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Acknowledgments The Eastern Sydney Medicare Local would like to acknowledge the Australian Government Department of Health for funding the preparation of this report. We extend sincere thanks to those representatives that contributed to the preparation of this report specifically, the South Eastern Sydney Local Hospital District Planning and Population Health Unit.
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Contents 1. Introduction ............................................................................................................. 6 2. Population and community characteristics .......................................................... 7 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7.
Population characteristics ..............................................................................................................7 Birth rate .........................................................................................................................................8 Cultural characteristics ...................................................................................................................8 Aboriginal and Torres Strait islander community ...........................................................................9 Family structure ..............................................................................................................................9 Private health insurance coverage................................................................................................10 Broadband internet access ...........................................................................................................10
3. Social determinants of health .............................................................................. 11 3.1. 3.2. 3.3. 3.4. 3.5. 3.6. 3.7.
Socio-economic characteristics ....................................................................................................11 Income ..........................................................................................................................................11 Employment ..................................................................................................................................12 Education levels ...........................................................................................................................13 Homelessness ..............................................................................................................................14 Social cohesion / community strength ..........................................................................................15 Barriers to accessing services......................................................................................................15
4. Health characteristics and risk factors ............................................................... 16 4.1. 4.2. 4.3. 4.4. 4.5. 4.6. 4.7. 4.8. 4.9. 4.10. 4.11.
Self-reported health status ...........................................................................................................16 Health risk factors .........................................................................................................................17 Immunisation, infant mortality and wellbeing ...............................................................................17 Prevalence of chronic disease .....................................................................................................19 Cancer screening rates ................................................................................................................20 Prevalence of cancer ....................................................................................................................21 Disability .......................................................................................................................................21 Mortality ........................................................................................................................................23 Alcohol-related domestic violence ................................................................................................24 Sexually Transmissible Infections ................................................................................................25 Infectious diseases .......................................................................................................................27
5. Health service availability..................................................................................... 30 5.1. 5.2. 5.3. 5.4. 5.5. 5.6.
Hospitals .......................................................................................................................................30 General practitioners ....................................................................................................................30 Allied health ..................................................................................................................................31 Mental health services ..................................................................................................................32 Community health services ..........................................................................................................33 Aged care .....................................................................................................................................33
6. Health service utilisation ...................................................................................... 34 6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. 6.8.
Primary care utilisation .................................................................................................................34 Hospital admission .......................................................................................................................35 Top 10 causes of hospital admission ...........................................................................................35 Ambulatory care sensitive admissions .........................................................................................36 Number of hospitalisations for conditions of interest....................................................................36 Hospitalisations resulting from risk factors ...................................................................................38 Mental health services ..................................................................................................................40 Home and Community Care (HACC) ...........................................................................................40
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List of figures Figure 1: Population profile (by age)............................................................................................................................... 7 Figure 2: Forecast population growth ............................................................................................................................. 7 Figure 3: Fertility rates ................................................................................................................................................... 8 Figure 4: Major primary languages spoken at home ....................................................................................................... 8 Figure 5: Breakdown of South East Asian (excl Thai) Languages .................................................................................. 9 Figure 6: Indigenous persons population profile ............................................................................................................. 9 Figure 7: Family structure ............................................................................................................................................. 10 Figure 8: Private health insurance coverage ............................................................................................................... 10 Figure 9: Broadband internet access at home .............................................................................................................. 10 Figure 10: Comparison of SEIFA Advantage and Disadvantage ................................................................................. 11 Figure 11: Annual household income, .......................................................................................................................... 11 Figure 12: Income support ............................................................................................................................................ 12 Figure 13: Top five Industry sectors of employment, .................................................................................................... 12 Figure 14: Unemployment ............................................................................................................................................ 13 Figure 15: Highest year of school completed ................................................................................................................ 13 Figure 16: Secondary school participation .................................................................................................................... 14 Figure 17: Homelessness ............................................................................................................................................. 14 Figure 18: Indicators of community strength ................................................................................................................. 15 Figure 19: Barriers to accessing services ..................................................................................................................... 15 Figure 20: Self assessed health ................................................................................................................................... 16 Figure 21 Health risk factors ......................................................................................................................................... 17 Figure 22: Percentage of children fully immunised ....................................................................................................... 