Canterbury - Sydney Local Health District...Prepared by the Planning Unit, Sydney Local Health District in collaboration with the Central and Eastern Sydney PHN. Chapters three and

Canterbury Local Government Area

Health Profile

2015

Copies of this document can be downloaded from the SLHD website at: http://www.slhd.nsw.gov.au/planning/profiles.html

Prepared by the Planning Unit, Sydney Local Health District in collaboration with the Central and Eastern Sydney PHN. Chapters three and four of this document were revised and updated by the SLHD Health Observatory. Chapter five of this document is revised and updated by the SLHD Public Health Unit.

Enquires in relation to this profile should be directed to: Dr Pamela Garrett

Director, Planning

SLHD Planning Unit

Telephone: 02 9515 9517

Email: [email protected]

Date of Publication: December 2015

http://www.slhd.nsw.gov.au/planning/profiles.html

mailto:[email protected]

Canterbury Local Government Area Health Profile

CONTENTS EXECUTIVE SUMMARY ...................................................................................................... 4 1 INTRODUCTION ............................................................................................................... 5 2 POPULATION AND COMMUNITY CHARACTERISTICS ................................................. 5

2.1 POPULATION CHARACTERISTICS ..................................................................................... 5 2.2 BIRTHS AND MATERNAL HEALTH ..................................................................................... 7 2.3 ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE............................................... 8 2.4 PEOPLE FROM CULTURALLY AND LINGUISTICALLY DIVERSE BACKGROUNDS......... 9 2.4 HUMANITARIAN ARRIVALS .................................................................................................. 9 2.5 EDUCATION LEVELS ............................................................................................................ 9 2.6 SOCIO-ECONOMIC CHARACTERISTICS .......................................................................... 10 2.7 HOMELESSNESS ................................................................................................................ 12

3 HEALTH RISKS OF THE POPULATION ........................................................................ 13 4 LONG TERM CONDITIONS AND CHRONIC DISEASE .................................................. 15

4.1 PREVALENCE OF CHRONIC DISEASE ............................................................................... 15 4.2 CANCER ................................................................................................................................. 18 4.3 MORTALITY ........................................................................................................................... 20

5 INFECTIOUS DISEASE ................................................................................................... 21 5.1 HIV .............................................................................................................................................. 21 5.2 CHLAMYDIA ............................................................................................................................... 22 5.3 GONORRHOEA ......................................................................................................................... 23 5.4 INFECTIOUS SYPHILIS ............................................................................................................. 24 5.5 HEPATITIS B .............................................................................................................................. 25 5.6 HEPATITIS C .............................................................................................................................. 26

6 HEALTH SERVICE UTILISATION ................................................................................... 27 6.1 PRIMARY CARE UTILISATION ................................................................................................. 27 6.2 EMERGENCY DEPARTMENT PRESENTATIONS ................................................................... 28 6.3 HOSPITAL SEPARATIONS ....................................................................................................... 29

6.3.1 DAY-ONLY HOSPITAL SEPARATIONS ............................................................................ 29 6.3.2 OVERNIGHT HOSPITAL SEPARATIONS ......................................................................... 30

6.4 AMBULATORY CARE SENSITIVE ADMISSIONS .................................................................... 31 6.5 HOME AND COMMUNITY CARE .............................................................................................. 32

7 HEALTH SERVICE PROVISION ..................................................................................... 34 7.1 HOSPITALS AND DAY SURGERY ............................................................................................ 34 7.2 COMMUNITY HEALTH SERVICES ........................................................................................... 35 7.3 GENERAL PRACTICE ............................................................................................................... 36 7.4 ALLIED HEALTH ........................................................................................................................ 37 7.5 AGED CARE ............................................................................................................................... 38

APPENDIX A: POSTCODE TO LGA / SLA CORRESPONDENCES ................................. 39 APPENDIX B: DATA LIMITATIONS AND ASSUMPTIONS ............................................... 40

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List of Tables Table 1: Projected population: Canterbury LGA and IWS,2006, 2011, 2016, 2021 and 2031 7 Table 2: Births to Canterbury LGA residents and fertility rate 2006 – 2013 ........................... 7 Table 3: Child Immunisation rates by age group: Canterbury SA3 and IWS, 2012-2013 ....... 8 Table 4: Preventive maternal indicators 2011-2013 .............................................................. 8 Table 5: Humanitarian migration stream, settlers arriving 2009–2014 ................................... 9 Table 6: IRSD by SLA, and rank within IWS, 2011 .............................................................. 10 Table 7: IRSD by Suburbs within Canterbury LGA, and rank within IWS, 2011 ................... 11 Table 8: Estimates of homelessness, 2011 ......................................................................... 12 Table 9: Modelled estimates of health risk factors, 2011-2013 ............................................ 13 Table 10: Health behaviour related hospitalisations, 2012-13 to 2013-14............................ 13 Table 11: Health behaviours of residents: IWS and NSW, 2013 .......................................... 14 Table 12: Modelled estimates of prevalence of chronic conditions, 2011-13 ....................... 15 Table 13: Modelled estimates of chronic disease burden, 2011-2013 ................................. 16 Table 14: Indicators of burden of disease - hospital separations by cause, 2012-14 ........... 16 Table 15: High body mass index, alcohol and smoking attributable deaths ......................... 17 Table 16: Age standardised cancer incidence rates by cancer site, 2004 to 2008 ............. 19 Table 17: Age standardised mortality rates by cancer site, 2004 - 2008 .............................. 20 Table 18: Deaths from all causes and potentially preventable deaths, 2010-11 .................. 20 Table 19: HIV notification rate, by LGA, IWS, 2005-2014 .................................................... 21 Table 20: Chlamydia notification rate, by LGA, 2005 to 2014 .............................................. 22 Table 21: Gonorrhoea notification rate, by LGA, IWS, 2005-2014 ....................................... 23 Table 22: Infectious syphilis notification rate, by LGA, IWS, 2005 – 2014 ........................... 24 Table 23: Hepatitis B age-standardised notification rate by LGA, IWS, 2005 – 2014 ........... 25 Table 24: Hepatitis C age-standardised notification rate by LGA, IWS, 2005 – 2014.......... 26 Table 25: Primary care services, age standardised rate: Canterbury LGA, IWS and NSW, 2010 .................................................................................................................................... 27 Table 26: Emergency department presentations, by hospital: Canterbury LGA, 2013 ......... 28 Table 27: Emergency department presentations, by triage category by LGA, 2013 ........... 28 Table 28: Day-only hospital separations for Canterbury LGA residents, 2013-14 ................ 29 Table 29: Overnight hospital separations for Canterbury LGA residents, 2013-14 .............. 30 Table 30: Potentially preventable hospitalisation separations for ACSCs by LGA, 2011-13 31 Table 31: HACC Client Profile, % of HACC clients; 2012-13 ............................................... 32 Table 32: HACC Service Profile, Instances of care per 1,000; 2012-13 .............................. 33 Table 33: Acute and day surgery facilities in Canterbury LGA, HERO Database, 2015 ....... 35 Table 34: Community health facilities in Canterbury LGA, HERO Database, 2015 .............. 36 Table 35: Total Aged Care Places and Ratios, IWs and NSW, 2014 ................................... 38 Table 36: Aged care facilities in Cantebury, HERO Datatbase, 2015 .................................. 38 Table 37: Postcode to SLA / LGA correspondences ........................................................... 39

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List of Figures Figure 1: Population profile by age, Canterbury LGA and NSW, 2014 .................................. 5 Figure 2: Population forecasts: Canterbury LGA and NSW by age and gender, 2031 ........... 6 Figure 3: Canterbury LGA projected population age groups 2011, 2016, 2021, 2026 and 2031 ...................................................................................................................................... 7 Figure 4: Language spoken at home: Canterbury LGA, IWS and NSW 2011 ........................ 9 Figure 5: Comparison of SEIFA Disadvantage percentiles within Canterbury LGA, 2011 .... 11 Figure 6: Type of Homelessness: Canterbury and NSW, 2011 ........................................... 12 Figure 7: Modelled estimates of health risk factors, 2011-2013 ........................................... 13 Figure 8: Modelled estimates of prevalence of chronic conditions, 2011-2013 .................... 15 Figure 9: Age-standardised incidence of selected cancers, 2004 to 2008 ........................... 18 Figure 10: Number and rate of notifications of newly diagnosed HIV infection, 2005-2014 .. 21 Figure 11: HIV notification rate, by LGA, IWS 2005-2014 .................................................... 21 Figure 12: Chlamydia notification rate, by IWS and NSW, 2010 to 2014 ............................. 22 Figure 13: Gonorrhoea notification rate, by IWS and NSW, 2010 to 2014 ........................... 23 Figure 14: Gonorrhoea notification rate, by LGA, 2005-2014 .............................................. 23 Figure 15: Infectious syphilis notification rate, by IWS and NSW, 2010-2014 ..................... 24 Figure 16:Infectious Syphilis notification rate, by LGA and IWS, 2005 – 2014 ..................... 24 Figure 17: Hepatitis B notification rate, by IWS and NSW 2005-2014 ................................. 25 Figure 18: Hepatitis B notification rate by LGA and IWS, 2005 – 2014 ................................ 25 Figure 19: Hepatitis C notification rate, by IWS and NSW, 2005-2014 ................................ 26 Figure 20: Hepatitis C notification rate by LGA and IWS, 2005 – 2014 ................................ 26 Figure 21: Primary care services age standardised ratio, 2010 ........................................... 27 Figure 22: Day-only hospital separations for Canterbury LGA residents, 2013-14 ............... 29 Figure 23: Overnight hospital separations for Canterbury LGA residents, 2013-14 ............. 30 Figure 24: Potentially preventable hospitalisations for ACSCs by LGA 2011-13 .................. 31 Figure 25: HACC Client Profile by Canterbury LGA, IWS and NSW, 2012-2013 ................. 32 Figure 26: HACC Service Profile By Canterbury LGA, IWS and NSW, 2012-13 .................. 33 Figure 27: General Practitioners and General Practice Services by LGA and IWS, 2015 .... 36 Figure 28: Private Allied Health Practitioners: Canterbury LGA and IWS, 2014................... 37

