPS)
ATAPS provides a psychological therapy service to children and adults across NCNSW in 21 townships in
the region. The model used in the region ensures that all available MBS items are utilised first, extending
access to those who would not otherwise be able to obtain it. This model is used to ensure best access of
the program in hard to reach populations.
NewAccess
NewAccess is a beyondblue program delivered by NCNSW that aims to deliver a model of support for
people who are not currently accessing existing mental health services. This includes hard-to-reach
groups such as men. It is for people over the age of 18 with mild to moderate depression and anxiety and
improves access to Low Intensity Cognitive Behavioural Therapy(CBT). People requiring more intensive
treatment are referred to more appropriate services.
headspace
Three headspace centres are established in NCNSW at Lismore, Coffs Harbour and Port Macquarie,
with a fourth due to open in Tweed in early 2015.
headspace helps young people aged between 12 and 25 years with a range of services including:
• mental health and well-being
• general health
• youth worker support
• connections to education, employment, alcohol and other drug services
• GPs, youth workers and counsellors are available
Each headspace works in consultation with its own Youth Reference Group, made up of young people
from the local area aiming to support the delivery of high quality, appropriate youth services.
Tarmons House Mental Health Service
Tarmons House in Lismore is an initiative of NCNSWML, providing low income earners with high quality
CBT sessions. Tarmons House provides short-term psychological intervention as a support to General
Practice. Services available include face-to-face psychological therapy, Aboriginal mental health services,
suicide prevention services, telephone CBT and mental health treatment plan referrals.
Drug and Alcohol Services
Drug and alcohol services are offered by public health services, private centres and not for profit
organisations. These include:
Northern NSW Local Health District
• Community Drug and Alcohol Counsellors located across the N NSWLHD – in particular Tweed Heads
and Lismore
• Riverlands 16-bed detoxification unit - Lismore
• Pharmacotherapy clinics for the treatment of heroin dependence
• Cannabis Clinic
• Magistrates’ Early Referral into Treatment Program (MERIT) - Lismore and Tweed Heads
• Drugs in Pregnancy service
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
75
Mid North Coast Local Health District
• Community Drug and Alcohol Counsellors located across the MNCLHD t – in particular Coffs Harbour,
Kempsey, Port Macquarie
• Pharmacotherapy clinics for the treatment of heroin dependence - Coffs Harbour and Port Macquarie
• Cannabis Clinic - Coffs Harbour and Port Macquarie
• Magistrates’ Early Referral into Treatment Program (MERIT) – Coffs Harbour
• Drugs in Pregnancy service – Coffs Harbour and Port Macquarie
Not for Profit Organisations
• Namatjira Haven - Alstonville
• The Buttery – Binna Burra
• Bulgarr Ngaru – limited Alcohol and Other Drugs (AOD) services at Grafton, Casino, Yamba and
Maclean
• Benelong’s Haven Family Rehabilitation Centre - Kempsey
• Mission Australia Centre for Youth Well Being - Junaa Buwa – Coffs Harbour
Private
• The Sanctuary, Byron Bay
Inpatient Mental Health Facilities
Mullumbimby & District War Memorial Hospital
Port Macquarie Mental Health Inpatient Unit within Port Macquarie Base Hospital is a 12 bed gazetted
mental health in-patient unit with 10 low dependency beds and two observation / low stimuli beds.
The Kempsey Mental Health Inpatient Unit is a 10 bed voluntary unit. The Unit operates as an integrated service with the Port Macquarie Mental Health Inpatient Unit and gazetted patients are admitted to the
Port Macquarie or Coffs Harbour units.
Coffs Harbour Acute Mental Health Unit is a gazetted 30 bed acute mental health in-patient unit with 6
High Dependency Unit beds and 24 Low Dependency Unit beds. Also in Coffs Harbour is the
North Coast Mental Health Rehabilitation Unit which is a 20 bed inpatient mental health rehabilitation unit.
Lismore Adult Mental Health Inpatient Unit is a 40 bed acute inpatient unit situated at Lismore Base
Hospital. The clinic is able to accommodate both voluntary and involuntary patients. Bed numbers include
an 8 bed high dependency unit. The North Coast Child & Adolescent Mental Health Inpatient Unit is also
within the Lismore Base Hospital. This unit has eight beds.
The Tweed Valley Clinic is a 25 bed acute inpatient unit situated at The Tweed Hospital. The clinic is also
able to accommodate both voluntary and involuntary patients. The Tweed Valley Clinic includes a 5 bed
high dependency unit.
Twenty public mental health beds are planned for Byron Bay in the coming two years.
Both the Mid North Coast Local Health District (LHD) and the Northern NSW LHD provide community
mental health services. There are no private psychiatric units within the NCNSW region.
3.2. Local Health District Services
3.2.1. Northern NSW Local Health District
N NSWLHD covers an area of 21,470 square kilometres and extends from Tweed Heads LGA in the
north to the Clarence Valley LGA in the South, the Pacific Ocean to the east and is bordered by the Great
Dividing Range in the west.
N NSWLHD is responsible for improving local patient outcomes and responding to local health issues and
is the regional operator of NSW state health services consisting of two base hospitals located in Lismore
and Grafton with 10 district hospitals situated in the smaller townships of Ballina, Bonalbo, Byron Bay,
Casino, Kyogle, Maclean, Mullumbimby, Murwillumbah, Tweed and Urbenville and a multi-purpose centre
in Nimbin.
76
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Lismore Base Hospital is a Level 5 base hospital which provides a wide range of services including
Maternity, Women’s Care, General Medical and Surgical, Orthopaedics, Coronary Care, Intensive Care,
Paediatrics, Renal, Mental Health, Pain Clinic, Cancer Care, Perioperative Unit and 24 Hour Emergency
Department.
The Tweed Hospital is a Level 5 hospital that provides services for General Medical and Surgical,
Orthopaedics, Coronary Care, Maternity and Women’s Care, Renal, Cancer Care, Paediatrics, Intensive
Care, Perioperative Unit and 24 Hour ED.
Grafton Base Hospital is a Level 3/4 base hospital which provides services for General Medical and
Surgical, Maternity and Women’s Care, Paediatrics, Renal, Chemotherapy, Perioperative Unit and
24 Hour ED.
Ballina District Hospital is a Level 3 hospital which provides services in the areas of General Medical and
Surgical, Renal, Rehabilitation, Chemotherapy and 24 Hour ED.
Casino & District Memorial Hospital is a Level 3 Acute Care Rural Hospital that provides services in
General Medical and Surgical, Antenatal Clinic, Palliative Care, Coronary Care, Perioperative Unit and
24 Hour Emergency Department staffed by Emergency Nurses and an on-call Medical Officer.
Maclean District Hospital is a Level 3 hospital that provides services for General Medical and Surgical,
Perioperative Unit and a 24 Hour ED.
Murwillumbah District Hospital is a Level 3 hospital that provides services for General Medical and
Surgical, Women’s Care and Maternity, Cancer Care and Haematology Unit, Paediatrics, Rehabilitation,
Amputee Clinic, Day Procedures Unit, Antenatal, Gynaecology and Paediatric Outpatient Units, and a
24 Hour ED.
Bonalbo Hospital is a Level 2 rural hospital which provides services for General Medical and has a 24
Hour ED staffed by emergency nurses and an on-call General Practitioner.
Mullumbimby & District War Memorial Hospital is a Level 2 hospital which provides services for General
Medical, Mullumbimby Birth Centre, Palliative Care, Aged Care and a 24 Hour ED.
Nimbin Multi Purpose Centre is a Level 2 rural hospital/multipurpose Centre which provides services
for General Medicine, General Practice, Aged Care & Nursing Home Care and a 24 Hour Emergency
Department serviced by On-call General Practitioners and an Emergency Nurse.
Urbenville Rural Hospital is a Level 2 rural hospital/multipurpose centre which provides services in
General Medicine, Aged Care Nursing Home and a 24 Hour Emergency Department serviced by on-call
General Practitioners and an emergency nurse.
Community Health Centres N NSWLHD also provides 20 Community Health Centres spread across the
region providing services including:
• Drug & Alcohol Counselling
• Aboriginal Health Services
• Aged Care Assessment
• Expectant Fathers Groups
• Antenatal Classes
• Immunisation Clinics
• Audiometry
• Men’s Health Nurses
• Breast Care Services
• NSW Chronic Diseases Management Programs
• Needle & Syringe Programs
• Cancer and Palliative Care Services
• Child & Family Health Clinics
• Occupational Therapy
• Child Protection Counselling Services
• Physiotherapy
• Chronic Care – Cardiac & Respiratory
• Podiatry
• Community Nursing
• Sexual Health Clinics
• Community Options
• Sexual Assault Services
• Day Therapy Units
• School Health Nurses
• Diabetes Education
• Social Workers
• Dietetics & Nutrition
• Speech Pathology
• Domestic Violence
• Women’s’ Health Clinic
N NSWLHD also operates drug and alcohol and mental health services, public health, sexual health
and oral health services. (47)
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
77
3.2.2. Mid North Coast NSW Local Health District
MNCLHD covers an area of 11,335 square kilometres and provides a diverse range of services to a
population of around 215,000. The Area extends from Port Macquarie Hastings LGA in the south to
Coffs Harbour LGA to the north, the Pacific Ocean to the east and the Great Dividing Range to the west.