17 Figure 23: Pertussis notifications .................................................................................................................................. 18 Figure 24: Pneumococcal notifications ......................................................................................................................... 18 Figure 25: Percentage of low birth weight babies and mothers who smoke whilst pregnant ........................................ 19 Figure 26: Prevalence of selected chronic conditions ................................................................................................... 19 Figure 27: Cancer screening rates................................................................................................................................ 20 Figure 28: Comparison of cancer screening outcomes................................................................................................. 20 Figure 29: Prevalence of selected cancers ................................................................................................................... 21 Figure 30: Proportion of people with profound or severe disabilities ............................................................................ 21 Figure 31: Proportion of people who have need for assistance with core activities ...................................................... 23 Figure 32: Premature mortality from chronic disease.................................................................................................... 23 Figure 33: Potentially avoidable deaths .................................................................................................................... 24 Figure 34: Alcohol related domestic violence .............................................................................................................. 24 Figure 35: HIV notifications ........................................................................................................................................... 25 Figure 36:Chlamydia notifications ................................................................................................................................. 25 Figure 37: Rectal chlamydia notifications ..................................................................................................................... 26 Figure 38: Gonorrhea notifications................................................................................................................................ 26 Figure 39: Syphilis notifications .................................................................................................................................... 27 Figure 40: Hepatitis B notifications ............................................................................................................................... 27 Figure 41: Hepatitis C notifications ............................................................................................................................... 29 Figure 42: GPs ............................................................................................................................................................. 30 Figure 43: After hours GP clinics .................................................................................................................................. 31 Figure 44: Allied health Practitioners ........................................................................................................................... 31 Figure 45: Number of ATAPS providers ....................................................................................................................... 32 Figure 46: Aged care availability ................................................................................................................................... 33 Figure 47: Selected primary care services ................................................................................................................... 34 Figure 48: MBS GP services ....................................................................................................................................... 34 Figure 50: Hospitalisation rate ..................................................................................................................................... 35 Figure 51 Top 10 causes of hospitalisation .................................................................................................................. 35 Figure 52: Preventable hospitalisations ....................................................................................................................... 36 Figure 53: Stroke hospitalisations ................................................................................................................................ 36 Figure 54: Coronary heart disease hospitalisations ...................................................................................................... 37 Figure 55: Diabetes related hospitalisations ................................................................................................................ 37 Figure 56: Alcohol related hospitalisations .................................................................................................................. 38 Figure 57: Smoking related hospitalisation ................................................................................................................... 38 Figure 58: High body mass related hospitalisations ..................................................................................................... 39 Figure 59: Number of falls per 1000 population 65 and over ........................................................................................ 39 Figure 60: Percentage of ATAPS referral’s by sub region ............................................................................................ 40 Figure 61: Characteristics of HACC clients ................................................................................................................... 40 Figure 62: Utilisation of HACC services ........................................................................................................................ 41
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Glossary of Terms Term Eastern Sydney Medicare Local
Eastern Sydney ESML SLA LGA ML ABS PHIDU
Explanation Refers to an independent organization that coordinates primary health care delivery for residents living within the sub-regions of Sydney-Inner SLA, Sydney-East SLA, Waverley LGA, Woollahra LGA, Randwick LGA, Botany Bay LGA and Lord Howe Island Refers to data associated with Sydney LGA, Waverley LGA, Woollahra LGA, Randwick LGA, Botany Bay LGA, but excludes Sydney-North LGA, Sydney West LGA and Lord Howe Island LGA Eastern Sydney Medicare Local Statistical Local Area Local Government Area Medicare Local Australian Bureau of Statistics Population Health Information Development Unit
Data Data was gathered from a number of different data sets and sources including the Australian Bureau of Statistics (ABS), Public Health Information Development Unit (PHIDU), South East Sydney LHD, NSW Health Stats and ESML. We have relied on the data wherever possible and have avoided carrying out an extrapolations or making assumptions around the data and how it can be interpreted. Data Limitations 1. Comparable data sets were not always available when comparing sub regional information to the Medicare Local level. As such two points of comparison have been primarily used and presented against a NSW figure (where possible); ESML catchment and Eastern Sydney. 2. Large portions of respondents to certain data sets (e.g. in ABS census data) had either not respondent or marked the question non applicable. In all cases where this has occurred these responses have been excluded from the graphical representations of the analysis undertaken. The result of this is that figures presented in certain graphs in this profile do not always total 100%. 3. The HWA data used to present the levels of Allied Health practitioners does not take into consideration those disciplines that are self-regulated. 4. Due to a small population size of approximately 350 residents, data relating to residents on Lord Howe Island have not been included where data is presented at sub-regional level due to privacy reasons.
Disclaimer th This report is prepared solely for the purpose set out in our job arrangement letter dated 10 December 2013 and is not to be used for any other purpose. The information provided in this report is based on information supplied by Eastern Sydney Medicare Local and other publicly available data sources. Paxton Partners has not verified the detailed assumptions and has relied on the information and data as sourced. The scope of work for this project did not include procedures considered necessary under generally accepted auditing standards for the purposes of expressing an opinion on the data provided. Accordingly, Paxton Partners does not express such an opinion
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1. Introduction Sydney is Australia’s largest city and the capital of New South Wales. Sydney-Inner is one of four Statistical Local Areas (SLA) that together form the City of Sydney. Its’ 2011 census count equaling 1 2 28,057 people represents roughly 17% of the total City of Sydney population , Sydney-Inner is bordered by Sydney Harbour to the north, the Sydney East SLA to the east, the Sydney West SLA to the south and west. Neighbourhoods within this catchment include Dawes Point, Haymarket, Barangaroo, Millers Point, the Rocks, Darling Harbour and the Sydney Central Business District (CBD). The Cadigal band of the Eora Aboriginal tribe are the traditional owners of these lands. Table 1 provides general characteristics of the Sydney Inner sub-region at a glance. Table 1: Characteristics of the Sydney Inner sub-region at a glance
Indicator Population* Population growth forecast (2011 – 2025) % indigenous persons Average household income * (Sydney city) Unemployment^ % Speak English in the home^ Private health insurance coverage
Value 28,057
Sub-region Rank within ML 6
Medicare local
NSW
383,014
7,211,486
88.5%
1
12.9%
15.3%
0.3%
5
0.9%
2.5%
$85,227
3
N/A
$64,324
2.95% 35% 39%
4 6 6
2.7% 69.8% 56.6%
5.3% 76.5% 48.2%
Source: ^Australian Bureau of Statistics; *City profile (profile.id); (unmarked) Public Health Information Development Unit and Australian Bureau of Statistics.