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EXECUTIVE SUMMARY Canterbury LGA is rich in cultural diversity, with 48.1% of the population born overseas and 45% born in non-English speaking countries. Canterbury LGA residents identify their primary language as being Arabic (13%; 18,175), followed by Greek (10%, 13,411) and Mandarin (6%, 7,697). Canterbury LGA is home to a large number of humanitarian entrants, with the majority being from Burma, Iraq and Syria. Aboriginal and Torres Strait Islander people make up 0.6% of the Canterbury LGA population, which is below the average for the Inner West Sydney (IWS) catchment (0.9%). Canterbury LGA is the most disadvantaged LGA within the IWS catchment, with an index score of socio-economic disadvantage of 922. Unemployment levels in Canterbury LGA are the highest across the IWS catchment. The percentage of the total homeless population that are living in ‘severely’ crowded dwellings (69%) is also notably higher than the state (33%). Canterbury LGA has a higher proportion of residents who are under 4 years of age and a lower proportion of residents who are 50 years of age and over, when compared to the state. The fertility rate in Canterbury LGA is slightly higher than the NSW rate. Population growth in Canterbury LGA is expected to be 25% between 2011 and 2031, which is lower than the expected population growth across metropolitan Sydney (27.8%). Health Risks and Chronic Disease in Canterbury LGA Canterbury LGA residents rates of smoking (15.3%) and obesity (25.4%) are significantly higher than the IWS catchment, however, they are equivalent to NSW rates. Respiratory system and musculoskeletal diseases are the most prevalent chronic conditions in Canterbury LGA, although they remain below the state average. There is a trend for increased estimated age-standardised rates of type 2 diabetes in Canterbury LGA residents (9.7 per 100) compared to IWS (7.4 per 100), with estimated levels being clearly higher than NSW (5.8 per 100). . In 2004-2008 rates of bladder, liver, lung, stomach and thyroid cancers were higher in Canterbury LGA relative to NSW. The overall age-standardised rate of cancer-related deaths in Canterbury LGA (187.7 per 100,000) is significantly higher than the state (176.9 per 100,000). The standardised rate of asthma related hospitalisations for Canterbury LGA residents (111.3) is significantly higher than the state (100). Overall, the rate of potentially preventable hospital separations (2288.4 per 100,000 persons) in Canterbury LGA representing the highest rate among all IWS LGAs. Despite being the highest in the IWS, it was still significantly lower than the state level. Infectious Diseases in Canterbury LGA The IWS catchment has higher rates of newly diagnosed HIV infections, hepatitis B, infectious syphilis, chlamydia and gonorrhoea than the state. Canterbury LGA has the third highest notification rates for Hepatitis B, after Burwood and Strathfield LGA’s. Health Service Utilisation in Canterbury LGA Whilst Canterbury LGA has both a district level hospital and a community health centre located within its boundaries the availability of GPs, Practice Nurses, Allied Health Professionals per capita is amongst the lowest within the IWS catchment. Canterbury Hospital provides the majority of emergency department presentations and hospital separations for Canterbury LGA residents.

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1 INTRODUCTION The Canterbury Local Government Area (LGA) Health Profile describes the characteristics of the Canterbury LGA population and compares it with the Inner West Sydney (IWS) catchment. The IWS catchment comprises the LGAs of Ashfield, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Strathfield and Statistical Local Areas (SLAs) of Sydney City South and West. Canterbury LGA has a population of 150,6261 and occupies 33.4 square kilometres, making it the largest LGA in the IWS catchment. It is made up of 17 suburbs including Croydon Park (postcode 2133), Belfield (postcode 2191), Belmore (postcode 2192), Ashbury (postcode 2193), Canterbury (postcode 2193 ), Hurlstone Park (postcode 2193), Campsie (postcode 2194), Lakemba (postcode 2195), Wiley Park (postcode 2195), Punchbowl (postcode 2196), Roselands (postcode 2196), Clemton Park (postcode 2206), Earlwood (postcode 2206), Kingsgrove (postcode 2208 ), Beverly Hills (postcode 2209), Narwee (postcode 2209), and Riverwood (postcode 2210).

2 POPULATION AND COMMUNITY CHARACTERISTICS 2.1 Population Characteristics The population profile of the Canterbury LGA in 2014 compared to NSW shows that there was a higher proportion of people in the younger age groups (under 4 years of age) and a lower proportion of people in the older age groups (50 years of age and over) when compared to the state.

Figure 1: Population profile by age, Canterbury LGA and NSW, 2014

Users of this information are strongly advised to refer to the source data to ensure accuracy, and to take note of the data explanations which accompany the profile. 1 ABS Estimated Resident Population 2014

14% 12% 10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10% 12% 14%

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+Canterbury Females 2014 NSW Females 2014 Canterbury Males 2014 NSW Males 2014

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Source: Population by age and sex, regions of Australia. Australian Bureau of Statistics. Cat. No. 3235

Figure 2 indicates higher population growth in Canterbury LGA for people in the 0 to 15 years age group and the working age groups (25 to 50 years of age), while significantly lower population growth is projected for Canterbury LGA residents between 50 – 70 years of age and those over 80 years of age.

Figure 2: Population forecasts: Canterbury LGA and NSW by age and gender, 2031

Source: NSW State and LGA Population Projections, 2011-2031: 2014 release. Department of Planning & Environment

Concurrent with population growth are proposed increases in the number of local homes and dwellings. The NSW Household and Implied Dwelling Projections 2011 – 2031 (2014) project an additional 15,150 dwellings from 2011 to 2031 in Canterbury LGA. Of these dwellings it is projected that 10,300 will be family households and 3,850 will be lone person households2.

Table 1 and Figure 3 further illustrate the projected changes in population numbers and the number of people in different age groups in the Canterbury LGA from 2011 – 2031. These numbers are based on the estimated resident population numbers released by the NSW Department of Planning and Environment in 2014. Currently Canterbury LGA accounts for a quarter of the IWS catchments population, this is projected to continue into 2031.

2 New South Wales State and Local Government Area Household and Implied Dwelling Projections: 2014 Final. Department Planning and Environment.

14% 12% 10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10% 12% 14%

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

CANTERBURY Females NSW Females 2031 CANTERBURY Males 2031 NSW Males 2031

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Table 1: Projected population: Canterbury LGA and IWS,2006, 2011, 2016, 2021 and 2031

Canterbury LGA IWS Catchment 2011 2016 2021 2026 2031 2011 2016 2021 2026 2031

Total population

145,089 152,588 161,917 171,751 181,865 581,936 628,537 681,493 728,193 772,368

0 4 years 10,831 12,200 12,726 13,146 13,431 36,373 41,391 44,652 46,838 47,689 5 - 14 years 17,392 18,351 20,478 22,144 23,153 51,476 58,228 66,702 72,778 76,748

15 - 24 years 18,790 18,118 18,473 19,549 21,368 77,887 73,294 76,692 82,112 89,093 25 - 44 years 45,293 46,768 48,572 50,145 51,089 218,353 235,564 249,104 256,808 260,590 45 - 64 years 33,426 35,598 37,533 39,385 42,076 129,929 140,960 153,144 164,527 178,495 65 - 84 years 17,109 18,726 20,849 23,656 26,415 59,207 68,272 78,747 90,820 102,430

85 years + 2,248 2,828 3,288 3,726 4,333 8,711 10,829 12,453 14,309 17,323 Source: NSW State and LGA Population Projections, 2011-2031: 2014 release. Department of Planning & Environment Across all age groups combined, population growth in the Canterbury LGA is expected to be 25% between 2011 and 2031, which is lower than the forecasted population growth across both the IWS catchment (32.7%) and NSW (27.8%).

Figure 3: Canterbury LGA projected population age groups 2011, 2016, 2021, 2026 and 2031

Source: NSW State and LGA Population Projections, 2011-2031: 2014 release. Department of Planning & Environment

2.2 Births and Maternal Health Table 2 shows the number of births to Canterbury LGA residents in the period 2006 - 2013. Across this period, the fertility rate in Canterbury LGA remained slightly higher than the NSW rate. Canterbury LGA ranked first within the IWS catchment for number of births in 2013 (2,461).

Table 2: Births to Canterbury LGA Residents and Fertility Rate 2006 – 2013 Year Canterbury LGA

estimated resident population

Canterbury LGA births

Canterbury LGA total fertility rate

NSW total fertility rate

2006 134,789 2,206 2.1 1.93 2007 136,803 2,381 2.18 1.99 2008 139,725 2,470 2.25 2.05 2009 142,023 2,474 2.29 1.98 2010 143,933 2,575 2.3 2.02 2011 145,089 2,442 2.26 1.96 2012 146,729 2,473 2.24 1.93 2013 148,853 2,461 2.19 1.94 Source: ABS Births, Australia, 2013 Catalogue No. 3301.0

0

10,000

20,000

30,000

40,000

50,000

60,000

2011 2016 2021 2026 2031

0 4 years5 - 14 years15 - 24 years25 - 44 years45 - 64 years65 - 84 years85 years +Pr

ojec

ted

Popu

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Table 3 shows the immunisation coverage rates for children aged 0 to 5 years calculated for the Canterbury Statistical Area Level 3 (SA3), the immunization rates across 1 and 5 years olds in the Canterbury were higher than the IWS catchment and national figures.

Table 3: Child Immunisation Rates by Age Group: Canterbury SA3 and IWS, 2012-2013 Canterbury Inner West Sydney National

Age Group % Fully Immunised 1 year 92.5% 90.5% 91.2%

2 years 90.6% 91.4% 92.5% 5 years 91.8% 89.6% 91.5%

Source: NHPA Analysis of Dept of Human Services, Australian Childhood Immunisation register (2012-13)

Table 4 shows that between 2011 and 2013 the rate of smoking during pregnancy in Canterbury LGA was significantly lower than the state average, with a smoothed prevalence ratio between 55.8 and 66.4 at 95% confidence interval3 (NSW = 100). For the same period, the smoothed prevalence ratio of attendance for antenatal care prior to 14 weeks gestation ranged between 90.9 and 93.6 at 95% confidence interval3, which was significantly below the NSW smoothed prevalence ratio of 100.

Table 4: Preventive maternal indicators, Canterbury LGA and NSW 2011-2013 Maternal Indicator Canterbury LGA NSW

Smoking in pregnancy

Smoothed estimate of prevalence ratio

95% confidence interval for smoothed ratio

61.2 (55.8 – 66.4) (--) 100

First antenatal visit before 14

weeks of gestation

No. of mothers per year 95% confidence interval for smoothed ratio 1705 (90.9 -93.6) (--) 100

Source: NSW Perinatal Data Collection (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health, -- significantly lower than the state at 1% significance

2.3 Aboriginal and Torres Strait Islander People Canterbury LGA was originally home to the people of the Eora Nation. Aboriginal and Torres Strait Islander people comprise a total of 0.6% of the total population of the LGA, which was below the average for both the catchment (0.9%) and NSW (2.5%). The Indigenous population was predominantly young, with over 45% of all Aboriginal and Torres Strait Islander persons within Canterbury LGA aged 24 or below.

3 A confidence interval is a range around a measurement that conveys how precise the measurement is.

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2.4 People from Culturally and Linguistically Diverse Backgrounds Based on the 2011 ABS Census, only 29.7% (40,806) of Canterbury LGA residents identify as speaking only English at home, with notable proportions of the population identifying their primary language as being Arabic (13%; 18,175), followed by Greek (10%, 13,411) and Mandarin (6%, 7,697). Approximately 15% (752) of residents indicated that they speak another language and do not speak English well or do not speak English at all.

Source: Australian Bureau of Statistics (2011)

2.4 Humanitarian Arrivals

Table 5 provides local and state data relating to humanitarian settlers during the period 1 January 2009 - 1 December 2014. Humanitarian arrivals settling in Canterbury LGA came from 46 different countries, with the largest number being from Burma.