MNCLHD provides health care through two major hospitals in the Coffs Harbour Health Campus and the
Port Macquarie Base Hospital. This is supplemented with five district hospitals at Bellingen, Dorrigo,
Kempsey, Macksville, and Wauchope. Services are also provided through 10 Community Health Centres
located at Bellingen, Camden Haven, Coffs Harbour, Dorrigo, Kempsey, Macksville, Port Macquarie, South
West Rocks, Wauchope and Woolgoolga.
Kempsey District Hospital redevelopment is to commence mid 2014 with completion anticipated mid 2016.
Port Macquarie Base Hospital expansion provides improved access to a wide range of services,
including cardiology (a dedicated Cardiac Catheterisation Laboratory) and increased capacity for elective
surgery, and Emergency Department admissions.
Wauchope Hospital provides a 24 hour, Level three service. Medical services are provided by
General Practitioners and specialist Surgeons and Anaesthetists contracted to the Health District.
Wauchope District Memorial Hospital currently has 26 inpatient beds, eight General Rehabilitation,
12 General Medical beds and a new eight bed Palliative Care unit. There is one operating theatre for
day only surgery, including endoscopy, orthopaedic, gynaecology, and urology.
Bellingen River District Hospital provides a 24 hour service. Medical services are provided by General
Practitioners. Surgical Services are provided by specialist Surgeons and Anaesthetists contracted to the
Health District. There are no staff medical officers on site. Bellingen Hospital forms part of the network of
services across the Health District working closely with Coffs Harbour Base Hospital and others as patient
needs require.
Coffs Harbour Health Campus is an acute major rural referral hospital built in 2001 and provides a broad
range of specialist services to the residents of Coffs Harbour, Bellingen and Nambucca LGAs.
Dorrigo Health Campus consists of Dorrigo Multipurpose Service and Dorrigo Community Health Centre.
Dorrigo Hospital provides a 24 hour service.
Macksville District Hospital is a local community, Level three, rural hospital providing care to over 2,900
patients every year.
During 2013-2014, MNCLHD provided over 497,000 Outpatient Occasions of Service (data excludes admitted hospital patients, emergency department presentations or diagnostic services).
Ten Community Health Centres throughout MNC provide a number of services including
• Aboriginal Health Services
• Drug & Alcohol Counselling
• Aged Care Assessment
• Expectant Fathers Groups
• Immunisation Clinics
• Antenatal Classes
• Audiometry
• Men’s Health Nurses
• NSW Chronic Diseases Management Programs
• Breast Care Services
• Cancer and Palliative Care Services
• Needle & Syringe Programs
• Child & Family Health Clinics
• Occupational Therapy
• Child Protection Counselling Services
• Physiotherapy
• Chronic Care – Cardiac & Respiratory
• Podiatry
• Community Nursing
• Sexual Health Clinics
• Community Options
• Sexual Assault Services
• Day Therapy Units
• School Health Nurses
• Diabetes Education
• Social Workers
• Speech Pathology
• Dietetics & Nutrition
• Domestic Violence
• Women’s Health Clinic
MNCLHD also operates drug and alcohol and mental health services, public health, sexual health and oral
health services. (48)
78
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
3.3. Private Facilities
3.3.1. Private Hospitals
In the NCNSW region there are three private hospitals, and another in the southern Gold Coast servicing
the northern residents.
St Vincent’s Private Hospital (Lismore). Lismore has 88 beds and offers day services of oncology,
endoscopy, day surgery unit, rehabilitation and renal dialysis as well as acute surgical, medical,
rehabilitation and palliative care beds.
Baringa Private Hospital (Coffs Harbour) offers a range of clinical services including medical, surgical,
rehabilitation and In Vitro Fertilisation (IVF). It also provides a number of day procedures including day
rehabilitation, pain management, chemotherapy and intravenous services. The perioperative suite consists
of three operating theatres and a minor procedures suite provides the following specialties:
• Cosmetic surgery
• General surgery
• Orthopaedics
• Vascular surgery
• Ear, nose and throat surgery
• Gynaecological surgery
• Plastic surgery
• Other elective surgery
• Neurosurgery
• Eye surgery
• Urological surgery
Port Macquarie Private Hospital is an acute medical/surgical and rehabilitation 69 bed hospital. It consists of a perioperative suite of four theatres, six chair renal unit, 19 bed rehabilitation and five bed high
dependency unit. This allows for the provision of the following services:
• Bariatric surgery • Orthopaedics
• Plastic surgery
• Cardiology • Rehabilitation
• Day surgery • Renal medicine
• Ear, nose, throat • Gastroenterology • Respiratory
• General medicine • Urology
• General surgery • Vascular surgery
• Gynaecology
3.3.2. Day Surgeries
Tweed Day Surgery is a small three operating theatre day surgery unit. It provides services for day only
procedures in the following clinical services:
• Ophthalmology
• Plastic, reconstructive & cosmetic surgery
• Ear, nose & throat surgery
• Maxillofacial surgery
• Gynaecology
• General surgery
• Orthopaedic
• Urology
• Oral and dental surgery
• Gastroenterology & Endoscopy
• Pain Management Clinic
St Vincent’s Private Hospital Lismore offers a variety of clinical services including; Aged Care,
Chemotherapy, Dialysis Unit, Elective Surgery, Hospice Care, Oncology Unit, Rehabilitation Unit. The
Elective Surgery consists of a Perioperative suite consisting of three operating theatres and a day surgery
unit which encompasses an endoscopy suite. This provides services for the following specialities:
• Ear Nose and Throat Surgery
• Oral / Maxillo Facial Surgery
• General Surgery
• Orthopaedics
• Gynaecology
• Urology
• Ophthalmology
• Vascular Surgery
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
79
Ballina Day Surgery is a day only procedural hospital. It provides for the following specialties:
• Cosmetic surgery
• Plastic surgery
• Eye surgery
• Other elective surgery
• Orthopaedics
Coffs Harbour Day Surgery Centre is a dedicated ophthalmic and plastic day surgery.
Coolenberg Day Surgery Port Macquarie is a day only procedural hospital. It consists of two operating
theatres and two procedural rooms and provides for the following specialties:
• Cosmetic surgery
• General surgery
• Eye surgery
Hastings Day Surgery Port Macquarie is a day only procedural hospital. It consists of one procedural
room and provides for:
• Minor General Surgery • Gastroenterology
3.4.Residential Aged Care Facilities (RACF)
There are 87 Residential Aged Care Facilities (RACFs) located across NCNSW (Table 26).
LGA
No. RACFs
Ballina
8
Bellingen
2
Byron
5
Clarence Valley
9
Coffs Harbour
10
Kempsey
6
Kyogle
3
Lismore
6
Nambucca
3
Port Macquarie – Hastings
11
Richmond Valley
4
Tweed
NCNSWML
18
87 *
Table 26 Residential Aged Care Facilities per LGA
*Urbenville has two RACFs that are not located within the LGAs listed above
Byron had the highest number of residential care places per 100,000 in N NSW. Kempsey has the highest
number of high and low care places per 100,000 of population for residential aged care (over 70 years)
with Byron, Lismore and Tweed also with a greater proportion of places compared to rates across NSW
per 100,000.
Dementia is expected to become an issue of concern. Australia faces a shortage of more than 150,000
paid and unpaid carers for people with dementia by 2029. It is expected that Dementia will become the
third greatest source of health and residential aged care spending within two decades. By the 2060s,
spending on dementia is set to outstrip that of any other health condition. It is projected to be around
11% of health and residential aged care sector spending. (49)
The aged population is expected to increase significantly in the next 20 years across the whole of NCNSW
but more specifically in Tweed and Port Macquarie-Hastings. RACFs operate in a dynamic funding
environment which is expected to bring changes to delivery of home care support. This combined with
a reportedly high number of older people moving into or out of the area specifically seeking family care/
support, makes the RACF sector a key regional stakeholder in primary health care.
80
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
3.5.eHealth and Telehealth utilisation
3.5.1. eHealth
85% of General Practices are eHealth ready, although meaningful use of the Personally Controlled eHealth
Record (PCeHR) utilisation has stalled pending expected changes to the system.
The health care community in NCNSW is vibrant and active, and are receptive to using new approaches to
be better connected and innovative.
• 2,261 providers and 16,740 consumers have participated in eHealth readiness information sessions
• Over 400 provider organisations have been engaged on eHealth record adoption
• NCNSW is the third highest performing region for overall consumer registration
• The overall number of documents uploaded (639) is above the national average of 316.
eHealth readiness
NCNSW
GP with a readiness assessment
94%
Provider organisations with a readiness assessment
57%
GP with PIP eHealth requirements
85%
Table 27 Comparison of GP Readiness for eHealth NCNSWML
3.5.2. Telehealth
Telehealth consultations, where audio and visual capabilities are utilised within a medical consultation
with a specialist, GP, registered or enrolled nurse and/or Aboriginal health care worker, offer potentially
important benefits to the NCNSW region as a means of overcoming barriers presented by a deficient
transport system.
Some projects in the region are exploring using this technology to monitor patients at home or better
connect health professionals in acute facilities with outlying hospitals and aged care facilities. One such
example is the Technology Enabled Multidisciplinary Care Advisory Service (TEMCAS). This joint project
between NCNSW and Feros Care Aged Care aims to demonstrate the benefits of video conferencing and
the eHealth record system to drive better multidisciplinary care in response to the needs of clients with
complex conditions in the residential and community sectors.
A barrier to the wider adoption of telehealth is the current Medicare Benefit Schedule (MBS). Telehealth
items provide payment for a general practitioner participating at the “patient-end”. There are no MBS
items available for a general practitioner led Telehealth.