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Our Boundary Fact Sheet. South Eastern Sydney Local Health District, Strategy and Planning Unit. May 2013. 2 http://profile.id.com.au/sydney/about; accessed 29 January 2014. www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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2. Population and community characteristics Headlines
Large proportion of the population aged 20-34 when compared to ESML and NSW.
Population growth from 2011-2025 projected to be 88.5% compared to 13.6% across NSW.
Lowest fertility rate of the ESML sub regions and below the NSW average.
Lowest proportion of English speakers of the ESML sub regions (35%).
2.1. Population characteristics Figure 1 shows that the population profile of Sydney Inner sub-region is higher than the Medicare Local (ML) for age ranges 2 0 - 3 4 . These age ranges account for 57% of the total population within the Sydney Inner catchment area, compared to 32.3% across the Eastern Sydney Medicare Local (ESML) catchment. In contrast, a smaller proportion of Sydney Inners population is aged between 0 and 19 years (9.3%) compared to ESML catchment (17.6%). Figure 1: Population profile (by age)
Source: PHIDU and Australian Bureau of Statistics (2013)
Population growth forecasts for Sydney Inner between 2011 and 2025 are provided in Figure 2. According to the Australian Bureau of Statistics (ABS) population growth is due to be 88.5% in Sydney Inner across all age groups compared to 12.9% in the ESML catchment and 13.6% across NSW. As a result of the projected increase in population average growth rates for all ages are larger in Sydney Inner when compared with ESML and NSW averages. High development areas within the Sydney Central Business District and City Centre include Central Park, Barangaroo, the former Sydney Water Building and the Goldfields House. Figure 2: Forecast population growth
Source: PHIDU and Australian Bureau of Statistics (2013) www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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2.2. Birth rate The birth rate in Sydney Inner is currently the lowest among all sub-regions in the ML (0.81 children per female). This represents only 62% of the average birth rate across the ESML catchment, and less than half (45%) of the average for NSW overall (1.80 children per female). Figure 3: Fertility rates
Source: PHIDU and Australian Bureau of Statistics (2013)
2.3. Cultural characteristics Figure 4 shows the major non English primary languages spoken at home in Sydney Inner. The largest grouping of the population identifies English as their primary language (35%) after this the most spoken languages are Chinese (24%), Southeast Asian (excluding Thai) (10%), Thai (9%) and South Asian (2%). Figure 4: Major primary languages spoken at home
Source: Australian Bureau of Statistics (2012)
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Figure 5 provides a further breakdown of South East Asian (excluding Thai) languages and shows that 4.1% of the population of Sydney Inner speaks Indonesian in the home compared with 1.83% of the population of ESML and 0.38% of the population of NSW. Figure 5: Breakdown of South East Asian (excluding Thai) Languages
Source: Australian Bureau of Statistics (2012)
2.4. Aboriginal and Torres Strait islander community Indigenous Australians comprise 0.3% of the total population of the Sydney Inner sub-region, which is lower than for the ESML catchment (0.9%) and the NSW average (2.4%). As a result of this the graph below illustrates that the proportion of indigenous population is lower in Sydney Inner for all age groups when compared with the ESML and NSW. Figure 6: Indigenous persons population profile
Source: PHIDU and Australian Bureau of Statistics (2013)
2.5. Family structure Figure 7 shows a breakdown of predominant family structures living within Waverley, ESML and NSW. The most common family type in Sydney Inner is a ‘couple family with no children’ (21%), which is lower than the ESML catchment (22%) and the NSW averages (24%). Sydney Inner also has lower percentages of one parent families and ‘couple family with children’ than both the ESML catchment area and NSW averages.
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Figure 7: Family structure
Source: Australian Bureau of Statistics (2012)
2.6. Private health insurance coverage Figure 8 shows that 39% of Sydney Inner residents have private health insurance. This is lower than ESML catchment (57%) and the NSW averages (48%). Figure 8: Private health insurance coverage
Source: PHIDU and Australian Bureau of Statistics (2013)
2.7. Broadband internet access Figure 9 shows that broadband internet penetration within households in Sydney Inner (80%) is higher than the ESML catchment area (75%) and the NSW average (70%). Figure 9: Broadband internet access at home
Source: PHIDU and Australian Bureau of Statistics (2013) www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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3. Social determinants of health Headlines
Higher proportion of people earning less than $42,000 per annum compared to the ESML average.
Lower proportion of people on income support compared to ESML and NSW averages.
Higher levels of homelessness when compared to the ESML and NSW averages.