Table 5: Humanitarian migration stream, settlers arriving 2009–2014: Canterbury LGA and NSW

Population characteristics Canterbury LGA

NSW

Humanitarian Stream-number of settlers arriving from 2009 - 14

1,205 27,450

Top 3 countries of birth for humanitarian migration stream, number of settlers arriving 2009 – 2014 Burma 218 Iraq 10,157

Iraq 161 Iran 2,913 Syria 129 Afghanistan 2,502

Source: Department of Immigration and Citizenship Settlement Database. Accessed Feb. 2015

2.5 Education Levels Secondary school participation data from the 2011 census showed that within the Canterbury LGA 53% of people aged over 15 years had completed Year 12 schooling (or equivalent). Full-time participation in secondary school at age 16 years was lower in Canterbury LGA (80%) than the IWS catchment overall (82.3%). In 2013 the proportion of school leavers from Canterbury LGA that undertook higher education qualifications (40.7%) was ranked second lowest in the IWS catchment.

0%

2%

4%

6%

8%

10%

12%

14%CANTERBURY

IWS

NSW

% o

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Figure 4: Language spoken (excludes English) at home: Canterbury LGA, IWS and NSW 2011

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2.6 Socio-Economic Characteristics

The Socio-Economic Indexes For Areas (SEIFA) are used to rank geographic areas across Australia according to their socio-economic characteristics. The Index of Relative Socioeconomic Disadvantage (IRSD) contains indicators of disadvantage such as low income, high unemployment and low levels of education. Relative disadvantage is associated with a low number. The average across Australia is 1,000. A number below 1,000 indicates lower socioeconomic status.

Table 6 shows that Canterbury LGA was the most disadvantaged LGA within the IWS catchment, with an index score of socio-economic disadvantage of 922.

Table 6: IRSD by SLA, and rank within IWS, 2011 Statistical Local Area Index score (based on

average of 1000) Minimum score for

SA1s in area

Maximum score for SA1s

in area

Rank (SLAs within IWS)

Ashfield (A) 1,015 856 1,112 8 Burwood (A) 996 870 1,073 9 Canada Bay (A) - Concord 1,066 948 1,140 3 Canada Bay (A) - Drummoyne

1,068 819 1,138 2

Canterbury (C) 922 413 1,081 10 Leichhardt (A) 1,079 733 1,150 1 Marrickville (A) 1,022 498 1,135 6 Strathfield (A) 1,022 749 1,134 5 Sydney (C) - South 1,017 435 1,138 7 Sydney (C) - West 1,022 615 1,138 4 IWS 1,006 413 1,150 Source: Australian Bureau of Statistics (2011)

Table 7 and Figure 5 show the variance of the index score for socio-economic disadvantage across the suburbs that make up Canterbury LGA. The suburbs of Punchbowl and Riverwood had the lowest index score for socio-economic disadvantage (858) in Canterbury LGA, indicating a greater level of disadvantage in the suburb when compared to Ashbury (1,057).

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Table 7: IRSD by Suburbs within Canterbury LGA, and rank within IWS, 2011 State Suburbs within

Canterbury LGA Score Rank within IWS* Rank within

Most disadvantaged to Least disadvantaged Punchbowl 858 1

518

Riverwood 858 2 520 Wiley Park 859 3 521 Lakemba 861 4 532 Campsie 895 6 848 Belmore 903 8

974

Narwee 948 10 1,904 Clemton Park 955 11 2,113 Canterbury (NSW) 967 12 2,483 Belfield 968 13 2,502 Roselands 969 14 2,545 Kingsgrove 994 22 3,461 Beverly Hills 1,000 23 3,766 Croydon Park 1,005 25 3,938 Hurlstone Park 1,010 27 4,207 Earlwood 1,013 28 4,345 Ashbury 1,057 53 6,390

Source: 2033.0.55.001-SEIFA, 2011. *77 suburbs within the IWS catchment were allocated an index score for socio-economic

disadvantage.

Figure 5: Comparison of SEIFA Disadvantage percentiles within Canterbury LGA, 2011


Average annual household incomes within the Canterbury LGA were the lowest of any LGA within the IWS catchment. Disadvantage within the Canterbury LGA was further reinforced by its high level of unemployment, which was the highest of any LGA within the IWS catchment at 7.3%, compared with a NSW average unemployment rate of 5.7%4.

4 Public Health Information Development Unit and Australian Bureau of Statistics (2009)

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2.7 Homelessness

In SLHD in 2011, there were an estimated 4068 people living with homelessness. This constituted 14% of NSW homelessness. Census data indicated that in SLHD in 2011:

• 25% were in severely overcrowded dwellings5 • 1% were sleeping rough • 57% of homeless people were living in boarding houses • There were less rough sleepers and more people in boarding houses than in

SESLHD.

In addition to Census data, a survey of mental health inpatients in SLHD and South Western Sydney LHD indicated that 20% were affected by unstable housing, and over a quarter of these people reported rough sleeping6.

Table 8: Estimates of homelessness: Canterbury LGA and NSW, 2011 Type of homelessness Number of people Persons in supported accommodation for the homeless 37 Persons staying in boarding houses 108 Persons in other temporary lodging 0 Persons living in ‘severely’ crowded dwellings 459 All homeless persons 663 Source: Australian Bureau of Statistics (2011)


The statistical area of Canterbury (SA3) had a homeless population of 663 in 2011 (Table 8). The percentage of the total homeless population that resided in a boarding house (16%) in Canterbury LGA was notably lower than the State (21%), whilst persons living in ‘severely’ crowded dwellings (69%), was well above the State (33%). The Canterbury LGA had the third lowest number of boarding houses (19) in the IWS catchment, only above Canada Bay (9) and the Strathfield LGA (6)7.

5 Severely crowded dwellings in the Census are defined as a dwelling which requires 4 or more extra bedrooms to accommodate the people who usually live there. 6 Homelessness in SLHD. Public Health Observatory. Population Health. SLHD. 2014 7 NSW Fair Trading: Boarding House Register. http://parkspr.fairtrading.nsw.gov.au/BoardingHouse.aspx. Accessed 29.01.2015

Figure 6: Type of Homelessness: Canterbury and NSWW W2011

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6% 16%

69%

17% 21%

33%

0%10%20%30%40%50%60%70%80%

Persons in supportedaccommodation for the

homeless

Persons staying inboarding houses

Persons living in'severely' crowded

dwellings

Canterbury

NSW

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http://parkspr.fairtrading.nsw.gov.au/BoardingHouse.aspx


3 HEALTH RISKS OF THE POPULATION 3.1 Health Risk Factors Figure 7 and Table 9 shows that modelled estimates of the prevalence of current smoking and obesity in Canterbury LGA were higher compared to the IWS catchment, but similar to NSW. In contrast, the estimated prevalence of risky alcohol consumption, psychological distress and overweight in Canterbury LGA were similar to both the IWS catchment and NSW levels.

Figure 7: Modelled estimates of health risk factors: Canterbury LGA, IWS and NSW, 2011-2013

Source: PHIDU - 2011-2013 National Health Survey Refer to Appendix B 1.3 for definitions of Health Risk Factors

Table 9: Modelled estimates of health risk factors: Canterbury LGA, IWS and NSW, 2011-2013 Indicator Canterbury Inner West

New South Wales

Current Smokers 15.3 [14.1-16.4] 12.9 [12.4-13.4] 16.2 [16.1-16.4] Risk Alcohol Consumption 4.5 [3.6-5.4] 4.6 [4.2-5.0] 4.8 [4.7-4.9] Psychologically Distressed 11.1 [9.6-12.6] 10.2 [9.5-10.8] 10.5 [10.3-10.7] Overweight 33.9 [31.5-36.2] 33.4 [32.3-34.5] 34.6 [34.3-34.9] Obese 25.4 [23.6-27.2] 20.1 [19.4-20.8] 26.4 [26.2-26.6] Source: PHIDU - 2011-2013 National Health Survey. Refer to Appendix B 1.3 for definitions of Health Risk Factors

Overall, Canterbury LGA residents had significantly fewer health behaviour related hospital separations per capita compared to the state (Table 10).

Table 10: Health behaviour related hospitalisations, Canterbury LGA, 2012-13 to 2013-14 Indicator Year Smoothed

number ti /

Smoothed rate/

100 000

sSSR8 [95% CI]

Smoking attributable 2012-14 704.6 499.2 79.7 [75.6-83.9]

Significantly lower than the state

High body mass index attributable

2012-14 619.3 452.7 86.5 [82-91.2] Significantly lower than the state

High blood pressure attributable

2012-14 925.9 1,109.4 84.2 [80.6-87.9]


Alcohol attributable 2012-14 634.1 438.8 61.4 [58.1-64.7]


Fall-related injury 2012-14 954 678.6 81.1 [77.7-84.7]


Source: Health Statistics NSW Centre for Epidemiology and Evidence, NSW Ministry of Health. sSSR: Smoothed estimate of standardised separation ratio; CI: Confidence interval

8 The smoothed estimate of standardised prevalence and mortality ratio enables comparison with the state average set at 100.

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Data on other health behaviours included in Table 11 are not available for LGAs. However, health behaviours of residents living in the IWS catchment were similar to the entire population of NSW. On average, less than 1 in 10 persons consumed the recommended vegetable intake, whereas approximately 50% of persons achieved the recommended fruit consumption. An estimated 51.5% of persons in NSW aged 16 years or more engaged in adequate levels of physical activity, whereas IWS residents performed slightly better, with an estimated 58.1% of persons having achieved recommended levels.

Table 11: Health behaviours of residents: IWS and NSW (% [95% CI]), 2013 Indicator IWS NSW

Consumes more than 2 standard drinks per day when drinking alcohol, persons aged 16+ years

29.3 [25.6-33.1]

26.6 [25.5-27.8]

Adequate physical activity, persons aged 16+ years 58.1 [54.0-62.1]

51.5 [50.2-52.7]

Recommended vegetable consumption, persons aged 16 and over 9.9 [7.2-12.5] 9.4 [8.7-10.1]

Recommended fruit consumption, persons aged 16 years and over 52.1 [48.0-56.2]

51.8 [50.6-53.1]

Vaccinated against influenza in the last 12 months, 65 years and over 64.5 [55.7-73.4]

71.0 [68.9-73.0]

Vaccinated against pneumococcal disease, persons aged 65 years 44.6 [34.6-54.5]

49.9 [47.5-52.2]

Source: 2013 NSW Adult Population Health Survey (SAPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health. CI: Confidence interval9

9 A confidence interval is a range around a measurement that conveys how precise the measurement is.

Page 14 of 41


4 LONG TERM CONDITIONS AND CHRONIC DISEASE 4.1 Prevalence of Chronic Disease The most prevalent chronic conditions across Canterbury LGA and the state were respiratory system diseases and musculoskeletal diseases. There is a trend for increased estimated age-standardised prevalence of type 2 diabetes in Canterbury LGA compared to IWS, with estimated levels being clearly higher than NSW. The estimated prevalence of mental and behavioural disorders and circulatory system diseases were similar across Canterbury LGA, IWS and NSW. There were trends for decreased estimated prevalence of respiratory system diseases and musculoskeletal diseases in Canterbury LGA compared to the state. However, levels of these diseases were similar to IWS (Figure 8 and Table 12).