3.6.
Health Promotion
A range of health promotion activities and agencies are present in NCNSW (Appendix 7). Health Promotion
is provided by a variety of organisations with a focus on chronic disease prevention. State and national
bodies such as NSW Heart Foundation, Australian Red Cross and NSW Cancer Council deliver programs
to meet state and national priorities. A range of non-Government and community organisations (Women’s
Health Centres, Interrelate, YWCA, PCYC, Neighbourhood Centres, Local Government, Medicare Local,
Aboriginal Health) working either independently or in partnership, deliver programs at a local level.
Two Health Promotion Alliances exist to maximise the potential of health promotion and disease prevention
initiatives through better collaboration and integration.
See Appendix 7 for a listing of all known health promotion agencies in NCNSW.
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81
3.7.
Community experiences with access to health care
The National Health Performance Authority Healthy Communities report (2013) documents experiences
accessing health care services in the NCNSW region and compares it to peer group regions which have
similar characteristics.
The report also highlighted that for NCNSW
• 51% of the population have long-term health conditions
• people attended the GP more often (5.2 per person) than in similar regions
• More adults visited a GP in 2011-12 (84%) than in similar regions (peer regional average 80%)
• 29% of people felt they waited longer than acceptable to get an appointment with a medical specialist
(peer regional average of 27%)
• 27% of people delayed seeing a dentist due to costs (the peer regional average 25%)
• 82.7% of GP attendances were bulk billed (peer regional average of 77.8%)
• 85% of people reported their health positively
• The amount of money spent on GP attendances ($244.33 per person) was the second highest in the
peer group. (Peer regional average $214.04)
• 49% of adults saw a dentist (peer group average 44%.)
• 38% of adults saw a medical specialist (peer region average 33%) (44)
“
The aged population is expected to increase
significantly in the next 20 years across the whole
of NCNSW but more specifically in Tweed and
Port Macquarie-Hastings.
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THE HEALTH NEEDS OF NORTH COAST NSW - 2014
4
Discussion
This report presents a range of information about the NCNSW region, its people, their health and access to
health services and highlights issues that set the North Coast community apart.
The population is spread across a large geographical area and is comprised of many unique communities.
There are some striking differences between the population and health of the people in the NCNSW
catchment and the rest of NSW however rates are not uniform which reflects the diversity within these
communities.
Whilst it is important to consider the health needs of the population as a whole, it is equally important to
consider variations within the population. Development of an understanding of health needs and service
gaps at a LGA or town level remains a work in progress. This report provides the foundations for further
localisation to develop.
4.1 Summary of Challenges
4.1.1 Regional Factors that Influence Health
The NCNSW region has a total population estimated to be 497 730 (2012), (50.9% females 49.1% males).
The desirable natural environment attracts higher than the state average population growth, particularly
in larger coastal centres. There are expectations of increased growth up to 100% in the next 20 years.
The region experiences high levels of socio-economic disadvantage which impact on the majority of
variances in health and service access identified in this report.
• Continually high levels of unemployment, under-employment and welfare dependency and a low workforce participation rate
• Low income levels with a high number of households with income under $500/week and the lowest rate
in NSW of households with income above $2,000/week
• Median weekly household income for the region is $642 or 62.5% of the national rate of $1,027
• Lower levels of university education than the NSW average
• The most disadvantaged LGAs have an Aboriginal population of greater than 5% (Kempsey, Kyogle,
Nambucca, Richmond Valley and Clarence Valley).
• The extent and impact of a transient and homeless population is not clear but demand for services
is growing
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
83
The population is ageing.
• The number of residents aged over 65 years old is expected to exceed 30% of the population by 2032
• The high median age is a reflection of the trend of retirees migrating to the region and the “sea and
tree” change phenomenon. Demand for heath care services such as aged care and home-based
palliative care is rising
• There is a dramatic drop in the age profile in the late teens, 20s and 30s. This indicates a drift away
from the region for education and employment, resulting in a workforce shortfall and demand for skills
training for young people who remain
Lifestyle and social determinants of health impact the NCNSW population. Higher rates of some risky
behaviour such as smoking and drinking alcohol and a higher proportion of at risk demographics
(Aboriginal, aged and socially disadvantaged) contribute to growing rates of chronic diseases, cancer
diagnosis and mental health burden. Extremely low levels of childhood immunisation and a trend of
onstantly low levels, places burden on the health care system.
The large Aboriginal population
• is young, with 34% of the Aboriginal younger than 14 years
• has low educational attainment with only 22% of Aboriginal residents reaching Year 12
• has a high unemployment rate -10% (almost double the state rate)
• experiences higher rates of chronic disease, mental illness, disadvantage and assault.
• experiences lower life expectancy and poorer
- general health,
- oral health
- access to services
Aboriginal people experience higher rates of potentially preventable hospitalisations and are more likely
to be hospitalised for smoking and alcohol attributable causes than non-Aboriginal people. Aboriginal
mothers have more preterm or low birth weight babies than non-Aboriginal mothers. Diabetes rates are
highest in the LGAs with a greater than 5% Aboriginal population.
The ageing population, net migration, lifestyle choices (such as smoking, alcohol consumption and low
levels of childhood immunisation) contribute to increasing chronic diseases and rising cancer diagnosis.
NCNSW has higher rates of diagnosis of cancer than NSW overall and the number of cancer deaths is
expected to be double the NSW average by 2021. Melanoma is a particular concern because the region
experiences the highest rate of diagnosis in NSW with nine of NCNSW’s 12 LGAs ranking in the top
28 LGAs for diagnosis of melanoma.
There are a number of determinants found across NCNSW that may impact some people’s mental health.
These include alcohol and cannabis usage, bereavement, family breakdown, limited financial income,
living in rural and remote areas, lower education attainment, transition to and from institutional settings
(particularly aged care), unemployment and lifestyle choices.
There is a high rate of potentially avoidable mortality particularly for males and Aboriginal people.
Hospitalisations are increasing at a rate which is higher than the NSW average, with Aboriginal people
experiencing even higher rates of hospitalisation. Overall, rates are higher than the NSW average for
cardiovascular and respiratory diseases and cancer. Hospitalisations for asthma are 25% higher than the
NSW average but there is a decreased rate of hospitalisation for diabetes for the first time in ten years.
Palliative Care hospitalisations have increased by 116% since 2009.
4.1.2 Healthcare Availability and Accessibility
The accessibility of health care in NCNSW is influenced by regional characteristics including limited
transport options, general disadvantage of the population, a high proportion of Aboriginal and older people
with expectations of large increases to the aged population. Access to services for this community are also
influenced by the geography and dispersed population which places limitations and stress on health
services and impacts on the ability of the community to access health services. Proximity to the Queensland
border and the associated activities also adds to the complexities of accessing and delivering services.
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THE HEALTH NEEDS OF NORTH COAST NSW - 2014
There is a distribution of primary health care services across NCNSW but health infrastructure in outlying
areas is limited and access to services for these communities is further complicated by lack of affordable
transport options. The GP workforce is clustered around the coast and large population centres with
smaller villages and inland communities having limited access. The mix of billing arrangements, coupled
with the high rate of disadvantage in the region, result in higher medical costs which creates a barrier for
some in the region.
Two LHDs located in NCNSW offer a total of 21 public hospitals including major non-metropolitan referral
hospitals, district hospitals, community acute hospitals and multipurpose services. Local communities
strongly support their small hospitals with a long history of seeking medical care from the local hospital
when a GP is not available. .Smaller hospitals do not generally have access to a medical practitioner in the
after hours period.
Mapping of services illustrates the diverse range of services but they are not evenly distributed. Local
consultation confirms that there is limited integration and co-ordination between the services. Health
care providers in the region have demonstrated an interest in adopting eHealth records, but to date this
has stalled so records and intake systems remain fragmented. People with chronic illness including mental
health conditions need services over a long period of time and so are most affected. Across the
continuum of health care, including the delivery of health promotion and disease prevention services,
this arrangement can impede the distribution of appropriate health information and the advancement of
health literacy.
The current size of the health workforce is insufficient to address the needs of the expanding and ageing
population into the future. Health care professionals, including medical specialists, GPs and Allied Health
practitioners are spread unevenly across the region, with coastal areas tending to attract the required
workforce, while smaller inland communities experience shortage.
Community health literacy and access to health information is complicated due to the myriad of health
promotion and disease prevention services which operate independently of each other. This hinders the
distribution of appropriate health information, inhibiting the delivery of adequate material for those for
whom there is the greatest benefit and impacting on health literacy.
Transport is a major barrier to accessing health services, particularly for vulnerable, frail aged, disabled
people and their carers and socially disadvantaged people. Limited public transport options and sparsely
located health services reduces the accessibility of health care. Many people are missing out on essential
health care due largely in part to insufficient or inappropriate transport options.
The number of GPs in a LGA can be misleading as the distribution is not evenly spread within the
LGA, significant fluctuations can occur. For example, Coffs Harbour LGA has a rate for the LGA
of 94.3/100,000 FTE, but in the regional centre of Coffs Harbour and its immediate locality, the
distribution is 164/100,000 FTE, making it the best supplied in the region.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
85
4.2 Priorities for Action
The challenges identified in this report are complex and require innovative local solutions.
Six key priorities have been identified for action in NCNSW. These are within the scope of influence of
the Primary Health sector but sustained efforts are required and these must be integrated with the wider
health sector including Local Health Districts, Aboriginal Medical Services, Specialist Medical Services
and Private Hospitals as well as the wider social and community sector.