3.1. Socio-economic characteristics The Socio-Economic Indexes for Areas (SEIFA) index score for socio-economic advantage and th disadvantage in Sydney Inner is 1017, which ranks 5 out of the six sub regions. The graph below highlights the respective percentile rank for both socio economic advantage and disadvantage. Figure 10: Comparison of SEIFA Advantage and Disadvantage
Source: Australian Bureau of Statistics (2013)
3.2. Income Figure 11 shows that household incomes for residents of Sydney Inner are lower on average than the ESML catchment overall, but higher on average compared to NSW. Figure 11: Average household income,
Source: Australian Bureau of Statistics (2012)
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Figure 12 shows that a lower proportion of people within Sydney Inner receive income support, than within the ESML catchment as a whole and the NSW average, in spite of the lower average incomes reported above. Figure 12: Income support
Source: PHIDU and Centrelink (2013)
3.3. Employment Industry An analysis of the occupations held by residents of Sydney Inner reveals that the top five industry sectors of employment are accommodation and food services (11%) professional, scientific and technical services (7%), financial and insurance services (6%), retail trade (4%) and healthcare and social assistance (3%). Together, these five industries employ 31% of the population, which is higher when compared to the ML (26%) and NSW (19%). Figure 13: Top five Industry sectors of employment,
Source: Australian Bureau of Statistics (2012)
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Employment status The percentage of people who are unemployed within Sydney Inner is 2.95%, which is higher than ESML (2.72%) but lower than the NSW average (5.25%). Figure 14: Unemployment
Source: PHIDU and Australian Bureau of Statistics (2013)
3.4. Education levels Within Sydney Inner 66% of people aged over 15 years have completed Year 12 schooling/ or equivalent. This is higher than the ESML catchment area (58%) and the overall figure for NSW (38%). Figure 15: Highest year of school completed
Source: Australian Bureau of Statistics (2012)
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Data available from PHIDU shows that secondary school participation at age 16 in Sydney Inner (49%) is lower than the ESML (83%) and NSW (80%) averages. However, proportion of school leavers from Sydney Inner that go on to pursue higher education qualifications ( 68%) is higher than both the ESML (41%) and NSW average (30%) averages. Figure 16: Secondary school participation
Source: Australian Bureau of Statistics (2012)
3.5. Homelessness Figure 17 shows that the per-capita rate of homelessness in Sydney Inner (3.7%) is higher than the level across both the ESML catchment (1.14%) and NSW (0.76%). Figure 17: Homelessness
Source: Australian Bureau of Statistics (2012)
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3.6. Social cohesion / community strength Figure 18 shows that Sydney Inner is broadly in line with the ESML and NSW when it comes to indicators of community strength, with the exception of the proportion of the population who disagree with the acceptance of other cultures which is higher in Sydney Inner. Figure 18: Indicators of community strength
Source: PHIDU and Australian Bureau of Statistics (2013)
3.7. Barriers to accessing services Figure 19 shows the major barriers to accessing services across Sydney Inner. The highest proportionate barrier to accessing services within the sub region was not accessing the internet (23%), which compares to 21% within ESML catchment area and 28% of people in NSW. The proportion of the population that cannot afford treatment or medication is higher than the ESML catchment average, but broadly in line with the overall NSW average. Figure 19: Barriers to accessing services
Source: PHIDU and Australian Bureau of Statistics (2013)
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4. Health characteristics and risk factors Headlines
High proportions of physically inactive and psychologically distressed people compared to ESML and NSW averages.
Lower than average levels of childhood immunization.
Low levels of people with profound or severe disabilities or who require assistance with core activities.
Significant amounts of data were not available at the Sydney Inner SLA level so Sydney LGA figures were used, these include areas of east, south, inner and west Sydney.
4.1. Self-reported health status Figure 20 shows that the levels for fair or poor self-assessed health in Sydney Inner (15.4%) are higher than ESML catchment (12.5%) and lower than the NSW average (16.6%). It also illustrates that the levels of those with restricted core activities are lower in Sydney Inner (9.2%) than the ESML (9.3%) and NSW (11.5%) averages. Figure 20: Self assessed health
Source: PHIDU and Australian Bureau of Statistics (2013)
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4.2. Health risk factors Figure 21 shows that the health risk profile of Sydney Inner is slightly higher than the ESML catchment in relation to smoking, physically inactive persons and psychological distress. With regards to risky alcohol consumption, overweight persons and obese persons the Sydney Inner risk profile is lower than ESML. Figure 21 Health risk factors, 2007-08
Source: PHIDU and Australian Bureau of Statistics (2013)
4.3. Immunisation, infant mortality and wellbeing Childhood immunisation Figure 22 shows the percentage of children that are fully immunised at one, two and five years of age. For all ages the percentage of children immunized in Sydney Inner are lower than those across the ESML and NSW. At 1 year the rates for Sydney Inner are 74% compared to 90% for ESML and 92% for NSW. At 2 years old the rate for Sydney Inner are 78% compared with 89% for ESML and 92% for NSW. Finally, at 5 years the rates for Sydney Inner are 68% compared to 84% for ESML and 90% for NSW. Figure 22: Percentage of children fully immunised
Source: PHIDU and Australian Childhood Immunisation Register / Medicare Australia (2013)
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Pertussis The graph below shows the number of pertussis notifications in Sydney LGA each year from 2008-12, along with an overall figure for Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The graph shows that the volume of notifications decreased across Sydney LGA from 68 notifications in 2008 to31 in 2012, a decrease of 54%. Figure 23: Pertussis notifications
Source: South Eastern Sydney Local Health DIstrict