Figure 8: Modelled estimates of prevalence of chronic conditions: Canterbury LGA, IWS and NSW, 2011-2013

Source: Public Health Information Development Unit - 2011-2013 National Health Survey

Table 12: Modelled estimates of prevalence of chronic conditions, ASR per 100 [95% CI], 2011-13

Indicator Canterbury LGA IWS NSW Type 2 Diabetes 9.7 [7.9-11.6] 7.4 [6.7-8.1] 5.8 [5.6-5.9] Mental and Behavioural Disorders 12.2 [11.1-13.3] 12.4 [11.8-12.9] 13.1 [13.0-13.3] Circulatory System Diseases 18.5 [17.0-19.9] 17.8 [17.1-18.5] 17.8 [17.6-17.9] Respiratory System Diseases 24.9 [22.5-27.3] 24.4 [23.3-25.5] 27.4 [27.1-27.7] Musculoskeletal Diseases 26.2 [23.6-28.8] 26.1 [24.8-27.3] 28.1 [27.8-28.5] Source: Public Health Information Development Unit - 2011-2013 National Health Survey. ASR: Age standardised rate; CI: Confidence interval

In terms of chronic disease burden, Table 13 shows that Canterbury LGA residents had similar estimated prevalence of chronic obstructive pulmonary disease, hypertension (18+ years) and arthritis compared to IWS and NSW. However, Canterbury LGA residents were estimated to have poorer levels of fair or poor self-assessed health. The estimated prevalence of asthma in Canterbury LGA was lower relative to the state, but similar to IWS.

Page 15 of 41


Table 13: Modelled estimates of chronic disease burden (ASR per 100 [95% CI]): Canterbury LGA, IWs and NSW, 2011-2013

Indicator Canterbury LGA IWS NSW Fair or poor self-assessed health, > 15 years

18.5 [17-20.1] 14.3 [13.7-14.9] 14.3 [14.2-14.5]

Asthma 6.7 [6-7.5] 7.2 [6.8-7.6] 9.6 [9.5-9.7]

Chronic Obstructive Pulmonary Disease

2.3 [1.8-2.8] 2.3 [2-2.5] 2.6 [2.6-2.7]

Hypertension, > 18 years 10.8 [9.5-12.2] 10.7 [10.1-11.4] 10.5 [10.4-10.7]

Arthritis 14.9 [13.8-16] 13.9 [13.3-14.4] 15.3 [15.1-15.4]

Source: Public Health Information Development Unit - 2011-13 National Health Survey ASR: Age standardised rate; CI: Confidence interval

Overall, Canterbury LGA residents had significantly fewer hospital separations per capita compared to the state. However, the rates of asthma-related hospitalisations were higher in Canterbury LGA compared to NSW (Table 14).

Table 14: Indicators of burden of disease - hospital separations by cause: Canterbury LGA, 2012-14

Indicator Year Smoothed number

separations/ year

Smoothed rate/

100,000

sSSR10[95% CI]

Potentially preventable

2012-14 3,112 2,160 88.7 [86.6-91]

Significantly lower than the

state Chronic obstructive pulmonary disease

2012-14 293 1,389 92.9 [85.8-100.3]

Not significantly different to the

state Coronary heart

disease 2012-14 743 540.5 81.1 [77-

85.2] Significantly

lower than the state

Circulatory disease 2012-14 2,498 1,804 97.2 [84.7-89.5]

Significantly lower than the

state Stroke 2012-14 47 132.1 76.5 [63.3-

91.7] Significantly


Asthma 2012-14 305 193.6 111.3 [102.5-120.5]

Significantly higher than the

state Influenza and

pneumonia 2012-14 414 288.9 86.9 [81.1-

92.8] Significantly


Source: Health Statistics NSW, Centre for Epidemiology and Evidence, NSW Ministry of Health. sSSR: Smoothed estimate of standardised separation ratio; CI: Confidence interval

10 The smoothed estimate of standardised separation and mortality ratio enables comparison with the state average set at 100.

Page 16 of 41


The rates of high body mass index, alcohol-and smoking-attributable deaths in Canterbury LGA were not significantly different to state levels (Table 15).

Table 15: High body mass index, alcohol and smoking attributable deaths: Canterbury LGA Indicator Year Smoothed

number of deaths/year

Smoothed rate/ 100,000

sSMR8 [95% CI]

High body mass index

2011 51 38.9 99.9 [87.3-115.1]

Not significantly different to the

state Alcohol 2011-

12 20.4 14.9 86.1 [71.7-

102.2] Not significantly different to the

state Smoking 2012 84 61.7 85.1 [73-98.3] Lower than the

state but not significantly

Source: Health Statistics NSW, Centre for Epidemiology and Evidence, NSW Ministry of Health. sSMR: Smoothed estimate of standardised mortality ratio; CI: Confidence interval

Page 17 of 41


4.2 Cancer Information on the incidence and age-standardised rates of cancer over the period 2004 to 2008 is presented in Figure 9 and Table 16. Prostate, breast, colon and lung cancer were the most common cancers in Canterbury LGA over this period.

Figure 9: Age-standardised incidence of selected cancers per 100,000 persons: Canterbury LGA, IWS and NSW, 2004 to 2008

Source: NSW Central Cancer Registry, Cancer Institute NSW

When compared to the state, the overall age-standardised rate of cancer was lower in Canterbury LGA residents, with significantly lower rates observed for breast, lip, melanoma, mesothelioma, prostate, and rectal cancer. There was also a trend for lower incidence of oesophageal cancer in Canterbury LGA relative to NSW. In contrast, rates of bladder, liver, lung, stomach and thyroid cancers were higher in Canterbury LGA relative to NSW.

Page 18 of 41


Table 16: Age standardised cancer incidence rates (per 100,000) by cancer site, 2004 to 2008 Cancer Site Canterbury LGA IWS NSW

Count Rate Count Rate Count Rate All types 2,984 435.6 [420.1-

451.5] 11,397 449.1 [440.8-

457.4] 177,519 483.2 [481.0-

485.5]

Bladder 89 13.0 [10.4-16.0] 243 9.7 [8.5-11.0] 3,631 9.7 [9.3-10.0]

Brain 40 5.9 [4.2-8.0] 166 6.3 [5.4-7.3] 2,356 6.6 [6.3-6.8]

Breast 337 49.5 [44.4-55.1] 1,447 56.2 [53.3-59.1] 21,102 58.2 [57.5-59.0]

Cervix 20 2.9 [1.8-4.5] 92 3.3 [2.7-4.1] 1,228 3.5 [3.3-3.7]

Colon 279 40.8 [36.2-45.9] 988 39.5 [37.1-42.0] 15,072 40.6 [39.9-41.2]

Head and neck 96 14.0 [11.4-17.1] 370 14.6 [13.1-16.1] 4,686 12.8 [12.5-13.2]

Kidney 83 12.1 [9.7-15.0] 321 12.8 [11.4-14.3] 4,857 13.2 [12.9-13.6]

Leukaemia 71 10.4 [8.1-13.1] 314 12.5 [11.1-13.9] 4,605 12.6 [12.3-13.0]

Lip 6 0.9 [0.3-1.9] 44 1.8 [1.3-2.4] 1,203 3.3 [3.1-3.5] Liver 63 9.1 [7.0-11.7] 224 8.9 [7.8-10.1] 2,088 5.7 [5.4-5.9]

Lung 355 51.4 [46.2-57.1] 1,157 46.5 [43.9-49.3] 15,905 43.0 [42.3-43.7]

Melanoma of skin

139 20.4 [17.1-24.1] 726 27.8 [25.8-29.9] 17,716 48.8 [48.1-49.5]

Mesothelioma 9 1.3 [0.6-2.5] 56 2.2 [1.7-2.9] 1,047 2.8 [2.6-3.0]

Myelodysplasia 59 8.6 [6.5-11.1] 195 7.8 [6.7-8.9] 2,817 7.5 [7.2-7.8] Non-Hodgkin’s lymphoma

122 17.9 [14.9-21.4] 485 18.9 [17.2-20.7] 6,828 18.6 [18.2-19.1]

Oesophagus 26 3.8 [2.5-5.6] 108 4.3 [3.5-5.1] 2,024 5.4 [5.2-5.7]

Ovary 54 7.9 [6.0-10.4] 195 7.6 [6.6-8.8] 2,191 6.0 [5.8-6.3]

Pancreas 85 12.3 [9.9-15.3] 275 11.0 [9.7-12.3] 4,062 10.9 [10.5-11.2]

Prostate 433 62.7 [57.0-68.9] 1,647 66.3 [63.1-69.6] 31,321 84.4 [83.4-85.3] Rectal 123 18.2 [15.1-21.7] 501 19.9 [18.2-21.8] 8,338 22.6 [22.1-23.1]

Stomach 81 11.8 [9.4-14.6] 285 11.4 [10.1-12.8] 3,275 8.8 [8.5-9.1]

Testis 19 2.7 [1.6-4.3] 80 2.6 [2.1-3.2] 1,084 3.2 [3.0-3.4]

Thyroid 98 14.4 [11.7-17.6] 316 11.7 [10.4-13.1] 3,301 9.4 [9.1-9.8]

Unspecified site

97 14.2 [11.5-17.3] 364 14.4 [13.0-16.0] 6,014 16.0 [15.6-16.4]

Uterus(body) 53 7.8 [5.8-10.2] 190 7.5 [6.5-8.6] 3,043 8.3 [8.0-8.6]

All Others 147 21.4 [18.1-25.2] 608 23.7 [21.8-25.7] 7,725 21.3 [20.8-21.7] Source: NSW Central Cancer Registry, Cancer Institute NSW. **Cell counts less than 5 are left blank Cancer-related mortality for Canterbury LGA, IWS and NSW is presented in Table 17. Between 2004 and 2008, cancer was the primary cause of death for 1282 persons in Canterbury LGA, with lung, colon, prostate and pancreas cancers the leading types.

The overall age-standardised rate of cancer-related deaths in Canterbury LGA (187.7 per 100,000) was significantly higher than the state (176.9 per 100,000), with higher rates of mortality observed for bladder, liver and lung cancers. A trend for increased mortality from head and neck cancer in Canterbury LGA compared to NSW was also observed. On the other hand, a trend for decreased mortality from breast cancer was observed in Canterbury LGA relative to NSW.