1. Co-ordinating care and reducing fragmentation
In order to reform health care and improve services, the delivery of care must be better co-ordinated,
networked and connected. Key areas for attention in order to improve care co-ordination include:
• flow of patient/client information
• improving opportunities for multi-disciplinary team care
• reconfiguring the health system by locating services together to encourage collaborative care and
improve navigation
2. Partnerships to improve health care
The individual health care sectors in NCNSW are relatively strong, however it is essential to build
enduring partnerships across these sectors to promote good health, prevent disease and achieve better
health outcomes. Crucial partnerships to develop and enhance are those between the acute, the primary
and the aged care sector.
3. Improving access to health care
Many community members experience difficulty accessing health care services. In order to improve
access, focussed attention needs to be directed to improving
• Availability (including increasing the access to care and removing barriers related to location,
transport, technology)
• Affordability (reducing the financial barriers to access services)
• Appropriateness (facilitating and fostering culturally and socially acceptable care)
4. Keeping people healthy and out of hospital
A strong primary health sector is best placed to provide care when and where people need it so that they
can better manage their own health care needs. Strengthening the capacity and fabric of the primary
health care sector requires
• support of primary care practitioners and practices
• investment in workforce development through training, continuous professional development,
establishment of communities of practice and networks and projects built on con-joint action
• exploration and establishment of alternative models of care
• improving quality of care and standardising care delivery - refining health pathways for consistent health service delivery, quality networks and ‘collaboratives’
Across the community there is a need to focus on health promotion and lifestyle management strategies to
minimise progression to and consequences of chronic diseases and improve lifestyle choices.
5. Reducing disadvantage and health disparity
Addressing health inequity is challenging and requires long term, sustained and collaborative action.
Evidence indicates that best outcomes are achieved when action is across the continuum of health care:
focusing on health promotion and disease prevention (social determinants of health) as well as high quality
and safe primary, acute and tertiary care. Consideration needs to be given to strengthening relationships
with the human and social services sector so that a holistic view of health and wellbeing can be advanced.
Best outcomes are also achieved when service delivery is empowering and strength-based.
Special attention needs to be paid to ensure integrated services are available, particularly for
• mental health
• Aboriginal health
• services for people experiencing homelessness
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THE HEALTH NEEDS OF NORTH COAST NSW - 2014
6. Innovation and local solutions
Generating, diffusing and applying knowledge is central to bringing about change. Collaborating with
tertiary education institutes, clinicians, service providers and the broader community will enhance the
understanding of factors influencing the health of the population at a local level. Harnessing and nurturing
local solutions to meet local and long-standing challenges need innovative approaches such as
• finding inclusive and creative opportunities for all to participate
• encouraging a culture of unfettered and altruistic sharing of knowledge and information
• facilitating the application of knowledge and development of local solutions
By addressing these priorities, the people of the region will be better able to access the care that they
need to improve and maintain their health and avoid, wherever possible, the need to access acute
services. This will guide the work of the primary health network into the future.
Some health concerns identified are beyond the influence of Primary Health Care and are largely the
work of other regional stakeholders.
Sexual Health – this is largely the work of the LHDs and non government sector.
Dementia – the ageing population that characterises the NCNSW region means that dementia rates
will continue to rise. There is little local data to triangulate this need. It is a matter for inclusion in the
ongoing development of the Needs Assessment.
Cancer – Cancer treatment is managed by the LHDs however by developing strong relationships
with the Cancer Institute and Cancer treatment services the primary health sector will be able to
better understand the role that it can play with regard to Cancer screening and management.
Increased Treatment of Oral Health – there is considerable community demand for increased
access to low cost oral health services. There is a need to better understand the drivers of oral
health demand and the barriers to access, particularly in the aged care setting and Aboriginal
population.
Transport Issues – health service accessibility is impacted by limited public transport services.
This needs to be considered in planning future service development.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
87
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Appendix 1 - Acronyms
ABS Australian Bureau of Statistics
Aged care assessment team
ACAT Advanced Care Directive
ACD Agency for Clinical Innovation
ACI ACIR Australian Childhood Immunisation Register
AF Atrial Fibrillation
AHGPH After hours GP helpline
Australian Institute of Health and Welfare
AIHW Australian Medicare Local Alliance
AMLA Aboriginal Medical Service
AMS AOD Alcohol and Other Drugs
ARIA Accessibility/Remoteness Index of Australia
ASGC Australian Standard Geographical Classification
Ashmnsw Australasian Society for HIV Medicine
Access to Allied Psychological Services
ATAPS ATSI Aboriginal and Torres Strait Islander
AVO Apprehended Violence Order
Coronary Artery Bypass Graph
CABG Cognitive Behavioural Therapy
CBT CHD Coronary Heart Disease
Confidence Intervals
CI Copernican Inversion Series
CIS Chronic Obstructive Pulmonary Disease
COPD Program Coordinated Veterans’ Care Program
CVC Coronary Vascular Disease
CVD General Practice or General Practitioner
GP dmft Decayed, Missing, Filled Teeth – 5-6 year olds
DMFT Decayed, Missing, Filled Teeth – 10 -11 year olds
Department of Health
DoH DVA Department of Veterans Affairs
Emergency Department
ED ENT Ear, Nose and Throat
Full time equivalent
FTE FWE Full time workload equivalent (General
Practitioners)
HCV Hepatitis C
Hep C Hepatitis C
hdA Health Direct Australia
Heart Failure
HF HIV Human Immunodeficiency Virus
HWA Healthy Workforce Australia
Index of Relative Socioeconomic Disadvantage
IRSD IVF In Vitro Fertilisation
Local Aboriginal Land Council
LALC
LGA Local Government Area
Local Health District
LHD LGBTI Lesbian, Gay, Bisexual, Transgender and
Intersex
Medical Benefit Scheme
MBS Medical Deputising Service
MDS MIDROC Mid North Coast Regional Organisation of
Councils
MNCLHD Mid North Coast NSW Local Health District
ML Medicare Local
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THE HEALTH NEEDS OF NORTH COAST NSW - 2014
MNC NSW Mid North Coast NSW (Referring to the Southern
Portion of NCNSW)
MSOAP services Medical Specialist Outreach Assistance Program
MSOAP Medical Specialist Outreach Assistance Program
ICD - Indigenous Chronic Disease
MSOAP Medical Specialist Outreach Assistance Program
MS - Maternity Services LGAs
NCML North Coast Medicare Local
NCOSS Council of Social Services of NSW
National Diabetes Services Scheme
NDSS National eHealth Transition Authority
NEHTA Non-English Speaking
NES NHMRC National Health and Medical Research Council
NHPA National Health Performance Authority
Northern NSW
N NSW N NSWLHD Northern NSW Local Health District
NCNSWML North Cost NSW Medicare Local
Non Government Organisation
NGO National Health Service Directory
NHSD NOROC Northern Rivers Regional Organisation of
Councils
NRGPT Northern Rivers General Practice Training
Police Citizens and Youth Club
PCYC Public Health Information Development Unit
PHIDU PHC Primary Health Care
Practice Incentive Payment
PIP PITCH Practical Ideas to Change Healthcare
Potentially Preventable Hospitalisations
PPH PSA Prostate Specific Antigen
Peripheral Vascular Disease
PVD RA Remoteness Area
RACF Residential Aged Care Facility
Rural Doctors Network
RDN ROSH Risk of Significant Harm
Rural, Remote and Metropolitan Area
RRMA SARAH or
SARRAH Services for Australian Rural and Remote
Allied Health
SEIFA Socio economic Indexes for Areas
SLA Statistical Local Area
Standardised Mortality Rate/Ratio
SMR Specialist Outreach Assistance
SOAP STI S
exually Transmitted Infection
Technical and Further Education
TAFE TEMCAS Technology Enabled Multidisciplinary Care
Advisory Service
TIA Trans Ischemic Attack
ToR Terms of Reference
University Centre for Rural Health
UCRH VMO Visiting Medical Officer
Young Women’s Christian Association
YWCA Appendix 2 - Glossar y
Age dependency ratio
Avoidable Mortality
Is the ratio of active workers (aged 15-65 years) compared to inactive workers (0-14 and
>65 years
Refer to deaths that occur before the age of 75 years that are considered preventable or
otherwise avoidable through better preventative health management or interventions at the
primary, secondary or tertiary levels of health care.
Burden of Disease
Burden of disease is a measure used to assess and compare the relative impact of different
diseases and injuries on populations. It quantifies health loss due to disease and injury that
remains after treatment, rehabilitation or prevention efforts of the health system and society
generally.
Confidence Interval
Direct standardisation
A confidence interval gives you an indication of how accurate your rate or value (point
estimate) is. The interval is usually set at 95%, which means that 95 out of 100 times the value or point estimate will lie between these two values. It is given as two values one being the
upper level and the other the lower level and the point estimate lies somewhere between the
two values. Through this document the confidence interval is represented by I or in the
case of the cancer trends the shading around the line.
Directly standardised rates give an indication of the number of events that would occur in a
standard population (NSW), if the population had the same age-specific rates of the local area
(Ballina LGA).
Full-time Equivalent
FTE is calculated as the number of employed health professionals in a particular category
multiplied by the average hours worked in the category divided by the standard working week
hours. The AIHW calculates FTE as a “standard working week” that varies across professions
as follows:
• medical practitioners: 40 hours/week is equivalent to 1.0 FTE
• nurses and midwives: FTE is based on a 38 hour standard working week as per most State
agreements and
• dental workforce: no agreed standard with 35, 37.5, and 40 hours reported variously.