Pneumococcal The number of pneumococcal notifications in Sydney LGA has increased from 4 in 2008 to 11 in 2012. For the Eastern Sydney region the number of notifications has increased from 23 per annum to 31, representing an increase of 34%. This is shown in the graph below. Figure 24: Pneumococcal notifications
Source: South Eastern Sydney Local Health DIstrict
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Low birth weight babies Figure 25 shows the percentage of low birth weight babies and the percentage of mothers who smoke whilst pregnant within the Sydney Inner sub region, ESML and NSW. Sydney Inner has a higher rate of low birth weight babies (6.4%) than ESML (5.5%) and NSW (6.1%). The level of women who smoke whilst pregnant in Sydney Inner is 3.4% compared with 2.5% in the ESML and 12.0% in NSW as a whole. Figure 25: Percentage of low birth weight babies and mothers who smoke whilst pregnant
Source: PHIDU and NSW Ministry of Health (2013)
4.4. Prevalence of chronic disease Figure 26 shows that the prevalence rates for most chronic diseases within Sydney Inner are favorable when compared to those shown for both the ESML and NSW. The exception to this is mood disorders which are higher in Sydney Inner than ESML and NSW. All other risk factors report lower proportions of the population affected than ESML and NSW averages. Figure 26: Prevalence of selected chronic conditions
Source: PHIDU and Australian Bureau of Statistics (2013)
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4.5. Cancer screening rates Figure 27 shows the percentage of people who were eligible for, and participated in bowel and cervical cancer screening programs in 2010. 26% of those eligible in Sydney Inner participated in the bowel cancer screening program which was lower than the ESML (30%) and NSW (35%) averages. 35% of those eligible for the cervical cancer screening program in Sydney Inner took part compared with 60% in the ESML catchment and 56% across NSW. No data was available regarding breast cancer screening Figure 27: Cancer screening rates
Sources: PHIDU and Department of Health and Ageing (2010). Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health and Ageing. NBCSP data included in this report provided by the Department of Health and Ageing is not part of the formal publication and reporting process for NBCSP data; PHIDU and NSW Central Cancer Registry (2009 and 2010).
Figure 28 shows the proportion of test results in relation to cancer screening programs that indicated some form of abnormality. The percentage of bowel cancer screening participants that showed some form of abnormality was 6.5% in Sydney Inner which was lower than the ESML catchment (7.3%) and NSW (8.4%). The rate of low-grade abnormalities from the cervical cancer screening was 4.4% in Sydney Inner compared with 4.6% in the ESML catchment and 3.2% in NSW. The rate of high-grade cervical screening abnormalities in Sydney Inner was 0.7% compared with 0.8% in the ESML and 0.6% in NSW. Figure 28: Comparison of cancer screening outcomes,
Sources: PHIDU and Department of Health and Ageing (2010). Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health and Ageing. NBCSP data included in this report provided by the Department of Health and Ageing is not part of the formal publication and reporting process for NBCSP data; PHIDU and NSW Central Cancer Registry (2009 and 2010).
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4.6. Prevalence of cancer Figure 29 shows the prevalence of certain cancer types across the sub regions and NSW as a whole. No data at the Medicare Local level was available. The data suggests that the Sydney LGA (comprising Sydney Inner, South, East and West) has the highest prevalence of lung cancer (0.55 per 1000 population) of any sub-region across the ESML catchment. Sydney LGA also reported the second-highest rate of prostate (0.91 per 1000 population) and cervical cancer (0.057 per 1000 population) across the ESML catchment. Figure 29: Prevalence of selected cancers
Source: Cancer Institute NSW (2010)
4.7. Disability Profound or severe disabilities 'People with profound/severe disability are those who need some ongoing help or supervision with 3 communication, self-care and/or mobility for six months or more . Figure 30 shows the proportion of persons with profound or severe disability within the Sydney Inner sub region, ESML and NSW. The graph shows that levels of profound or severe disability are generally lower in Sydney Inner across all categories. Figure 30: Proportion of people with profound or severe disabilities
Source: PHIDU and Australian Bureau of Statistics (2013)
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Australian Bureau of Statistics, accessed from http://www.abs.gov.au/ausstats/abs@.nsf/Products/4367.0~20072008~Main+Features~Introduction?OpenDocument; on 5 Feb 2014 www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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Need for assistance with core activities The proportion of people who require assistance with core activities in Sydney Inner (0.56 %) is lower than the average across the ESML catchment (2.96%), and the average across NSW (4.69%), as shown in Figure 31. Figure 31: Proportion of people who have need for assistance with core activities
Source: PHIDU and Australian Bureau of Statistics (2013)
4.8. Mortality Premature mortality refers to deaths among people aged less than 75 years. Figure 32 presents mortality rates from chronic conditions in Sydney Inner for persons aged between 0 and 74. The data shows that premature mortality is higher in Sydney Inner than the ESML average for suicide (20% higher) and external causes (8% higher) but is lower for all other factors. The prevalence of cancer is the most significant cause of mortality and is 2% lower in Sydney Inner than the ESML average. There is no data recorded in relation to respiratory system disease in Sydney Inner. Figure 32: Premature mortality from chronic disease
Source: PHIDU and Australian Bureau of Statistics (2013)
A potentially avoidable death is one that, theoretically, could have been avoided given an understanding of causation, the adoption of available disease prevention initiatives and the use of 4 available health care. The graph below illustrates that the per-capita rate of avoidable mortality i n S y d n e y (1.39 deaths per 1,000 persons) is 7 1 % higher than the ESML catchment (0.82 deaths per 1,000 persons) and 53% higher than the NSW average (0.91 deaths per 1,000 persons).