Page 19 of 41


Table 17: Age standardised mortality rates (per 100,000) by cancer site, 2004 - 2008 Cancer Site Canterbury LGA IWS NSW

Site Count Rate Count Rate Count Rate All types 1,282 187.7 [177.6-

198.3] 4,547 181.0 [175.7-

186.3] 66,228 176.9 [175.5-178.2]

Bladder 45 6.6 [4.8-8.8] 106 4.2 [3.4-5.1] 1,644 4.3 [4.1-4.5]

Brain 38 5.5 [3.9-7.6] 126 4.9 [4.1-5.8] 1,716 4.7 [4.5-5.0]

Breast 70 10.2 [8.0-12.9] 296 11.7 [10.4-13.1] 4,693 12.6 [12.3-13.0]

Cervix 5 0.7 [0.2-1.7] 28 1.1 [0.7-1.5] 415 1.1 [1.0-1.2] Colon 99 14.8 [12.0-18.0] 365 14.5 [13.0-16.0] 5,511 14.6 [14.3-15.0]

Head and neck 45 6.6 [4.8-8.8] 154 6.1 [5.2-7.2] 1,762 4.7 [4.5-5.0]

Kidney 25 3.7 [2.4-5.4] 87 3.4 [2.8-4.3] 1,605 4.3 [4.1-4.5]

Leukaemia 32 4.7 [3.2-6.7] 148 5.9 [5.0-6.9] 2,248 6.0 [5.8-6.3]

Liver 46 6.7 [4.9-8.9] 162 6.5 [5.5-7.6] 1,527 4.1 [3.9-4.3]

Lung 275 39.9 [35.3-44.9] 937 37.7 [35.3-40.2] 12,781 34.4 [33.8-35.0]

Non-Hodgkin’s lymphoma

46 6.8 [5.0-9.0] 176 6.9 [5.9-8.0] 2,569 6.8 [6.6-7.1]

Skin melanoma 35 5.2 [3.6-7.3] 125 5.0 [4.1-5.9] 2,314 6.2 [6.0-6.5]

Mesothelioma 9 1.3 [0.6-2.4] 56 2.3 [1.7-3.0] 947 2.5 [2.4-2.7]

Myelodysplasia 23 3.4 [2.1-5.1] 74 2.9 [2.3-3.7] 1,036 2.7 [2.5-2.9]

Oesophagus 20 3.0 [1.8-4.6] 92 3.6 [2.9-4.4] 1,590 4.2 [4.0-4.4]

Ovary 21 3.0 [1.9-4.6] 104 4.2 [3.4-5.1] 1,394 3.7 [3.5-3.9]

Pancreas 80 11.6 [9.2-14.4] 240 9.6 [8.4-10.9] 3,611 9.6 [9.3-9.9]

Prostate 93 13.7 [11.0-16.7] 287 11.4 [10.1-12.8] 4,904 12.8 [12.4-13.1]

Rectal 55 8.1 [6.1-10.5] 194 7.7 [6.7-8.9] 3,018 8.1 [7.8-8.4] Stomach 51 7.6 [5.6-9.9] 182 7.3 [6.2-8.4] 2,232 6.0 [5.7-6.2]

Thyroid ** ** 12 0.5 [0.3-0.9] 168 0.4 [0.4-0.5]

Unspecified 79 11.5 [9.1-14.4] 287 11.4 [10.1-12.8] 4,473 11.8 [11.5-12.2]

Uterus(body) 11 1.6 [0.8-2.9] 43 1.7 [1.2-2.3] 614 1.6 [1.5-1.8]

All Others 74 10.8 [8.5-13.6] 263 10.5 [9.2-11.8] 3,375 9.1 [8.8-9.4] Source: NSW Central Cancer Registry, Cancer Institute NSW. **Cell counts less than 5 are left blank

4.3 Mortality In 2007, life expectancy at birth for males and females in Canterbury LGA is 80.9 and 85.5 years, respectively, which are similar to state (80 and 85 years for males and females, respectively). The standardised mortality from all causes in Canterbury LGA in 2011-13 was slightly lower compared to the state. However, mortality from amenable and preventable causes in Canterbury LGA was similar to NSW levels (Table 18).

Table 18: Deaths from all causes and potentially preventable deaths: Canterbury LGA, 2010-11 Indicator Deaths per year sSMR11 [95% CI] Deaths from all causes 813 91.1 [87.0-95.5]

Amenable to health care 77 97.0 [84.7-110.2]

Preventable causes 115 93.1 [82.3-104.5]

Amenable and preventable causes 193 95.4 [86.9-104.8] Source: Health Statistics NSW Centre for Epidemiology and Evidence, NSW Ministry of Health. sSMR: Smoothed standardised mortality ratio; CI: Confidence interval12

11 The smoothed estimate of standardised prevalence and mortality ratio enables comparison with the state average set at 100. 12 A confidence interval is a range around a measurement that conveys how precise the measurement is.

Page 20 of 41


5 INFECTIOUS DISEASE 5.1 HIV The rate of newly diagnosed HIV infections in NSW in 2014 was 5 cases per 100,000 population. In 2014, there were 82 new HIV infections diagnosed in the IWS catchment. The IWS catchment had the highest rates of newly diagnosed HIV infections in the state at 13.4 cases per 100,000 population (Figure 10). Sydney City (South and West) SLA’s and Marrickville LGA had the highest notification rates, at 45 and 19 cases per 100,000 population, respectively (Figure 11 and Table 19). Figure 10: Number and rate of notifications of newly diagnosed HIV infection in IWS, 2005-2014

Source: NSW HIV/AIDS database. (Accessed 21/04/2015)

Figure 11: HIV notification rate (per 100,000 of population), by LGA, IWS 2005-2014

Source: NSW HIV/AIDS database. (Accessed 21/04/2015)

Table 19: HIV notification rate (per 100,000 of population), by LGA, IWS, 2005-2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 15 5 8 3 7 7 5 5 2 1 Burwood 10 5 6 5 4 5 2 11 0 5 Canada Bay 9 9 3 6 4 5 1 6 2 4 Canterbury 2 5 11 2 4 5 4 3 7 5 Leichhardt 14 6 4 15 7 7 13 11 5 0 Marrickville 32 28 26 24 28 16 27 28 27 19 Strathfield 5 7 10 3 0 3 3 10 0 2 Sydney City* 54 38 46 42 51 41 43 59 47 45 * Sydney City (South and West SLAs). Source: NSW HIV/AIDS database. (Accessed 18/05/2015)

0.0

5.0

10.0

15.0

20.0

25.0

0

20

40

60

80

100

120

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Total notifications Notification rate/100,000 population

Tota

l not

ifica

tions

Rate

/100

,000

pop

ulat

ion

0

10

20

30

40

50

60

70

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

AshfieldBurwoodCanada BayCanterburyLeichhardtMarrickvilleStrathfieldSydney*

Ra

te/1

00,0

00 p

erso

ns

Page 21 of 41


In 2014, the average age of newly diagnosed HIV cases in the IWS catchment was 37 years, and 94% of the cases were male. This has remained constant since 2004. In 2014, 48% of all HIV notifications were in Australian born residents. Of the total notifications (50%) in Australian residents born overseas, 39% were born in a high prevalence country and 11% were born in a low prevalence country. In 2014, 59% of newly diagnosed HIV infections were defined as at an early stage of infection and there was a 13% increase in notifications classified as early between 2013 and 2014. For the period 2005 to 2014, on average, greater than 88% of all notifications were homosexually acquired, 6% heterosexually acquired and 2% acquired through injecting drug use (IDU).

5.2 Chlamydia Between 2010 and 2014, notification rates for chlamydia remained higher in the IWS catchment compared to NSW. In 2014, the IWS catchment had 1.5 times the rate of chlamydia notifications compared to NSW i.e. 36.8 versus 26.4 cases/100,000 population (Figure 12). Around half of all cases from 2010 to 2014 occurred in the 20-29 year age group. In 2014, 54% of cases were male, with males continuing to have slightly higher rates of chlamydia in the IWS catchment compared to females.

Figure 12: Chlamydia notifications (per 100,000 population) for IWS and NSW, 2010 to 2014

Source: NSW NCIMS database. (Accessed 26/02/2015) Table 20 shows that Sydney and Marrickville LGAs had the highest chlamydia notification rates of all LGAs in IWS. During the period from 2009 to 2014 there was almost a doubling of the notification rate for Sydney from 529 to 1009 cases/100,000 population.

Table 20: Chlamydia notifications (per 100,000 population), by LGA, 2005 to 2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 173.9 143.0 188.5 180.1 177.7 213.8 218.2 244.6 244.5 259.9 Burwood 183.0 127.3 182.4 251.9 225.5 195.1 266.3 270.8 221.0 310.5 Canada Bay 124.0 143.5 128.2 178.4 161.9 212.3 219.8 254.0 242.6 268.7 Canterbury 126.3 148.4 114.0 134.5 152.8 164.7 202.6 187.3 209.6 208.2 Leichhardt 261.2 253.7 243.8 235.3 216.2 238.3 316.3 271.6 284.8 318.5 Marrickville 302.4 338.3 338.7 346.0 323.1 362.0 457.3 496.8 561.1 629.1 Strathfield 152.4 136.2 175.3 189.6 136.6 181.1 244.4 244.3 273.7 257.4 Sydney City* 542.8 490.9 556.4 573.0 529.0 636.3 703.7 762.3 732.8 1009.2 * Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

051015202530354045

0

50

100

150

200

250

300

01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11

2010 2011 2012 2013 2014

Rate

/100

,000

pop

ulat

ion

Tota

l Not

ifica

tions

Total notifications IWS IWS notification rate/100,000 population NSW notification rate/100,000 population

Page 22 of 41


5.3 Gonorrhoea The IWS catchment continues to have notification rates of gonorrhoea that are 2-3 times greater than NSW. In 2014, the average annual notification rate per 100,000 was 14.4 for IWS versus 5.3 for all of NSW (Figure 13). In 2014, the notification rate for males was almost 10 times higher than for females. Greater than 50% of all cases occured in the 20-39 age group for both sexes. Marrickville LGA and Sydney City (South and West) SLA’s continue to have the highest notification rates in the IWS catchment (Figure 14 and Table 21).

Figure 13: Gonorrhoea notifications (per 100,000 population), by IWS and NSW, 2010 to 2014

Source: NSW NCIMS database. (Accessed 26/02/2015)

Figure 14: Gonorrhoea notification rate (per 100,000 population), by LGA, 2005-2014

* Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

Table 21: Gonorrhoea notification rate (per 100,000 population) LGA, IWS, 2005-2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 24.5 29.1 16.7 16.6 30.4 30.2 36.8 57.1 77.0 96.3 Burwood 18.9 21.7 9.1 30.0 23.7 35.5 58.5 72.0 59.5 119.2 Canada Bay 28.4 24.9 21.4 22.1 23.9 23.2 47.5 59.6 67.1 54.0 Canterbury 24.7 27.4 19.0 12.2 28.2 29.2 44.1 56.5 41.6 59.9 Leichhardt 35.4 37.1 46.1 28.2 35.1 65.5 59.3 87.0 108.3 91.8 Marrickville 143.2 131.8 90.2 66.6 70.7 129.4 150.4 288.8 266.6 315.2 Strathfield 37.3 21.2 32.1 25.5 27.3 35.1 34.9 39.8 73.0 38.6 Sydney* 196.7 225.8 160.0 136.2 164.5 243.3 274.2 374.7 471.9 460.7 * Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

02468101214161820

0

20

40

60

80

100

120

01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11

2010 2011 2012 2013 2014IWS total notifications IWS notification rate/100,000 population NSW notification rate/100,000 population

Tota

l not

ifica

tions

Rate

/100

,000

pop

ulat

ion

050

100150200250300350400450500

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

AshfieldBurwoodCanada BayCanterburyLeichhardtMarrickvilleStrathfieldSydneyRa

te/1

00,0

00 p

opul

atio

n

Page 23 of 41


5.4 Infectious Syphilis Figure 15 shows the infectious syphilis notification rate remained relatively stable between 2010 and 2012 for the IWS catchment, but increased between 2013 and 2014 to almost three times the average annual notification rate in NSW. Males comprised the vast majority (98%) of cases of infectious syphilis in 2014. The highest proportion of cases occured in the 40-49 year age group. Marrickville LGA and Sydney City (South and West) SLA’s continue to have the highest notification rates (Figure 16 and Table 22).