Full-time workload equivalent
(FEW) general practitioners
Homelessness Indirect Standardisation
Population projections
Potentially Preventable
Hospitalisations:
A measure of medical workforce supply that takes into account the differing working patterns
of doctors. FEW is calculated by dividing each doctor’s Medicare billing by the average billing
of full-time doctors for the year. There is no cap on a doctor’s FEW, recognising that there is a
full range of service provision both above and below the average.
When a person does not have suitable accommodation alternatives they are considered
homeless if their current living arrangement: is in a dwelling that is inadequate; or has no
tenure, or if their initial tenure is short and not extendable; or does not allow them to have
control of, and access to space for social relations.
Indirectly standardised rates compare the actual number of events in an area (e.g. Ballina LGA)
with the expected number of events based on rates of a reference population
Are population estimates calculated and released by NSW Department of Planning and
Infrastructure based on the estimated residential populations taken from the 2011 Census.
Calculations are made on assumptions about future trends in fertility, mortality and migration
and are not precise predictions of the demographic future. Whilst the latest data is used in
conjunction with expertise on fertility, mortality and migration, these variables are subject to a
wide variety of social, economic and political factors which cannot be foreseen. Due to
rounding some of the projections may not add up to the total population.
Potentially Preventable Hospitalisations (PPH) are those conditions for which hospitalisation is
considered potentially avoidable through preventive care and early disease management,
usually delivered in an ambulatory setting, such as primary health care. This terminology is
inter-changeable with Potentially Avoidable Hospitalisations, Potentially Preventable
Admissions and Admissions from Ambulatory Care Sensitive Conditions.
Quintiles Is a method of dividing data into five equal parts each representing 20% (or 1/5th) of the range
of the data. Within this document quintiles are used along with the index of relative social
disadvantage and the index of education and occupation. In this scenario the 1st quintile
represents those with the least disadvantaged and the 5th quintile representing the most
disadvantaged.
Significant Standardised Rates
The use of significant/significantly within this document indicates a difference that is
statistically significant at the 95% confidence interval.
Standardisation allows the comparison of rates between two or more populations whose
characteristics (i.e. age, gender, etc.) may have different distributions. There are two methods
of standardising rates; direct standardisation and indirect standardisation.
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
91
Appendix 3 - Cultural and Language Diversity
92
Australian
Born
%
Born NES
%
Poor
English
%
Ballina
33,169
84.5
1,476
3.8
72
0.2
Bellingen
10,490
83.8
494
3.9
10
0.1
Byron
21,977
75.2
2,105
7.2
71
0.3
Clarence Valley
43,577
87.7
1,292
2.6
69
0.1
Coffs Harbour
56,183
82.1
4,044
5.9
497
0.8
Kempsey
24,526
87.2
767
2.7
34
0.1
Kyogle
7,841
85.0
312
3.4
8
0.1
Lismore
36,768
86.0
1,819
4.3
133
0.3
Nambucca
15,863
85.1
547
2.9
23
0.1
Port Macquarie - Hastings
61,024
83.9
2,539
3.5
76
0.1
Richmond Valley
19,596
88.9
465
2.1
40
0.2
Tweed
67,469
79.3
3,909
4.6
231
0.3
N NSW
230,828
83.1
11,393
4.1
625
0.2
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Appendix 4 - Local Aboriginal Land Council Contacts
Baryulgil Square
Baryulgil Square Community
BARYULGIL VIA GRAFTON NSW 2460
PO Box 1383
Ph 02 66 472 131 Fax 02 66 472 131
[email protected]
CEO John Magner
Dorrigo Plateau
c/- Showgrounds, North Dorrigo Road
DORRIGO NSW 2453
PO Box 55 DORRIGO NSW 2453
Ph 02 66 572 606 Fax 02 66 572 607
[email protected]
CEO Robyn Heath
Birpai
33 Aston Street PORT MACQUARIE NSW 2444
PO Box 876
Ph 02 65 849 066 Fax 02 65 838 172
[email protected]
CEO Steven Miles
Grafton Ngerrie
50 Wharf Street SOUTH GRAFTON NSW 2460
PO Box 314
Ph 02 66 426 020 Fax 02 66 426 994
[email protected]
CEO Crystal Skinner-Donovan
Birrigan Gargle
Youth Stadium, 2 Robinson Street
YAMBA NSW 2464
PO Box 62
Ph 02 66 461 664 Fax 02 66 461 672
[email protected]
CEO Norma Collins
Gugin Gudduba
53 Ettrick Street KYOGLE NSW 2474
PO Box 597
Ph 02 66 321 056 Fax 02 66 322 324
[email protected]
CEO Ron Randall
Bogal
2-4 Yabsley Street YAMBA NSW 2471
PO Box 72 CORAKI NSW 2471
Ph 02 66 832 510 Fax 02 66 832 698
[email protected]
CEO Lance Manton
Bowraville
66 High Street BOWRAVILLE NSW 2449
PO Box 90
Ph 02 65 647 812 Fax 02 65 647 843
[email protected]
CEO Harry Phillip Hall
Casino - Boolangle
93 Barker Street CASINO NSW 2470
PO Box 1047
Ph 02 66 626 286 Fax 02 66 626 290
[email protected]
CEO Ross James
Coffs Harbour
Cnr Pacific Highway & Arthur Street
COFFS HARBOUR NSW 2450
PO Box 6150
Ph 02 66 528 740 Fax 02 66 525 923
[email protected]
Chris Spencer
Jali
129 Tamar Street BALLINA NSW 2478
PO Box 1677
Ph 02 66 867 055 Fax 02 66 868 255
[email protected]
CEO Joanne Bolt (acting)
Jana Ngalee
Malabugilmah Village
BARYULGIL VIA GRAFTON NSW 2460
PO Box 1398
Ph 02 66 472 209 Fax 02 66 472 119
[email protected]
CEO John Magner
Jubullum
Jubullum Street, Jubullum Village
VIA TABULAM NSW 2469
PO Box 25
Ph 02 66 661 337 Fax 02 66 661 386
[email protected]
CEO Owen Trembath
Kempsey
Suite 8, 1 John Street KEMPSEY NSW 2440
PO Box 540
Ph 02 65 628 688 Fax 02 65 631 293
[email protected]
CEO Jo’anne Kelly
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
93
Muli Muli
Muli Muli Crescent VIA WOODENBONG NSW 2476
PO Box 68
Ph 02 66 351 487 Fax 02 66 351 498
[email protected]
CEO Mathew Green
Nambucca Heads
159A Mann Street NAMBUCCA HEADS NSW 2448
PO Box 358
Ph 02 65 689 281 Fax 02 65 689 161
[email protected]
CEO Louise Robinson
Ngulingah
53 Conway Street LISMORE NSW 2480
PO Box 981
Ph 02 66 215 541 Fax 02 66 215 068
[email protected]
CEO Cedrick Hinton
Thungutti
Thungutti Village BELLBROOK NSW 2440
Post Office BELLBROOK NSW 2440
Ph 02 65 672 050 Fax 02 65 672 169
[email protected]
CEO Margaret Kelly
94
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Appendix 5 - Targeted Communities - Areas of Need
Communities
NCML
Category
Attributes
• Bellbrook
• Bowraville
• Bonalbo
• Comboyne
• Coraki
• Coramba - Nana Glen
- Bucca
• Crescent Head
• Scotts Head
• Urbenville
A
Outer regional rural and remote communities with no or very limited
AH or distant service choices
• Nil to limited or shortage in FTE clinical workforce (Solo or poor
population to GP ratio)
• limited access or multiple service gaps or distant proximity (> 30mins)
to services (Ambulance, Emergency Department Pharmacy, Pathology, Radiology, Limited or restricted emergency services
• socioeconomic disadvantage (SEIFA score - 875-900)
• Population < 2000
• Evans Head
• Iluka
• South West Rocks Stuart Point
• Woodburn
• Wooli-Minnie Waters
B
Coastal and rural communities with limited AH servicen choices
• Limited workforce availability in after hours
• Gaps in services access (Ambulance, Emergency Department, Pharmacy,
Pathology, radiology), or distance proximity to District Hospital (<30mins)