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Australian Bureau of Statistics, accessed from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1370.0~2010~Chapter~Potentially%20avoidable%20deaths%20 on 5 February 2014 www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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Figure 33: Potentially avoidable deaths
Source: Health Statistics NSW and NSW Ministry of Health Note: Sydney LGA includes other areas of the city besides Sydney Inner SLA
4.9. Alcohol-related domestic violence The graph below illustrates that the alcohol-related domestic violence rates are higher in the Sydney LGA (2.4 incidences per 1000 population) than in Eastern Sydney (1.5) and NSW (1.4). The rate of alcoholrelated domestic violence is the highest in Sydney of any sub-region in the ESML catchment. Figure 34: Alcohol related domestic violence
Source: NSW Bureau of Crime Statistics and Research (2012) Note: Sydney LGA includes other areas of the city besides Sydney Inner SLA
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4.10. Sexually Transmissible Infections HIV The graph below illustrates the volume of HIV notifications since 2011. The data is split between those notifications that occurred in Sydney LGA and those in the rest of the ESML catchment. The reason the data has been presented in this format is due to the sensitivities around providing it at an LGA level due to the low levels of notifications in certain LGA’s. The data shows that from 2011 to 2012 notifications increased in Sydney LGA by 31%, but decreased by 20% in the rest of the region and that this resulted in a 15% increase overall. The data provided for 2013 only covered the period from January – September so has not been used for comparative purposes. Figure 35: HIV notifications
Source: South Eastern Sydney Local Health District
Chlamydia The graph below shows the annual number of notifications of chlamydia in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has risen from 918 to 1258 per annum in Sydney LGA over the period representing an increase of 37%. The overall number of notifications for Eastern Sydney has increased from 1887 to 2556 per annum, representing an increase of 35%. Figure 36:Chlamydia notifications
Source: South Eastern Sydney Local Health District
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Rectal Chlamydia in males The graph below shows the annual number of notifications of rectal chlamydia in males in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has increased from 173 to 329 per annum in Sydney over the period representing an increase of 90%. In 2012 the notifications in Sydney LGA represented 77% of the total from the Eastern Sydney region. The overall number of notifications for Eastern Sydney has increased from 249 to 429 per annum, representing an increase of 72%. Figure 37: Rectal chlamydia notifications
Source: South Eastern Sydney Local Health District
Gonorrhea The graph below shows the annual number of notifications of gonorrhea in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has risen from 262 to 751 per annum in Sydney LGA over the period representing an increase of 187%. In 2012 the notifications in Sydney LGA represented 67% of the total from the Eastern Sydney region. The overall number of notifications for Eastern Sydney has increased from 384 to 1114 per annum, representing an increase of 190%. Figure 38: Gonorrhea notifications
Source: South Eastern Sydney Local Health District www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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Syphilis The graph below shows the annual number of notifications of syphilis in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has risen from 131 to 136 per annum in Sydney LGA over the period, representing an increase of 3.8%. The overall number of notifications for Eastern Sydney has increased from 179 to 191 per annum, representing an increase of 6%. Figure 39: Syphilis notifications
Source: South Eastern Sydney Local Health District
4.11. Infectious diseases Hepatitis B From 2008 – 2012 there has been a downward trend in the number of notifications in both Sydney LGA and in the Eastern Sydney region. In Sydney LGA the number of notifications has gone from 101 in 2008 to 67 in 2012, a decrease of 34%. In Eastern Sydney they have decreased from 210 in 2008 to 137 in 2012, a decrease of 35%. This is illustrated on the graph below. Figure 40: Hepatitis B notifications
Source: South Eastern Sydney Local Health District
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Hepatitis C The graph below illustrates the number of Hepatitis C notifications in Sydney LGA and the Eastern Sydney region annually from 2008 to 2012. The number of notifications in Sydney LGA has decreased from 165 notifications in 2008 to 100 in 2012, a decrease of 39%. The overall figure for the Eastern Sydney region has declined from256 notifications in 2008 to 179 in 2012, a decrease of 30%. This is shown on the graph below. Figure 41: Hepatitis C notifications
Source: South Eastern Sydney Local Health District
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5. Health service availability Headlines
Highest level of GPs per 1000 population (Sydney LGA).
Higher levels of community aged care beds compared to ESML and NSW averages.
Highest levels of allied health practitioners per 1000 population (Sydney LGA).
5.1. Hospitals There are 2 hospitals located within the Sydney East SLA both of which are public facilities. Hospital name Sydney Hospital Sydney Eye Hospital
Hospital type Tertiary referral for hand trauma, Emergency room Specialist in eye, hand and sexual health as well as specialist alcohol and other drug treatment services
No of beds 113 (2 levels of wards and 1 operating theatre)
5.2. General practitioners The graph below shows that the number of GPs per 1000 population in Sydney (2.26 per 1000 population) is higher than all the sub regions that comprise ESML, as well as being above the Eastern Sydney average (1.77). The availability of GPs within Randwick meets the benchmark of 1 GP for every 1133 5 residents (or the equivalent of 0.88 per 1,000 capita). Figure 42: GPs
Source: Health Workforce Australia (2013) Note: Sydney LGA includes other areas of the city besides Sydney East and Inner
5
Benchmark figure is 1 GP per every 1133 people (0.88 per 1000) based on: May J, Jones et all, ‘GP perceptions of workforce shortage in a rural setting’ (2007); Wilkinson D. Inequitable distribution of general practitioners in Australia, Australian Journal of Rural Health (2000); May J, Morrissey et al ‘Supporting the rural GP workforce: impact of a managed care practice. In, Proceedings, General Practice & Primary Health Care Conference; 5-7July 2006; Perth, WA; (2006). www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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After hours GP services ‘After hours’ services are defined as any primary service that is open:
Before 8:00am and after 6pm weekdays;
Before 8:00am and after 12:00pm on Saturday’s; and
All day Sundays and public holidays.