Figure 15: Infectious syphilis notification rate (per 100,000 population), by IWS and NSW, 2010-2014


Figure 16:Infectious Syphilis notification rate (per 100,000) by LGA and IWS, 2005 – 2014


Table 22: Infectious syphilis notification rate (per 100,000) by LGA, IWS, 2005 – 2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 0.0 9.7 7.2 2.4 4.7 18.6 4.6 6.9 13.6 13.4 Burwood 0.0 6.2 3.0 12.0 5.9 8.9 11.7 5.8 8.5 27.7 Canada

4.5 1.5 2.8 2.8 1.3 1.3 5.0 3.6 8.2 14.9

Canterbury 3.7 2.2 4.4 6.4 2.1 3.5 1.4 5.4 9.4 8.6 Leichhardt 11.8 9.8 21.1 11.3 18.5 9.1 14.4 10.6 10.5 32.9 Marrickville 14.7 13.3 26.2 32.0 56.8 29.9 29.6 34.3 58.2 69.5 Strathfield 6.2 6.1 0.0 5.7 5.5 2.7 0.0 0.0 7.8 0.0 Sydney* 30.8 44.5 79.5 68.6 83.7 74.3 54.3 65.1 116.4 150.9 * Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

0

1

2

3

4

5

6

0

5

10

15

20

25

30

35

01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11 01 03 05 07 09 11

2010 2011 2012 2013 2014

IWS total notifications IWS notification rate/100,000 population NSW notification rate/100,000 population

Tota

l not

ifica

tions

Rate

/100

,000

pop

ulat

ion

020406080

100120140160

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

AshfieldBurwoodCanada BayCanterburyLeichhardtMarrickvilleStrathfieldSydney

Rate

/100

,000

pop

ulat

ion

Page 24 of 41


5.5 Hepatitis B For the IWS catchment, the hepatitis B notification rate has remained relatively stable between 2010 and 2014. However, notification rates were consistently higher in the IWS catchment relative to NSW, and in 2014, was almost twice the rate of NSW (Figure 17).

Figure 17: Hepatitis B notification rate (per 100,000 population), by IWS and NSW 2005-2014


Males continue to have higher rates of hepatitis B infection (69.7 notifications/100 000 population) compared to females (56.8 notifications/100 000 population). In 2014 the 20-39 year age group had the highest number of notifications for both males and females. The LGAs with the highest notification rates for 2014 were (in decreasing order): Strathfield, Burwood, Canterbury and Ashfield LGA’s (Figure 18 and Table 23).

Figure 18: Hepatitis B notification rate (per 100,000) by LGA and IWS, 2005 – 2014


Table 23: Hepatitis B age-standardised notification rate (per 100,000) by LGA, IWS, 2005 – 2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 92.2 78.0 99.4 91.5 101.8 66.2 74.1 106.3 73.7 73.8 Burwood 126.3 117.1 99.0 76.5 95.5 84.7 68.6 83.5 99.2 88.5 Canada Bay 46.5 37.1 36.9 30.4 43.7 50.4 38.8 35.4 49.8 45.8 Canterbury 109.3 102.6 90.0 87.2 85.4 75.2 80.0 71.4 80.9 82.9 Leichhardt 14.1 9.4 25.3 16.0 17.2 10.8 14.0 9.6 17.6 15.3 Marrickville 73.0 75.2 60.5 55.6 54.2 44.1 51.0 41.0 41.4 37.1 Strathfield 130.3 92.6 67.6 88.4 75.4 81.1 70.6 89.2 68.1 89.3 Sydney* 84.0 56.6 62.3 51.5 48.5 50.6 48.8 54.3 47.3 45.6 * Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

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2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Total number of notifications IWS Age-standardised rate IWS Age-standardised rate NSW

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Page 25 of 41


5.6 Hepatitis C The hepatitis C notification rate has decreased over time in the IWS catchment, and in 2014 was the same as the NSW notification rate (Figure 19). In 2014, notifications in males occurred at more than twice the rate (68.7 notifications/100 000 population) as those in females (33.3 notifications/100,000 population). The highest numbers of notifications were in the 20-39 year age group for females and in the 30-49 year age group for males. The LGAs with the highest notification rates for 2014 were (in decreasing order): Sydney City (South and West) SLA’s, Ashfield, Leichhardt and Marrickville LGA’s (Figure 20).

Figure 19: Hepatitis C notification rate (per 100,000 population), by IWS and NSW, 2005-2014


Figure 20: Hepatitis C notification rate (per 100,000) by LGA and IWS, 2005 – 2014


Table 24: Hepatitis C age-standardised notification rate (per 100,000) by LGA, IWS, 2005 – 2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 65.4 61.7 62.8 43.8 41.6 35.0 37.6 32.4 27.9 59.9 Burwood 57.8 58.0 36.1 21.5 27.6 34.1 40.3 33.0 15.9 18.5 Canada Bay 29.5 31.8 23.3 18.9 30.9 30.5 25.8 21.3 12.6 16.4 Canterbury 56.8 41.0 41.1 41.4 40.5 38.4 39.5 35.0 44.1 29.7 Leichhardt 46.7 54.1 38.1 31.2 75.2 65.3 50.5 62.2 75.1 47.9 Marrickville 113.1 87.8 83.5 66.2 83.4 66.2 66.6 66.3 63.3 47.9 Strathfield 38.6 40.8 47.7 21.6 25.6 39.9 20.0 20.9 26.6 18.3 Sydney* 120.1 128.0 108.2 85.7 102.8 117.9 87.4 72.6 85.9 117.9 * Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

0102030405060708090

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Page 26 of 41


6 HEALTH SERVICE UTILISATION 6.1 Primary Care Utilisation The age standardised rate of primary care services (per 100,000) is presented in Table 25, with age-standardised ratios and statistical comparisons to national levels displayed in Figure 21. The rate of 45 year old health checks in Canterbury LGA was slightly higher compared to IWS and state levels. The standardised rates of general practitioner (GP) health assessments (75 years or more), GP enhanced primary care and GP practice nurse services in Canterbury LGA were similar to the IWS catchment, but lower compared to state levels. The rate of GP mental health care plans was lower in Canterbury LGA compared to the IWS catchment and NSW.

Table 25: Primary care services, age standardised rate per 100,000: Canterbury LGA, IWS and NSW, 2010

Indicator Canterbury LGA

Inner West Sydney New South Wales

45 year old health checks^ 5,392.5 4,796.6 4,627.8

GP health assessment (75+) 18,787.4 17,377.5 20,867.4

GP enhanced primary care 2,220.8 2,147.8 2,618.4

GP practice nurse services 15,786.4 16,320.0 29,844.9

GP Mental Health care plans 6,097.5 7,625.4 8,222.3

Source: Public Health Information Development Unit and Department of Health and Ageing (2014) ^For persons aged between 45-49 years

Figure 21: Primary care services age standardised ratio: Canterbury LGA, IWS and NSW, 2010

Source: Public Health Information Development Unit and Department of Health and Ageing (2014)

Dashed line: National reference level; * Significantly different to state at 95% confidence level; ** Significantly different to state at 99% confidence level ^For persons aged between 45-49 years

Page 27 of 41


6.2 Emergency Department Presentations The distribution of emergency department presentations by Canterbury LGA residents across hospitals in the IWS catchment and all other NSW hospitals is presented in Table 26. Canterbury Hospital provided the largest percentage of emergency department presentations by Canterbury LGA residents (54.6%), constituting 63.1% of all emergency department visits at Canterbury Hospital.

Table 26: Emergency department presentations (%) by hospital: Canterbury LGA, 2013 Indicator Canterbury

hospital Concord hospital

RPA hospital

Other NSW hospitals

Total

LGA Presentations

24,214 (54.6) 1,668 (3.8) 4,058 (9.2) 14,392 (32.5) 44,332 (100)

All Presentations

38,397 (1.5) 36,662 (1.4) 71,576 (2.8) 2,410,994 (94.3) 2,557,629 (100)

Canterbury % of total

63.1 4.5 5.7 0.6 1.7

Source: NSW Admitted Patient Data Collection, Centre for Epidemiology and Evidence, NSW Ministry of Health

The rates of emergency department presentations (per 1,000 persons) by triage category are shown in Table 27. The age-standardised rates of emergency department presentations for all triage classifications were significantly higher for Canterbury LGA residents compared to IWS. The largest percentage increases in rates were observed for non-urgent and emergency triage categories.

Table 27: Emergency department presentations (per 1,000 persons) by triage category by LGA, 2013

LGA Non-urgent Semi Urgent Urgent Emergency Resuscitation Ashfield 16.5 [15.3-

17.7] 82.6 [80.0-85.2] 88.3 [85.7-90.9] 31.4 [29.8-

33.0] 1.7 [1.3-2.0]

Burwood 15.0 [13.7-16.3]

100.2 [97.0-103.5] 80.9 [78.0-83.8] 26.1 [24.4-27.7]

2.2 [1.8-2.7]

Canada Bay

15.1 [14.3-15.9]

105.6 [103.5-107.7]

75.2 [73.4-77.0] 23.0 [22.0-24.0]

1.7 [1.4-2.0]

Canterbury 22.0 [21.2-22.7]

110.0 [108.4-111.6]

115.2 [113.7-116.8]

41.7 [40.7-42.7]

2.4 [2.2-2.7]

Leichhardt 17.4 [16.3-18.6]

71.5 [69.2-73.7] 92.5 [90.0-94.9] 35.0 [33.5-36.6]

1.3 [1.0-1.7]

Marrickville 21.8 [20.8-22.9]

101.9 [99.7-104.1] 114.8 [112.5-117.1]

43.4 [42.0-44.8]

2.0 [1.7-2.3]

Strathfield 16.4 [15.1-17.7]

114.1 [110.9-117.4]

74.4 [71.7-77.0] 23.5 [21.9-25.0]

2.2 [1.7-2.6]

Sydney 10.4 [9.7-11.0] 36.2 [34.9-37.5] 40.3 [38.9-41.7] 15.6 [14.7-16.5]

0.7 [0.5-0.8]

IWS 17.4 [17.1-17.7]

90.3 [89.6-91.1] 88.6 [87.9-89.3] 31.3 [30.9-31.8]

1.8 [1.7-1.9]

NSW 52.0 [51.8-52.1]

148.6 [148.3-148.8]

103.8 [103.6-104.0]

33.6 [33.5-33.7]

2.0 [2.0-2.0]

Source: NSW Admitted Patient Data Collection, Centre for Epidemiology and Evidence, NSW Ministry of Health

Page 28 of 41


6.3 Hospital Separations

6.3.1 Day-only Hospital Separations Canterbury LGA resident separations from hospital on a day-only13 basis are shown in Table 28. In 2013-14, 43% (12,216 separations) of all day-only separations were provided by SLHD hospitals, followed by private hospitals at 20% (5,800 separations) and South Eastern Sydney LHD hospitals at 12% (3,343 separations) hospitals.