• Socioeconomic disadvantage (SEIFA score < 925)
• Population <5000
• Tweed Coast (Kingscliff Pottsville)
• Brunswick Heads Ocean Shores
• Sapphire Coast (Korora Emerald Beach- Woolgoolga)
• Macksville/Nambucca Heads, Urunga
C
Coastal communities with limited AH workforce availability
• GP Workforce shortage (Solo or small practices)
• GPs only VMO workforce or non resident to community
• Gaps in services ( Ambulance, Emergency Department, Pharmacy,
Pathology, Radiology), distance proximity to Hospital (< 15mins)
• Socio economic disadvantage ( SEIFA score <950)
• Population <10,000
Other NCML Communities
D
Communities not included in NCML categories A-C
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
95
Yes
9.35
Yes
Bangalow
B
Yes
5,345
8.4
Bellingen
C
Yes
5,644
5.95
Brunswick Heads Ocean Shores
C
Yes
7,870
9.8
Community Health
Yes
10
Yes
Ballina
3
989
989
13km to Byron
Bay
Community Health
Byron
1
Yes
Contains
Yes
1
Byron
2
8.7km to
Mullumbimby
SEIFA
Pathology / Radiology
27.9
15,497
Pharmacy AH
16,683
Ballina Region
Pharmacy
Ambulance
Hospital
FTE GP
Ballina
Byron Bay
Yes
989
950
Yes
10,297
14.3
Yes
Community Health
Yes
5
Yes
977
Casino
C
Yes
11,764
12.1
Yes
Community Health
Yes
5
Yes
977
Casino Region
A
Yes
6,828
2.6 Yes
Contains Bonalbo,
Coraki
Bonalbo
3
Woodburn
Yes
8
Yes
900
Yes
3
Yes
958
Volunteer
0
Coffs Harbour North
17,229
5.3
Yes
Coffs Harbour South
10,263
39.8
Yes
0
900
Coramba - Nana
Glen - Bucca
A
Yes
3,516
Dorrigo
C
Yes
3,184
2.4 Yes
GP - Moonee Beach
23klms
Yes
1
Evans Head
B
Yes
5,364
5.5
Community Health/
MPS
Yes
2
950
12,450
10.7
7.1km to Lismore
Community Health
Lismore
1
900
Yes
8
Goonellabah
958
Yes
C
18,409
31.2
Yes
Grafton Region
A
14,827
0
Yes
Kempsey
C
Yes
14,228
20.1
Yes
Yes
5
Kempsey Region
A
Yes
9,028
1.5
Yes
Kempsey
1
Kingscliff Fingal Head
C
Yes
11,493
5.6
Contains Bellbrook/
Crescent Heads/
Willawarrin
Yes
3
Korora - Emerald
Beach
C
Yes
7,996
1.5
Community Health
Coffs
0
Kyogle
C
Yes
7,386
4.2 Yes
GP Moonee Beach
Yes
1
Community Health
Port
4
907
Contains Camden
Haven
Ballina
1
969
Yes
6
Alstonville
Volunteer
1
15,646
12.1
7,389
5.8
Lismore
16,172
16.6
Yes
Lismore Region
14,558
2.95
Yes
Lennox Head Skennars Head
96
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
12.3km to Ballina
Community Health
Community Health
Yes
919
Grafton
Laurieton - Bonny
Hills
Population 2011 Census
ASGC Remote <15,000
NCML Locality Category
Town (SA -2)
Appendix 6 - Audit of Known Ser vices Across NCNSW
Grafton
953
919
Yes
919
880
3
880
959
Yes
Yes
958
989
953
C
Mullumbimby
C
Yes
16,605
14.7
Yes
Contains Nimbin
Community Health
3
Yes
953
Maclean
Yamba
5
Yes
900
Pharmacy
SEIFA
Macksville
Ambulance
Hospital
FTE GP
Population 2011 Census
7.2
7,285
12.4 Yes
Community Health x 3
Yes
2
Murwillumbah
8,251
27.8 Yes
Community Health
Yes
5
Murwillumbah
Region
9,554
0 Yes
Community Health
Murwillumbah
0
959
6,747
7
yes
3
959
7,209
1
Nambucca
Heads
0
900
Yes
9
Nambucca Heads
C
Nambucca Heads
Region
A
Yes
4,625
Pathology / Radiology
Maclean - Yamba
- Iluka
yes
Pharmacy AH
B
ASGC Remote <15,000
NCML Locality Category
Town (SA -2)
Macksville - Scotts
Head
Yes
Yes
27,317
24.8 Yes
Port Macquarie West
15,191
17.5 Yes
Yes
4
969
4,914
0 Yes
Port
3
969
excludes Wauchope
Kingscliff
2
969
Healthone
Coffs
1
A
Pottsville
C
Yes
Sawtell - Boambee
12,261
1
18,853
10
Yes
977
Port Macquarie East
Port Macquarie
Region
Bowraville
919
Yes
900
959
South West Rocks
B
Yes
5,351
8.7
Kempsey
3
Tweed Coast
(KingscliffPottsville)
C
Yes
9,534
7.6
Kingscliff
3
2
958
959
Tweed Heads
19,105
19.9 Yes
Healthone - Pottsville
Yes
5
10
959
Tweed Heads South
26,331
25.8 Yes
Community Health
Yes
7
2
959
Yes
1
907
950
Urbenville
A
Yes
2,000
0.9 Yes
Urunga
C
Yes
4,654
6.6
Community Health
Yes
1
Yes
10,001
6.2 Yes
incl. Valla Beach
Yes
2
Yes
1
958
Grafton
0
919
Wauchope
Woolgoolga Arrawarra
C
Yes
11,594
5.6
Wooli-Minnie
Waters
B
Yes
189
0
496,637
460 *
Total
Yes
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
969
97
Appendix 7 - Key National State, Regional and Local
Promotion Programs in NCNSW 2013
Prevention in Primary Care – NSW Heart
Foundation
• Primary Health Care Program Manager, Heart
Foundation
Healthy Communities Initiative (HCI)
• Healthy Communities Coordinator,
Port Macquarie/Hastings Council
• Healthy Communities Coordinator Kempsey Shire
Council
• Healthy Communities Coordinator Nambucca
Shire Council
• Healthy Clarence Community Coordinator
Clarence Valley Council
• Healthy Communities Coordinator Lismore
City Council
Healthy Children’s Initiative
• N NSWLHD Coordinator, Healthy Children’s
Initiative
• MNCLHD - Healthy Communities Coordinator,
Healthy Children’s Initiative
Stepping On
• Falls Coordinator – N NSWLHD
• Project Coordinator – MNCLHD
Eat it to Beat it Program
• Eat it to Beat it Coordinator [email protected]
• Bugalwena Quit Smoking Program
Ronella Phillips Ph (07) 055 067 850
C.H.E.G.S
• Coordinator: N NSWLHD Ph: 6620 7523
Food Mapping Project
• Australian Red Cross
Energise
• Program Coordinator, GenHealth
Quit 4 New Life Program
• Manager, Health Promotion N NSWLHD - MNCLHD
• Manager, Healthy Communities MNCLHD
Juumes Stop!
• Pauline Stewart - Program Coordinator Galambilla Aboriginal Medical Service
Good Sports Program
• Australian Drug Foundation
[email protected]
MNCLHD Health Promotion Tobacco Plan (2012- 17)
• Manager, Healthy Communities
Rural Primary Healthcare Services Program (RPHS)
Health Promotion Officer – Macksville
Losing it in the Bush
• RPHS Health Promotion Officer, Macksville Health
Campus
98
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Connecting Youth to Health Project
• Maclean/Yamba (2 days) Ph: 66 400 154
• Murwillumbah (3/4 days per week) Ph: 66 70 9418
• Evans/Coraki/Ballina (2 days)Ph: 66 25 0111
• Casino/Woodenbong/Muli /Tabulam Kyogle/
Bonalbo/Jabulum. (Full time) Ph: 66 600 622
HEALInG Program
• Program Coordinator – N NSWLHD
Go 4 Fun
• N NSWLHD Coordinator Go 4Fun
• MNCLHD Coordinator Go 4Fun
The Australian Red Cross Good Start
Breakfast Clubs
• Regional Manager, Australian Red Cross
Deadly Living Program
• Jess McCormack and Rebecca Plamer
Diabetes Prevention Project
• Program Coordinator, Diabetes Prevention Project
Officer, Durri Aboriginal Medical Service Kempsey
Ph: 65 602 300
Local Food Futures Alliance Project
• Coffs Harbour Council Ph: 66 484 646
Spring into Shape
• Pauline Stewart, Program Coordinator
Galambilla AborignialMedical Service
N NSWLHD Health Promotion Tobacco Plan and
Aboriginal Tobacco Strategy (2012-2017)
• N NSWLHD TREES Coordinator
Ph: 66 20 7500
Tobacco e-learning and Tobacco
Relapse Project
• Health Promotion Officer Healthy Communities
MNCLHD
RRISK – reduce risk, increase student
knowledge Drinksafe
• Coordinator N NSWLHD
Power of Choice
• Crash Investigation Unit, Port Macquarie
Northern Rivers Tackling Smoking & Healthy
Lifestyle (TSHL)
• TSHL Coordinator
Appendix 8 - Data Summar y of Key Focus Areas
Focus Area
Key Evidence
Description of Evidence
Health Inequities
& Demographic
Trends
Estimated resident
population
2012 ERP – 497,729
Projected Population
Growth
27.5% increase by 2031 (Considered one of the highest growth areas in
NSW)
495,549 in 2011 up to 631,789 in 2031
The highest projected growth is in Tweed (42% Port MacquarieHastings, Coffs Harbour and Byron all 38%, and Ballina 33% -all above
NSW projected growth rate of 22%).