The data illustrated on the graph below details the number of general practices in the region registered with the ESML after hour’s program. The graph shows that there are 36 such practices in Sydney Inner. Figure 43: After hours GP clinics
Source: Eastern Sydney Medicare Local
5.3. Allied health As shown in Figure 44, Sydney LGA has below average levels of allied health providers across all areas covered in comparison to the other sub regions in ESML. This is partly due to the fact that there are significantly higher levels of allied health practitioners in the Randwick sub region, which has increased the average across the entire ESML catchment. Figure 44: Allied health Practitioners
Source: Health workforce Australia (2013) Note: Sydney LGA includes other areas of the city besides Sydney East and Inner
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5.4. Mental health services Figure 45 shows the total number of ATAPS providers by sub region, as well as providing a calculation to show the number per 100,000 population. The graph shows that there are 22 ATAPS providers in Sydney LGA and 31 per 100,000 population. Figure 45: Number of ATAPS providers
Source: Eastern Sydney Medicare Local
The table below illustrates the volume of available mental health facilities within the ESML catchment area. Many of the facilities within the region will offer more than one of the types of services listed in the first column of the table below. However, in order to identify the number of facilities in the region we have only included each facility in the table below once. This means that they have been grouped under the classification that bests first their primary service offering. The table shows that Sydney Inner has 43 facilities delivering mental health services out of the ESML wide total of 91. Table 2: Mental health providers Adolescent mental Health General mental health services General Mental Health Services Mental Health Advocacy Mental health assessment/triage/ crisis response Mental health case management/continuing care Mental health information/referral Mental health inpatient services (hospital psychiatric unit) Mental Health non-residential rehabilitation Mental health residential rehabilitation/community care unit Psychiatry (requires referral) Psychology
ESML Total
Botany Bay 0 0 0 0 0 0 0 0 0 0 0 0
0
Sydney (C) - Sydney (C) Inner East Randwick (c) Waverley (A) Woollahra (A) ESML Total 0 1 0 0 0 1 2 1 3 0 0 6 2 1 3 0 0 6 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 2 4 0 0 0 6 0 0 0 1 0 1 0 0 1 0 0 1 0 0 0 0 0 0 20 5 2 6 2 35 15 1 6 7 4 33
43
13
15
14
6
91
Source: Eastern Sydney Medicare Local / National Health Service Directory (2013)
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5.5. Community health services The table below illustrates the volume of available unique community health service facilities within the ESML catchment area. Many of the facilities within the region will offer more than one of the types of services listed in the first column of the table below. However, in order to identify the number of facilities in the region we have only included each facility in the table below once. This means that they have been grouped under the classification that bests first their primary service offering. The table shows that Sydney Inner has 28 of 59 (48% of the total) facilities delivering community care services in ESML. Table 3: Community health care facilities
Source: South East Sydney Local Health District (2013) and National Health Services Directory (2013)
5.6. Aged care Figure 46 illustrates the availability of aged care services across the Sydney Inner sub region as compared to the ESML and NSW catchments. Availability is defined by the number of high and low residential aged care places and community-based aged care packages. According to PHIDU, there are no high care residential places and a lower number of low care places available to residents within Sydney Inner as compared to the ESML and NSW catchments. In contrast to this there are 287% more community care places in Sydney Inner as compared to the ESML catchment. Figure 46: Aged care availability,
Source: PHIDU and Department of Health and Ageing (2013)
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6. Health service utilisation Headlines
Highest levels of stroke and alcohol related hospitalisations within the region (Sydney LGA).
Lowest levels of coronary heart disease and high body mass related hospitalisations within the region (Sydney LGA).
Significant amounts of data were not available at the Sydney Inner SLA level so Sydney LGA figures were used, these include areas of east, south, inner and west Sydney.