Table 28: Day-only hospital separations for Canterbury LGA residents, 2013-14 Hospital No. of Separations Per cent of Total Separations SLHD Hospitals 12,216 43% Private Hospitals 5,800 20% South Eastern Sydney LHD Hospitals 3,343 12% Private Day Procedure Centres 3,274 11% South Western Sydney LHD Hospitals 2.563 9% Other LHDs 1,459 5% Total 28,655 100% Source Flow-Info v5.0

As shown in Figure 22, 43% (12,216 separations) of Canterbury LGA resident day-only separations occurred in SLHD hospitals. RPA Hospital provided for 46% of the total separations within SLHD (5,645 separations), followed by Concord Hospital at 38% (4,614 separations) and Canterbury Hospital 16% (1,906 separations).

Figure 22: Day-only hospital separations for Canterbury LGA residents, 2013-14

Source Flow-Info v5.0

13 Day-only Separations: A person who is admitted to hospital and leaves on the same calendar day

Private Hospitals 20% (n=5800)

Private Day Procedure Centres

11% (n=3274)

South Eastern Sydney

12% (n=3343)

South Western Sydney

9% (n=2563)

Other LHDs 5%(n=1459)

Concord 38% (n=4614)

Royal Prince Alfred 46% (n=5645)

Canterbury 16% (n= 1906)

Sydney LHD 43% (n=12216)

Page 29 of 41


6.3.2 Overnight Hospital Separations

The breakdown of Canterbury LGA resident overnight14 hospitalisations is shown in Table 29. In 2013-14, the majority (58%; 13,653 separations) of all overnight hospital separations were provided by SLHD hospitals, followed by private hospitals at 15% (3,416 separations) and South Eastern Sydney hospitals at 12 % (2,888 separations).

Table 29: Overnight hospital separations for Canterbury LGA residents, 2013-14 Hospital No. of Separations Percent of Total Separations SLHD Hospitals 13,653 58% Private Hospitals 3,416 15% South Eastern Sydney LHD Hospitals 2,888 12% South Western Sydney Hospitals 2,363 10% Other LHD Hospitals 1,414 6% Total 23,734 100% Source Flow-Info v5.0

As shown in Figure 23, SLHD hospitals provided for 58% (13,653 separations) of all Canterbury LGA resident overnight separations. Canterbury Hospital provided 8,451 or 62% of the total overnight separations within SLHD, followed by RPA Hospital at 22% (3,064 separations) and Concord Hospital at 14% ( 1,849 separations)

Figure 23: Overnight hospital separations for Canterbury LGA residents, 2013-14

Source Flow-Info v5.0

14 Overnight Separations: A person who is admitted to hospital and leaves on a different calendar day.

Private Hospitals 15% (n=3416)

South Eastern Sydney

12% (n=2888)

South Western Sydney

10% (n=2363)

Other LHDs 6% (n=1414)

Concord 14% (n=1849)

Royal Prince Alfred 22% (n=3064) Canterbury

62% (n=8451)

Sydney LHD 58% (n=13653)

Page 30 of 41


6.4 Ambulatory Care Sensitive Admissions The numbers and rates of potentially preventable hospital separations classified as Ambulatory Care Sensitive Conditions (ACSCs) by IWS LGAs are presented in Table 30 and Figure 24 ACSC admissions are those in which the resulting hospitalisation is thought to be largely preventable via the application of public health interventions that are usually provided in an ambulatory setting such as primary care.

Higher rates of ACSC hospitalisations may reflect indirect evidence of problems with the provision of health care such as difficulties in accessing primary health-care services and a lack of appropriate skills and resources. ACSCs include vaccine-preventable conditions, selected acute conditions and chronic conditions that are amenable to behaviour modification and lifestyle change. The rate of ACSC separations was 2288.4 per 100,000 persons in Canterbury LGA representing the highest rate among all IWS LGAs. Despite being the highest in the IWS catchment, the rate of separations for ACSCs in Canterbury LGA in 2011-13 was significantly lower than the state level.

Table 30: Potentially preventable hospitalisation separations for ACSCs by LGA, 2011-13 LGA Separations per year Separations per 100,000 sSSR15 relationship to state

levels Ashfield 837 1,882.5 Significantly lower than the state

Burwood 631 1,847.5 Significantly lower than the state

Canada Bay 1,507 1,869.0 Significantly lower than the state

Canterbury 3,255 2,288.4 Significantly lower than the state

Leichhardt 953 1,944.6 Significantly lower than the state

Marrickville 1,488 2,124.9 Significantly lower than the state

Strathfield 593 1,749.5 Significantly lower than the state

Sydney 3,010 2,222.1 Significantly lower than the state Source: Health Statistics NSW, Centre for Epidemiology and Evidence, NSW Ministry of Health

Figure 24: Potentially preventable hospitalisations for ACSCs by LGA 2011-13

Source: Health Statistics NSW, Centre for Epidemiology and Evidence, NSW Ministry of Health. sSSR: Smoothed estimate of standardised separation ratio; CI: Confidence interval

15 The smoothed estimate of standardised prevalence and mortality ratio enables comparison with the state average set at 100.

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6.5 Home and Community Care Figure 25 and Table 31 shows the profile of Home and Community Care (HACC) clients in Canterbury LGA compared to the IWS catchment and NSW. During this reporting period, there were 25 Indigenous HACC clients in the Canterbury LGA. There were a high proportion of clients that did not speak English (45%) relative to NSW. The proportion of clients with a carer (24%) was similar to the overall catchment (23%) and NSW (21%), and the proportion of clients that live alone (33%) was lower than both the IWS catchment (39%) and NSW (39%).

Figure 25: HACC Client Profile by Canterbury LGA, IWS and NSW, 2012-2013

Source: Public Health Information Development Unit (2014)

Table 31: HACC Client Profile, % of HACC clients (actual number); 2012-13

Indicator Canterbury LGA Inner West Sydney New South Wales Living alone 32.8 (1533) 39.1 (6499) 39.0 (106308) Living with carer 23.8 (1112) 23.0 (3825) 20.7 (56385) Indigenous 0.5 (25) 1.4 (230) 3.8 (10268) Non-english speaking 45.4 (2125) 39.0 (6484) 11.2 (30469)


Page 32 of 41


Figure 26 and Table 32 provides a graphical comparison of selected HACC services in Canterbury LGA, IWS and NSW. The rate of allied health care, case management and centre-based day care services received by HACC clients in Canterbury LGA was higher compared to NSW, but similar to IWS. In contrast, the rates of domestic assistance and transport services in Canterbury LGA were lower compared to NSW, but again similar to IWS levels. The instances of care coordination per 1,000 were markedly lower in Canterbury LGA compared to IWS and NSW.

Figure 26: HACC Service Profile, by Canterbury LGA, IWS and NSW, 2012-13


Table 32: HACC Service Profile, Instances of care per 1,000 (actual number); 2012-13 Indicator Canterbury LGA Inner West Sydney New South Wales

Allied health care 4.2 (593) 3.5 (1822) 2.3 (17549) Care counselling 3.1 (441) 2.8 (1476) 3.5 (26863) Case management 3.7 (528) 3.0 (1580) 2.0 (15261) Centre-based daycare 4.7 (678) 4.7 (2446) 2.8 (21907) Care coordination 1.5 (207) 4.1 (2096) 4.0 (30940) Domestic assistance 6.0 (855) 5.8 (2979) 7.1 (54720) Transport 7.4 (1063) 8.0 (4120) 9.4 (72274) Source: Public Health Information Development Unit (2014)

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7 HEALTH SERVICE PROVISION 7.1 Hospitals and Day Surgery Canterbury LGA residents access public hospital services at the Royal Prince Alfred Hospital, the Concord Hospital, the Canterbury Hospital, and the Balmain Hospital.

The Royal Prince Alfred Hospital (RPA) is a principle referral hospital providing tertiary and quaternary referral acute services to its IWS catchment, rural and other metropolitan residents, interstate and overseas patients. Examples of RPA’s tertiary and quaternary medical, surgical and diagnostic services include Liver and Kidney Transplantation, open heart surgery, Cardiology, Neurology, Respiratory, Immunology, Maternity, Gynaecology, Neo-natal Intensive Care, Colorectal and Upper GI surgery, Emergency and Critical Care and Trauma services.

The Institute of Orthopaedics and Rheumatology and the Professor Marie Bashir Mental Health Centre are located at RPA. Cancer care, including Haematology and Neurosurgery is provided at the highest level at RPA with other selected cancer services provided in collaboration with the Chris O’Brien Lifehouse, a not-for-profit hospital located on the RPA campus. RPA provides a wide range of non-inpatient services across all medical and surgical specialties, including Hospital-in-the Home. A defining attribute of RPA is its world class research and teaching. The SLHD, in collaboration with the University of Sydney, and thirteen affiliated Medical Research Institutes forms Sydney Research. The SLHD is part of Sydney Health Partners which is an Advanced Health Research and Translation Centre of the NHMRC.

Concord Repatriation General Hospital (CRGH or Concord Hospital) is a principle referral hospital providing tertiary and quaternary referral acute services to its IWS catchment, rural and other metropolitan residents, interstate and overseas patients. Examples of the tertiary and quaternary medical and surgical services at Concord Hospital include the state-wide Burns service, Andrology, Bariatric surgery, Neurology and Stroke, Cardiology, Aged Care, Medical Rehabilitation, Ophthalmology, Urology, Immunology, Upper GI, Colorectal, Orthopaedics, Plastic surgery, integrated Cancer care, Emergency Medicine and Critical Care. Inpatient Maternity and Paediatric services are not available at Concord Hospital.

Concord Hospital provides a wide range of non-inpatient services across all medical and surgical specialties, including Hospital-in-the Home. The Concord Centre for Mental Health is located at Concord Hospital. The Concord Hospital provides world class research and teaching in collaboration with the University of Sydney and its affiliated Medical Research Institutes.

The Balmain Hospital is a specialist Aged Care and Rehabilitation Hospital. It provides General Practice Casualty service through a consortium of local General Practitioners. The hospital provides a range of outpatient services including Hospital-in-the Home.

The Canterbury Hospital is a major metropolitan hospital that provides district level hospital care to its local community. Canterbury hospital provides emergency services, maternity, paediatrics, aged care, medical and surgical services and a range of non-inpatient services including Hospital-in-the Home.

As per the NSW Health Establishment Registration Online Database (HERO) the Canterbury LGA is home to the Canterbury Hospital, a day surgery facility and an oral health clinic (Table 33).

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Table 33: Acute and day surgery facilities in Canterbury LGA, HERO Database, 2015 Health Service Name Service Type Location

Canterbury Hospital Public Hospitals Canterbury

Canterbury Oral Health Clinic Oral Health Services Campsie

Excel Endoscopy Centre Day Surgery Campsie

Source: NSW Health Establishments Registration Online (HERO) database

7.2 Community Health Services The Sydney Local Health District delivers a comprehensive range of community health and community based health services providing prevention, early intervention, assessment, treatment, health maintenance and continuing care services. Community based services include:

• Community Health Services (see below) • Health Promotion • Aboriginal Health Services • Community Mental Health Services • Community Aged Care, Chronic Care and Rehabilitation Services • Community Oral Health Services • Community Drug Health Services

The services provided by Community Health include:

• Sydney District Nursing Service

• Community Development

• Sexual Health /Community HIV services

• Early Childhood Health

• Palliative Care Nursing

• Women’s Health

• Multicultural Health • Youth Health • Child and Family Health

• Sexual Assault Services

• Counseling

• Community Nutrition • Child Protection

Community based health services are located in numerous facilities including community health centres, community clinics, schools and outreach centres. Large multidisciplinary community health centres are located at Croydon, Marrickvillle, Canterbury and Redfern. Community health services located within Canterbury LGA, that are currently registered on the NSW Health Establishment Registration Online Database (HERO) include early childhood and youth health services (Table 34).