Kyogle is the only LGA with negative growth (-5%)
Age Profile
2012 NCNSW population consists of:
• 0-14 years - 18.3%
• 15-24 years - 11.2%
• 25-44 years - 20.9%
• 45-64 years - 28.9%
• 65 years and over - 20.7%
Index Relative Social
Disadvantage (IRSD)
IRSD for NCNSWML 948- below State average
All LGAs below State average with the lowest in Kempsey (880),
Nambucca and Richmond Valley (900)
(SEIFA scores are an average for the whole LGA and areas exist
within these regions with more or less disadvantage)
Higher unemployment rate than NSW average sustained over many years
Highest rates in Nambucca, Byron Bay
Long-term unemployment rates are almost double NSW rate
16.54% of all St Vincent de Paul support services provided across NSW is
utilised in NCNSWML (Sydney 20.48% and all others below 13%)
Age of first pregnancy is high for 12-19 years (6.3% Mid North Coast, 5.6%
Northern compared to 3.3% NSW)
Remoteness
Diverse settlement patterns – coastal cluttering and sparser
settlements inland
Many villages spread across region
Discrepancies exist with classifications
RRMA classification 2-5
ASGC RA 1-3
Some towns classified as RRMA 5 but display characteristics
of RRMA 6 and function as rural/remote places with limited
infrastructure, transport and other services. (LGA, RDA reports,
LHD service investigations and NCNSWML analysis)
Tweed is classified as RRMA 2 however functions as a RRMA 1 due to high
growth rate and proximity to the Gold Coast (Australia’s 4th largest city)
Smaller settlements/villages are classified similarly to major centres but
function differently
Transport
Disadvantage
Council of Social Services (NCOSS) and localised, regional studies show
transport is a major barrier to accessing services especially vulnerable
groups (frail aged, carers, one-parent families and people who are
socio-economically disadvantaged)
Smaller, inland villages are remote with limited services, some people have
to catch the school bus early in the morning and return later in the day for
an hour’s appointment
Ambulance service becomes the default method of transport out of hours
Community transport barriers include:
• Limited knowledge of service
• Strict and rigid eligibility criteria
• Restrictions on traversing State border (to access specialists)
• Unsustainable service due to vulnerable funding options
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
99
Focus Area
Key Evidence
Description of Evidence
Crime and domestic
violence
Bureau of crime statistics show Kempsey, Coffs Harbour, Richmond Valley
have much higher rates of domestic violence compared to NSW with no
improvement over last ten years
2404 apprehended violence orders (AVO) (10% of all NSW AVOs but only
have 7% of NSW population)
Byron Bay has high rates of alcohol related violence; 1247.8 / 100,000
compared to NSW with 197.6 / 100,000
Aboriginal women across Australia compared to non-Aboriginal women are:
• 6 times more likely to be victim of domestic violence-related assault
• 35 times more likely to be hospitalised due to family-related violence
• 10 times more likely to be victim of homicide (this has impact for
NCNSWML given the high proportion of Aboriginal population up to 10%)
Special Needs
Populations
Aboriginal
Aboriginal4.1% of NCNSWML population identify as Aboriginal (almost
double that of NSW 2.3%).
• 10.2% of Kempsey residents are Aboriginal
• Nambucca and Richmond Valley have 6.2%
LGAs with high Aboriginal population also have the low SEIFA score for
relative disadvantage
First antenatal visits by Aboriginal women are later than rest of regional
mums
Poorer infant and maternal health outcomes (preterm and low birth weight)
Homeless
0.5% N NSW counted as homeless 2011 Census (0.4% NSW)
Rough sleepers in N NSW account for 19.8% of NSW rough sleeping
homeless population
31.31% of all NSW support provided by St Vincents de Paul Society was
for people in homeless or temporary accommodation in NCNSWML (next
closest was Wollongong 12.75%)
Local youth homelessness specialists believe there is:
• acute shortage of options for young people in N NSW
• Long waiting list for homelessness support
Disability
NCNSW the highest percentage of persons providing unpaid assistance
to persons with a disability 2011 in Australia (NCNSW 13.1%, NSW 11.4%
Aust. 10.9%) The highest LGAs;
• Kyogle (14.8%)
• Clarence Valley (14.4%)
• Kempsey (14.3%)
• Nambucca (14.3%)
• Richmond valley (14.3%)
NCNSWML has the second highest percentage of people living with a
profound or severe disability for all ages (NCNSWML 6.5%, NSW 4.9%
Aust. 10.9%) and for people under 65 years of age in Australia (NCNSWML
3.8% NSW 2.6% Australia 2.5%). The highest LGAs;
• Kempsey 8.2% (<65 years 5.4%)
• Clarence Valley 7.6% (<65 years 4.7%)
• Richmond Valley 7.3% (<65 years 4.6%)
• Tweed 6.9% (<65 years 3.4%)
• Kyogle 6.7% (<65 years 4.6%)
• Port Macquarie-Hastings 6.7% (<65 years 3.9%)
NCNSWML has the second highest percentage of people living with a
profound or severe disability and living in the community
• All ages (NCNSWML 5.5%, NSW 4.1% and Aust. 3.9%)
• People under 65 years (NCNSWML 3.7%, NSW 2.5% and Aust. 2.4%)
• LGAs with highest numbers of under 65 years:
- Nambucca 7.3% (<65 years 5%)
- Kempsey 7% (<65 years 5.2%)
- Clarence Valley 6.3% (<65 years 4.5%)
- Richmond Valley 6.3% (<65 years 4.5%)
- Kyogle 6% (<65 years 4.5%)
100
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Focus Area
Key Evidence
Description of Evidence
Ageing Population
Age dependency ratio 0.63 in 2011 increasing to 0.88 by 2031.
0-14 years remains stable; the increase is due to +65 years.
10/12 LGAs have higher percentage of over 65 year residents than the
NSW average
Population > 65 years
• Nambucca 24% and Port Macquarie-Hasting 24% • Tweed 23%
• Ballina 21% and Clarence Valley 21%
20% of population over 65 years in NCNSW (compared to NSW 15%)
By 2031 it is projected that NCNSWML will have 30% over 65 years
(compared NSW 20%)
Rural residents
NCNSW locality profiling has demonstrated areas of greater disadvantage
due to low population, SEIFA index, limited or shortage of GP, emergency,
transport and other essential services as opposed to existing rural and
remote categorisations
Rural residents tend to have limited access to a range of services on par
with remote residents
Health Status &
Health Outcomes
Potentially preventable
Hospitalisations &
Potentially Avoidable
Mortality
NCNSW has significantly higher rates of potentially preventable
hospitalisations (PPH) (2,798/100,000 compared to NSW 2,354.2/100,000)
• Kyogle, Richmond Valley, Clarence Valley, Coffs Harbour, Bellingen,
Nambucca and Kempsey all had significantly higher PPH compared
to NSW
NCNSW has significantly higher rates of potentially avoidable mortality
compared to NSW (106/100,000 NCNSWML, 99/100,000 NSW)
• Clarence Valley, Coffs Harbour, Kempsey, Nambucca and Richmond Valley all were significantly higher than NSW Chronic Disease
Respiratory Disease
• Significantly higher rates of COPD compared to NSW (292.9/100,000 compared to 249.3/100,000)
• Significantly higher rates of influenza and pneumonia compared to NSW (353.7/100,000 compared to 317.3/100,000).
• Significantly higher rates of acute respiratory infections (492.7/100,000 compared to 360.2/100,000)
Diabetes
• NCNSW has significantly higher rates of diabetes hospitalisations in the LGAs of;
- Clarence Valley
- Coffs Harbour
- Kempsey
Coronary Heart disease (CHD)
• MNC males have significantly higher rates of hospitalisation due to CHD (1040.4/100,000) compared to NSW 865.3/100,000)
• MNC females have significantly higher rates of hospitalisation for CHD(543.3/100,000) compared to NSW (374/100,000)
• LGAs with significantly higher rates of hospitalisation for CHD;
- Richmond Valley
- Coffs Harbour
- Nambucca
- Kempsey
- Port Macquarie-Hastings
Cancer
• NCNSW has significantly higher rates of cancer diagnosis (528.3/100,000) compared to NSW (483.2/100,000).
• N NSW and MNC both have significantly higher rates of prostate cancer mortality (14.9/100,000 & 16.2/100,000) compared to NSW (12.8/100,000)
• N NSW and MNC both have significantly higher rates of melanoma
incidence (80.8/100,000 & 64.7/100,000) compared to NSW (48.8/100,000)
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
101
Focus Area
Key Evidence
Description of Evidence
Mental Health
• High or very high psychological distress among people over 16 years is greater than NSW average
• Regional youth census found that the third most common concern for young people in Northern NSW is physical and mental health (ranked higher than Mission Australia’s National results)
• Suicides in 2011
- NCNSWML had 40
- Northern NSW 21
- Mid North Coast 19
- Northern NSW has an average 25 suicides/year
Local youth homelessness specialists believe there is:
• acute shortage of options for young people in N NSW
• Long waiting list for homelessness support
Disability
NCNSW the highest percentage of persons providing unpaid assistance
to persons with a disability 2011 in Australia (NCNSW 13.1%, NSW 11.4%
Aust. 10.9%) The highest LGAs;
• Kyogle (14.8%)
• Clarence Valley (14.4%)
• Kempsey (14.3%)
• Nambucca (14.3%)
• Richmond valley (14.3%)
NCNSWML has the second highest percentage of people living with a
profound or severe disability for all ages (NCNSWML 6.5%, NSW 4.9%
Aust. 10.9%) and for people under 65 years of age in Australia (NCNSWML
3.8% NSW 2.6% Australia 2.5%). The highest LGAs;
• Kempsey 8.2% (<65 years 5.4%)
• Clarence Valley 7.6% (<65 years 4.7%)
• Richmond Valley 7.3% (<65 years 4.6%)
• Tweed 6.9% (<65 years 3.4%)
• Kyogle 6.7% (<65 years 4.6%)
• Port Macquarie-Hastings 6.7% (<65 years 3.9%)
NCNSWML has the second highest percentage of people living with a
profound or severe disability and living in the community
• All ages (NCNSWML 5.5%, NSW 4.1% and Aust. 3.9%)
• People under 65 years (NCNSWML 3.7%, NSW 2.5% and Aust. 2.4%)
• LGAs with highest numbers of under 65 years:
- Nambucca 7.3% (<65 years 5%)
- Kempsey 7% (<65 years 5.2%)
- Clarence Valley 6.3% (<65 years 4.5%)
- Richmond Valley 6.3% (<65 years 4.5%)
- Kyogle 6% (<65 years 4.5%)
Ageing Population
Age dependency ratio 0.63 in 2011 increasing to 0.88 by 2031.