6.1. Primary care utilisation Figure 47 shows that the number of primary care services per-capita billed for Sydney Inner residents to the MBS were lower than the Eastern Sydney catchment and NSW for 45 year old health checks, GP health assessments for persons aged 75+, GP enhance primary care services and practice nurse services. With regards to GP mental health plans the Sydney Inner number per 1000 population is higher than both the Eastern Sydney and NSW. Figure 47: Selected primary care services
Source: PHIDU and Department of Health and Ageing (2013)
Figure 48 shows that the level of General Practitioner (GP) MBS services delivered per person per year is lower in Sydney Inner (3.53) than in Eastern Sydney (5.1) or NSW (5.8). Figure 48: MBS GP services
Source: PHIDU and Department of Health and Ageing (2013)
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6.2. Hospital admission Figure 49 illustrates that the hospitalisation rates for Sydney LGA (321 per 1000 population) are 21% lower than the Eastern Sydney catchment (404) and 11% lower than NSW (360). Figure 49: Hospitalisation rate
Source: Health Statistics NSW and NSW Ministry of Health (2011) Note: Sydney includes other areas of the city besides Sydney Inner SLA
6.3. Top 10 causes of hospital admission The graph below outlines the top 10 causes of hospitalisation within Sydney by DRG along with the number of separations. It shows that rehabilitation, same day (Z60C) is the largest cause of hospitalisation in the sub region. The graph below is based on data provided by the LHD using a postcode analysis. For the purposes of this exercise it was assumed that the following postcodes constitute the nearest available match to Sydney LGA: 2000, 2010, 2011, 2021 and 2026. Figure 50 Top 10 causes of hospitalisation
Source: South Eastern Sydney Local Health District Note: Sydney includes other areas of the city besides Sydney Inner SLA
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6.4. Ambulatory care sensitive admissions Ambulatory care sensitive conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in the ambulatory setting. The graph below shows the levels of preventable hospitalisation for ambulatory care sensitive conditions in Sydney (21.9 per 1000 population) are 6% higher than Eastern Sydney (20.7) catchment but 8% lower than NSW (23.8). Figure 51: Preventable hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner SLA
6.5. Number of hospitalisations for conditions of interest This section presents data describing the number of hospitalisations per 1000 persons for stroke, coronary heart disease and diabetes. Stroke Figure 51 shows that Sydney LGA’s number of stroke related hospitalisations (1.56 per 1000 of the population) is the highest of the sub regions within ESML and the NSW average. No data is available for the overall ESML catchment. Figure 52: Stroke hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: * The data available for the Sydney LGA includes the east, inner, south and west but excludes Northern Sydney. This differs from the area covered by the ESML catchment which includes only Sydney (Inner) and Sydney (East).
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Coronary heart disease Figure 52 shows that hospitalisations for coronary heart disease are lower in Sydney LGA (4.3 per 1000 population) than any sub-region across the ESML catchment. CHD hospitalisations for Sydney residents are also 29% lower than the NSW average (6.1 per 1000 population). Figure 53: Coronary heart disease hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner SLA
Diabetes Figure 54 shows that the levels of diabetes-related hospitalisations within Sydney LGA fall within the midrange of the ESML sub regions. Diabetes-related hospitalisations for Sydney LGA are level with the NSW average. Figure 54: Diabetes related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner SLA
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6.6. Hospitalisations resulting from risk factors This section presents data on hospitalisations arising from modifiable risk factors, including alcohol, smoking, high body mass and falls. Alcohol Figure 55 shows that Sydney LGA (9.8 per 1000 population) has higher levels of alcohol-related hospitalisations compared to all other LGA’s in the ESML catchment and the NSW average. Figure 55: Alcohol related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: * The data available for the Sydney LGA includes the east, inner, south and west but excludes Northern Sydney. This differs from the area covered by the ESML catchment which includes only Sydney (Inner) and Sydney (East).
Smoking Figure 56 shows that the levels of smoking-related hospitalisations within Sydney LGA fall within the midrange of the sub regions (6.2 per 1000 population) but are above the NSW average (5.7). Figure 56: Smoking related hospitalisation
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner SLA
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High body mass Figure 57 illustrates that the levels of hospitalisation related to high body mass are 42% lower in Sydney LGA (3.99 per 1000 population) than in NSW (4.41). The number of hospitalisations attributable to high body mass in Botany Bay is also below the NSW average. Figure 57: High body mass related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner SLA
Falls Sydney LGA has the third highest level of fall related hospitalisations for those aged 65 years and over in ESML catchment (37.74 per 1000 population), behind Randwick (39.89) and Botany Bay (38.13). All of the sub regions have higher rates than the NSW average of 31.29. Figure 58: Number of falls per 1000 population 65 and over
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner SLA
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6.7. Mental health services The graph below illustrates the correlation between the percentages of total ESML residents in each sub region compared to the percentage of total ATAPS referrals. The graph shows that Sydney LGA has 20% of the residents in ESML and provides 19% of the ATAPS referrals. Figure 59: Percentage of ATAPS referral’s by sub region
Source: Eastern Sydney Medicare Local
6.8. Home and Community Care (HACC) Figure 60 shows characteristics of HACC consumers in Sydney Inner, compared to the ESML catchment overall and NSW. The greatest variances between Sydney Inner, ESML and NSW in terms of HACC consumers are:
Clients with carer (9.2% compared to 11.3% across ESML and 20.9% in NSW);
Indigenous clients (14.5% compared to 6.6% across ESML and 5.5% in NSW);
Total clients per 100 population (27.1% compared to 33.7% across ESML and 36.7% in NSW); and
Non English speaking clients (22.8% compared to 19.5% across ESML and 10.6% in NSW). Figure 60: Characteristics of HACC clients, 2010-11
Source: PHIDU and Department of Health and Ageing (2013)
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Figure 61 presents the number of instances of care for selected HACC services across Sydney Inner, which shows that Sydney Inner residents are less frequent consumers of most HACC services than both the overall ML and NSW. Notably, the greatest variances in HACC service utilisation relate to:
Transport (6.6 instances per 1000 compared to 8.1 across ESML and 8.9 in NSW);
Domestic assistance (3.3 instances per 1000 compared to 6.6 across ESML and 7.7in NSW); and
Care coordination (2.7 instances per 1000 compared to 3.1 across ESML and 4.3 in NSW). Figure 61: Utilisation of HACC services, 2010-11
Source: PHIDU and Department of Health and Ageing (2013)
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