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Table 34: Community health facilities in Canterbury LGA, HERO Database, 2015 Health Service Name Service Type Location

Tresillian Family Care Centre Child Health Services Belmore

Belmore Early Childhood Health Centre Child Health Services Belmore

Tresillian Family Care Centre - Canterbury Child Health Services Belmore

Canterbury Community Health Centre Community Health Canterbury

Campsie Early Childhood Health Centre Child Health Services Campsie

Earlwood Early Childhood Health Centre Child Health Services Earlwood

Lakemba Early Childhood Centre Child Health Services Lakemba

Riverwood Youth Service Youth Health Services Riverwood

Source: NSW Health Establishments Registration Online (HERO) database

7.3 General Practice Selected characteristics of General Practitioners currently practicing across the IWS catchment are shown in Figure 27. Figure 27, sourced from the Central and Eastern Sydney PHN clearly shows that the availability of GPs per capita in Canterbury LGA was among the lowest within the catchment. The number of practice nurses per-capita was similarly low.

Figure 27: General Practitioners and General Practice Services by LGA and IWS, 2015

Source: CESPHN (2015).

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7.4 Allied Health Figure 28, sourced from the Central and Eastern Sydney Primary Health Network shows the availability of allied health practitioners in Canterbury LGA on a per-capita basis, compared to the IWS catchment. Canterbury LGA had a lower per-capita provision of allied health practitioners in almost all practitioner types compared to the average across the IWS catchment.

Figure 28: Private Allied Health Practitioners: Canterbury LGA and IWS, 2014

Source: CESPHN (2014). Rates reported are crude (not age standardised).

Page 37 of 41


7.5 Aged Care Aged care reforms are being progressively implemented over the next ten years. The reform moves aged care towards consumer-directed care that is sustainable and affordable. In 2013-14 new Home Care Packages and supplements in both home care and residential care were released.

Table 35 shows that at 30 June 2014 the total number of aged care places and ratios (places per 1,000 people aged 70 years and over)in the Inner West catchment 126.2 was higher than the state (111.2 per 1,000 people over 70 years). Under the Government framework a national provision level of 125 residential and home care packages for every 1,000 people aged over 70 years or over is to be achieved by 2021-22.

Table 35: Total Aged Care Places and Ratios (per 1,000 aged over 70 yrs), IWs and NSW, 2014 Total Operational Places Total Operational Ratios Residential IWS NSW IWS NSW Low care 1,488 32,205 33.7 40.7 High care 2,910 34,575 65.8 43.7 Total residential 4,398 66,780 99.5 84.5 Home Care IWS NSW IWS NSW Low care 995 17,307 22.5 21.9 High care 187 3,826 4.2 4.8 Total home care 1,182 21,133 26.7 26.7 Grand total Residential + Home care

5,580 87,913 126.2 111.2

Source: Stocktake of Australian Government subsidized aged care places and ratios, Department of Social Services, Australian Government, June 2014

Much of the health-related care delivered to older people is delivered directly by the Aged Care and Rehabilitation (AC&R) service, a core part of the Sydney Local Health District. Other religious, charitable and community organisations also provide services throughout the IWS catchment area. Aged Care services located within Canterbury LGA, that are currently registered on the NSW Health Establishment Registration Online Database (HERO) are identified in Table 36.

Table 36: Aged care facilities in Cantebury, HERO Datatbase, 2015 Aged Care Facility Service Type Location Canterbury Aged Services Aged Care Canterbury Belmore Nursing Home Nursing Homes Belmore Rosemore Residential Aged Care Facility (RACF) Nursing Homes Belmore Canterbury District Nursing Home Nursing Homes Campsie Chow Cho-Poon Nursing Home RACF Nursing Homes Earlwood St Basil's Nursing Home Nursing Homes Lakemba Wallgrove RACF Nursing Homes Lakemba Regis Delphi House RACF Nursing Homes Belmore Bupa Ashbury RACF Nursing Homes Ashbury Opal Canterbury RACF Nursing Homes Campsie Leigh Place Retirement Housing RACF Private Nursing Homes Roselands Greek Orthodox Community Home for the Aged Private Nursing Homes Earlwood Bupa Narwee Residential Aged Care Facility Private Nursing Homes Narwee Source: NSW Health Establishment Registration Online (HERO) database

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APPENDIX A: POSTCODE TO LGA / SLA CORRESPONDENCES In a number of cases, data was only available at the postcode level, rather than an LGA or SLA level. Where this occurred, the data at the postcode level was mapped to the LGA or SLA according to the correspondences shown in Table 37. The correspondences are based upon published data sourced from the Australian Bureau of Statistics regarding postcode to SLA or LGA mappings detemined under the Australian Standard Geographical Classification.

In some cases, a single postcode spans a number of LGAs or SLAs. These postcodes are only included when more than 10% are within an LGA or SLA boundary.

Table 37: Postcode to SLA / LGA correspondences

LGA / SLA POSTCODE % WITHIN

LGA BOUNDARY

LGA / SLA POSTCODE

% WITHIN LGA

BOUNDARY

Ashfield

2045 99.62

Leichhardt

2038 98.95 2130 99.97 2039 100.00 2131 100.00 2040 99.99 2132 40.71 2041 100.00

Burwood

2132 59.29

Marrickville

2042 60.98 2133 51.54 2044 99.74 2134 100.00 2048 99.95 2135 20.33 2049 100.00 2136 52.34 2050 40.17

Canterbury

2133 40.35

2203 100.00 2191 78.20 2204 99.96 2192 100.00

Strathfield

2129 100.00 2193 95.86 2135 72.70 2194 100.00 2136 47.66 2195 100.00 2140 100.00 2196 74.57 2191 21.80 2206 100.00

Sydney City South

2008 33.62 2208 50.22 2015 100.00 2209 32.92 2016 100.00 2210 17.78 2017 100.00

Canada Bay

2046 100.00 2018 37.02 2047 100.00 2042 39.02 2137 100.00 2043 100.00 2138 100.00

Sydney City West

2006 100.00 2139 100.00 2007 92.59

2008 66.38 2009 100.00 2037 100.00 2050 59.83

Page 39 of 41


APPENDIX B: DATA LIMITATIONS AND ASSUMPTIONS

B.1 Background to the LGA Health Profiles

The LGA Health Profiles were initially published in 2010 by the Sydney Local Health District. This version of the LGA Health Profiles 2015 was a collaborative project with the Central and Eastern Sydney PHN and the Sydney Local Health District.

Unfortunately the breadth of detail required to inform the LGA/SLA profiles is not available within a single data source. Accordingly, data has been sourced on a range of relevant indicators using the most appropriate, recently available source for each indicator. In some cases, the absence of complete data consistency across all indicators may require consumers of the LGA/SLA profiles to interpret some findings with caution, and this document aims to identify those areas where this is most likely to be the case. Source references are identified and should be used in conjunction with this document when interpreting the LGA/SLA profiles.

B.1.1 PHIDU Social Health Atlas of Australia

In some cases data has been sourced from the October 2014 release of the Social Health Atlas of Australia, compiled by the Public Health Information Development Unit (PHIDU), which is under the auspices of the University of Adelaide.

The data obtained from PHIDU is provided at the LGA/SLA, state and national levels and includes a broad number of indicators that are relevant to population health needs. However, in a number of cases the data collections that underpin these indicators have been compiled by different organisations that use different sampling techniques and assumptions. Furthermore, the range of indicators presented in PHIDU’s Social Health Atlas use data collected over different years. The breadth of data sources, collection techniques and collection timeframes used in PHIDU’s Social Health Atlas should therefore be taken into consideration when interpreting the data and readers should be cautious about drawing direct comparisons between indicators that are based upon data that has been collected at different timeframes, by different organisations, or using different assumptions.

Some indicators presented within PHIDU’s Social Health Atlas of Australia are ‘synthetic predictions’ that have been derived by PHIDU at the LGA or SLA level, based upon various different data collections. As a result, these predictions do not represent data collected in administrative or other data sets, and should be used with caution, and be treated as indicative of the prevalence of the health condition or risk factor in an area with these demographic and socioeconomic characteristics. Synthetic predictions within the PHIDU dataset have been made for indicators relating to the prevalence of chronic disease and health risk factors.

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B.1.2 Other Data Sources

The need to obtain data from a range of sources introduces the possibility of misalignment of populations and assumptions when comparing data across time periods, or from different data sources. Nonetheless, it has been necessary as part of the development of the LGA/SLA profiles to draw conclusions between indicators that are based upon different data collections. Although the LGA/SLA profiles have been constructed in such a way that the most relevant, recently available data has been used for each indicator, it is important to recognise the limitations in comparing data sourced from different collections, and over different timeframes.

Considering the diversity of data sources used to construct the LGA/SLA profiles, data was not always available for all indicators at the state, PHN or LGA/SLA level. As a result, some indicators have been derived in order to provide comparisons between indicators at these different levels. Consumers should exercise caution when making comparisons between derived benchmarks and reported results. The PHN provided workforce data on general practice and private allied health provider for this report. The SLHD Public Health Unit provided data on infectious disease prevalence, incidence and notification rates.

B.1.3 Health Risk Factors – Definitions The data in Figure 7 are self-reported data, reported to interviewers in the 2011–13 National Health Survey. A current smoker is an adult (over 18 years of age) who reported at the time of interview that they smoked cigarettes, cigars or pipes at least once a week.

Risky alcohol consumption was based on estimated alcohol consumption in the seven days prior to interview using two components – the number of days on which the respondent reported consuming alcohol in the previous week; and the quantity consumed in the most recent days on which they consumed alcohol. For people who drank on no more than three days in the last week, their daily consumption was simply the total consumed divided by seven. Harmful use of alcohol is defined as average daily consumption of more than 75 ml (three standard drinks) for males and 50 ml (two standard drinks) for females.

Physical inactivity is defined as those aged 15 years and over who did not exercise in the two weeks prior to interview for the 2011-13 NHS, through sport, recreation or fitness (including walking).

Psychological Distress: This data is derived from the Kessler Psychological Distress Scale (K-10), which is a scale of non-specific psychological distress based on 10 questions asked of respondents about negative emotional states in the 4 weeks prior to interview. 'High' and ‘Very High’ distress are the two highest levels of distress categories (of a total of four categories).

Overweight and Obesity: The BMI was calculated from self-reported height and weight information and grouped as follows to allow reporting against both World Health Organization and National Health & Medical Research Council guidelines – normal range: 18.5 to less than 20.0 and 20.0 to less than 25.0; overweight: 25.0 to less than 30.0; obese: 30.0 and greater.

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Documents

Canterbury - Sydney Local Health District...Prepared by the Planning Unit, Sydney Local Health District in collaboration with the Central and Eastern Sydney PHN. Chapters three and