0-14 years remains stable; the increase is due to +65 years.
10/12 LGAs have higher percentage of over 65 year residents than the
NSW average
Population > 65 years
• Nambucca 24% and Port Macquarie-Hasting 24%
• Tweed 23%
• Ballina 21% and Clarence Valley 21%
20% of population over 65 years in NCNSW (compared to NSW 15%)
By 2031 it is projected that NCNSWML will have 30% over 65 years
(compared NSW 20%)
Rural residents
NCNSW locality profiling has demonstrated areas of greater disadvantage
due to low population, SEIFA index, limited or shortage of GP, emergency,
transport and other essential services as opposed to existing rural and
remote categorisations
Rural residents tend to have limited access to a range of services on par
with remote residents
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THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Focus Area
Key Evidence
Description of Evidence
Health Status &
Health Outcomes
Potentially preventable
Hospitalisations &
Potentially Avoidable
Mortality
NCNSW has significantly higher rates of potentially preventable
hospitalisations (PPH) (2,798/100,000 compared to NSW 2,354.2/100,000)
• Kyogle, Richmond Valley, Clarence Valley, Coffs Harbour, Bellingen, Nambucca and Kempsey all had significantly higher PPH compared to
NSW
NCNSW has significantly higher rates of potentially avoidable mortality
compared to NSW (106/100,000 NCNSWML, 99/100,000 NSW)
• Clarence Valley, Coffs Harbour, Kempsey, Nambucca and Richmond Valley all were significantly higher than NSW Chronic Disease
Respiratory Disease
• Significantly higher rates of COPD compared to NSW (292.9/100,000 compared to 249.3/100,000).
• Significantly higher rates of influenza and pneumonia compared to NSW
(353.7/100,000 compared to 317.3/100,000).
• Significantly higher rates of acute respiratory infections (492.7/100,000
compared to 360.2/100,000)
Diabetes
• NCNSW has significantly higher rates of diabetes hospitalisations in the
LGAs of;
- Clarence Valley
- Coffs Harbour
- Kempsey
Coronary Heart disease (CHD)
• MNC males have significantly higher rates of hospitalization due to CHD
(1040.4/100,000) compared to NSW 865.3/100,000)
• MNC females have significantly higher rates of hospitalisation for
CHD(543.3/100,000) compared to NSW (374/100,000)
• LGAs with significantly higher rates of hospitalisation for CHD;
- Richmond Valley
- Coffs Harbour
- Nambucca
- Kempsey
- Port Macquarie-Hastings
Cancer
• NCNSW has significantly higher rates of cancer diagnosis (528.3/100,000) compared to NSW (483.2/100,000).
• N NSW and MNC both have significantly higher rates of prostate cancer
mortality (14.9/100,000 & 16.2/100,000) compared to NSW (12.8/100,000)
• N NSW and MNC both have significantly higher rates of melanoma
incidence (80.8/100,000 & 64.7/100,000) compared to NSW (48.8/100,000)
Mental Health
• High or very high psychological distress among people over 16 years is
greater than NSW average
• Regional youth census found that the third most common concern for
young people in Northern NSW is physical and mental health (ranked
higher than Mission Australia’s National results)
• Suicides in 2011
- NCNSWML had 40
- Northern NSW 21
- Mid North Coast 19
- Northern NSW has an average 25 suicides/year
• Self harm hospitalisations2012-2013;
- 450 people from Northern NSW (253.9)
- Mid North Coast 205.3 (NSW 144.2)
- 15-24 year olds 209.5/100,000 NCNSWML compared to NSW 182.8/100,000
- 15-24 year old females 665.4/100,000 NCNSWML compared NSW
465.8/100,00 statistically higher
THE HEALTH NEEDS OF NORTH COAST NSW - 2014
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Focus Area
Key Evidence
Description of Evidence
Health Risk Factors
Higher rates of adult smoking in NCNSW (19.7%) compared to NSW (16%)
• NCNSW has significantly higher rates of smoking attributable
hospitalisation (631/100,000) compared to NSW (565/100,000)
• All LGAs except Byron has significantly higher rates of smoking whilst
pregnant compared to NSW
NCNSW has higher rates of risk drinking (33%) compared to NSW (27.9%)
• NCNSWML has significantly higher rates of alcohol attributable
hospitalisations (672.2/100,000) compared to NSW 633.4/100,000)
Communicable Diseases
• N NSW has higher notification rates of Chlamydia compared to LHDs
outside of metropolitan Sydney (4th highest burden in NSW based on
total notifications)
• N NSW has the highest number of people living with HIV outside of
metropolitan Sydney
• N NSW has the highest burden of Hepatitis C in NSW based on total
notifications
Significantly higher rate of obesity compared to NSW particularly in females.
Hospitalisations
Significantly higher rates of hospitalisations in NCNSW (36,435/100,000)
compared to NSW (36,015/100,000)
• Ballina, Clarence Valley, Kempsey, Kyogle, Lismore and Tweed LGAs all
have hospitalisation rates significantly higher than NSW
Top causes of hospitalisations for males in NCNSWML that are significantly
higher than NSW:
• Dialysis
• Injury & Poisoning
• Digestive system diseases
• Nervous and sense disorders
• Symptoms and abnormal findings
Top causes of hospitalisations for females in NCNSW that are significantly
higher than NSW:
• Maternal, neonatal and congenital
• Dialysis
• Injury & poisoning
• Digestive system diseases
• Nervous and sense disorders
Top causes of hospitalisations for Aboriginal people in NCNSW that are
significantly higher than NSW:
• Dialysis
• Injury & poisoning
• Symptoms and abnormal findings
• Respiratory diseases
• Digestive system disorders
Oral Health
N NSW is the only LHD that has significantly higher number of children aged
5-6 years with decayed, missing and filled teeth compared to all of NSW
MNC is the only NSW LHD that has significantly higher number of children
aged 11-12 years with decayed, missing and filled teeth compared to all of
NSW
The quintile with the highest disadvantage also has the highest number of
children aged 5-6 years and 11-12 years with decayed, missing and filled
teeth. 5 out of 12 LGAs in NCNSWML are in the 5th Quintile of disadvantage:
• Clarence Valley
• Kempsey
• Kyogle
• Nambucca
• Richmond Valley
Higher rates of hospitalisations for removal and restoration of teeth for dental
caries in persons aged 0-14 years (471.5) and 15 years and over (61.7) in
2008-09 compared to the State average (344.1 and 58.5 respectively)
Reticulated water supply without fluoridation in many LGAs
Poor oral health rates for Aboriginal population nationally, therefore, assume
similar rates for NCNSWML
Consultation with Aged Care Providers highlighting the concerns of oral
health of residents
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THE HEALTH NEEDS OF NORTH COAST NSW - 2014
Focus Area
Key Evidence
Description of Evidence
Palliative Care
74% of Australians want to die at home only 16% are able
A GP registrar project to assist this in N NSW shows
81.2% of the control group and 47.8% of intervened group die in hospital
18.2% of control group and 34.8% of intervened group die at home
Immunisation
NCNSWML has the lowest rate of childhood immunisation of 1 and 2 year
olds and the second lowest immunisation of 5 year olds
NCNSWML has the largest cohort of conscientious objectors for 1 and
5 year old immunisations and the 3rd largest for 2 year olds
Mullumbimby has the lowest rate in Australia for all 1 year olds (31%)
2 years (46%) and 5 years (49%) year childhood immunisations
NCNSWML has 6/10 of the lowest post code areas in Australia for 1 year
old immunisations
NCNSWML has 4/10 of the lowest post code areas in Australia for 2 and
5 year old immunisations
Primary Health
Services
Access to Health Care
NHPA data experiences with access to health care indicate
• 51% of the population in NCNSWML have long-term health conditions.
• Average number of age-standardised GP attendances was 5.2 per
person which is higher than the peer region average of 4.8 per person
• NCNSW has poorer health and has more attendances to GPs than the
national average
• 84% of adults in NCNSW visited a GP in 2011-12 higher than the
regional average of 80%
• 29% of people felt they waited longer than acceptable to get an
appointment with a medical specialist compared to the peer regional
average of 27%
• 27% of people delayed seeing a dentist due to costs which is higher
than the peer regional average of 25%
• 82.7% of GP attendances were bulk billed compared to the peer
regional average of 77.8%
• NCNSWML ranked the highest ML in our peer region (regional 2) with
85% of people reporting their health positively
• NCNSW had the second highest expenditure on GP attendances (age
standardised) in our peer region. ($244.33 per person compared to the
average $214.04)
• NCNSW had the highest number of GP attendances in aged care homes
within our peer region with 14.8% compared to the average of 12%
• NCNSW had the 2nd highest percentage of adults who saw a dentist
within our peer region 49% compared to an average of 44%
• 38% of adults saw a medical specialist which is the highest amount in
peer region (average 33%)
After hours
Online Consumer Survey showed
• 60% attended EDs afterhours
• 30% attended after hours clinic (not usual practice)
• 70% patients did not have chronic health condition
• 82% had lack of availability and 64% indicated waiting time as barriers
to access
• Older people from Aged Care Facilities are transferred to hospital
unnecessarily with incomplete handovers
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THE HEALTH NEEDS OF NORTH COAST NSW - 2014