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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 ...................................................................................................................9 Aboriginal and Torres Strait islander community ...........................................................................9 Family structure ............................................................................................................................10 Private health insurance coverage................................................................................................10 Broadband internet access ...........................................................................................................11

3. Social determinants of health .............................................................................. 12 3.1. 3.2. 3.3. 3.4. 3.5. 3.6. 3.7.

Socio-economic characteristics ....................................................................................................12 Income ..........................................................................................................................................12 Employment ..................................................................................................................................13 Education levels ...........................................................................................................................14 Homelessness ..............................................................................................................................15 Social cohesion / community strength ..........................................................................................16 Barriers to accessing services......................................................................................................16

4. Health characteristics and risk factors ............................................................... 17 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 ...........................................................................................................17 Health risk factors .........................................................................................................................17 Immunisation, infant mortality and wellbeing ...............................................................................18 Prevalence of chronic disease .....................................................................................................20 Cancer screening rates ................................................................................................................20 Prevalence of cancer ....................................................................................................................21 Disability .......................................................................................................................................22 Mortality ........................................................................................................................................23 Alcohol-related domestic violence ................................................................................................24 STI Rates......................................................................................................................................24 Infectious diseases .......................................................................................................................27

5. Health service availability..................................................................................... 28 5.1. 5.2. 5.3. 5.4. 5.5. 5.6.

Hospitals .......................................................................................................................................28 General practitioners ....................................................................................................................28 Allied health ..................................................................................................................................29 Mental health services ..................................................................................................................30 Community health services ..........................................................................................................30 Aged care .....................................................................................................................................31

6. Health service utilisation ...................................................................................... 32 6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. 6.8.

Primary care utilisation .................................................................................................................32 Hospital admission .......................................................................................................................33 Top 10 causes of hospital admission ...........................................................................................33 Ambulatory care sensitive admissions .........................................................................................34 Number of hospitalisations for conditions of interest....................................................................34 Hospitalisations resulting from risk factors ...................................................................................36 Mental health services ..................................................................................................................38 Home and Community Care (HACC) ...........................................................................................38

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List of figures Figure 1: Population profile ........................................................................................................................................... 7 Figure 2: Forecast population growth ............................................................................................................................ 8 Figure 3: Fertility rates ................................................................................................................................................... 8 Figure 4: Major primary languages spoken at home ....................................................................................................... 9 Figure 5: Indigenous persons population profile ............................................................................................................. 9 Figure 6: Family structure ............................................................................................................................................. 10 Figure 7: Private health insurance coverage ............................................................................................................... 10 Figure 8: Broadband internet access at home .............................................................................................................. 11 Figure 9: Comparison of SEIFA* Advantage and Disadvantage .................................................................................. 12 Figure 10: Annual personal income .............................................................................................................................. 12 Figure 11: Income support ............................................................................................................................................ 13 Figure 12: Top five Industry sectors of employment ..................................................................................................... 13 Figure 13: Unemployment ............................................................................................................................................ 14 Figure 14: Highest year of school completed ................................................................................................................ 14 Figure 15: Secondary school participation .................................................................................................................... 15 Figure 16: Homelessness ............................................................................................................................................. 15 Figure 17: Indicators of community strength ................................................................................................................. 16 Figure 18: Barriers to accessing services ..................................................................................................................... 16 Figure 19: Self assessed health ................................................................................................................................... 17 Figure 20 Health risk factors ......................................................................................................................................... 17 Figure 21: Percentage of children fully immunised ....................................................................................................... 18 Figure 22: Pertussis notifications .................................................................................................................................. 18 Figure 23: Pneumococcal presentations ....................................................................................................................... 19 Figure 24: Percentage of low birth weight babies and mothers who smoke whilst pregnant ........................................ 19 Figure 25: Prevalence of selected chronic conditions ................................................................................................... 20 Figure 26: Cancer screening rates................................................................................................................................ 20 Figure 27: Comparison of cancer screening outcomes................................................................................................. 21 Figure 28: Prevalence of selected cancers ................................................................................................................... 21 Figure 29: Proportion of people with profound or severe disabilities ............................................................................. 22 Figure 30: Proportion of people who have need for assistance with core activities ...................................................... 22 Figure 31: Premature mortality from chronic disease.................................................................................................... 23 Figure 32: Potentially avoidable deaths .................................................................................................................... 23 Figure 33: Comparison of alcohol related domestic violence incidence........................................................................ 24 Figure 34: HIV notifications ........................................................................................................................................... 24 Figure 35:Chlamydia notifications ................................................................................................................................. 25 Figure 36: Rectal chlamydia notifications ..................................................................................................................... 25 Figure 37: Gonorrhea notifications................................................................................................................................ 26 Figure 38: Syphilis notifications .................................................................................................................................... 26 Figure 39: Hepatitis B notifications ............................................................................................................................... 27 Figure 40: Hepatitis C notifications ............................................................................................................................... 27 Figure 41: GPs per 1000 population ............................................................................................................................. 28 Figure 42: After hours GP clinics .................................................................................................................................. 29 Figure 43: Allied health Practitioners ........................................................................................................................... 29 Figure 44: Number of ATAPS providers ....................................................................................................................... 30 Figure 45: Aged care availability ................................................................................................................................... 31 Figure 46: Selected primary care services ................................................................................................................... 32 Figure 47: MBS GP services per person .................................................................................................................... 32 Figure 49: Hospitalisation rate ..................................................................................................................................... 33 Figure 50 Top 10 causes of hospitalisation .................................................................................................................. 33 Figure 51: Preventable hospitalisations for ambulatory-care sensitive conditions ....................................................... 34 Figure 52: Stroke hospitalisations ................................................................................................................................ 34 Figure 53: Coronary heart disease hospitalisations ..................................................................................................... 35 Figure 54: Diabetes related hospitalisations ................................................................................................................ 35 Figure 55: Alcohol related hospitalisations .................................................................................................................. 36 Figure 56: Smoking related hospitalisations ................................................................................................................. 36 Figure 57: High body mass related hospitalisations ..................................................................................................... 37 Figure 58: Fall related hospitalisations ........................................................................................................................ 37 Figure 59: Percentage of ATAPS referrals by sub region ............................................................................................. 38 Figure 60: Characteristics of HACC clients .................................................................................................................. 38 Figure 61: Utilisation of HACC services ........................................................................................................................ 39

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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 The Waverly Local Government Area (LGA) (2011 pop: 63,486) is a south eastern locality of metropolitan 1 Sydney in New South Wales. Spanning just 9 square kilometers, including substantial foreshore areas and beaches, this LGA is bordered by the Woollahra Municipal Council area in the north and west, the Tasman Sea in the east, and Randwick City in the south. Suburbs in this catchment include Bondi, Bondi Beach, Bondi Junction, Bronte, Dover Heights, North Bondi, Queens Park, Rose Bay (part), Tamarama, Vaucluse (part) and Waverley. The Cadigal people are the traditional owners of these lands. The Waverley Council area is predominantly residential, with the Bondi Junction shopping district, Bondi Beach, Tamarama Beach, Bronte Beach, the Eastern Beaches Coastal Walk and the Coastal Cliff Walk as major features in this region. Table 1.1 provides general characteristics of the Waverley sub-region at a glance. Table 1: Characteristics of the Waverley sub-region at a glance

Indicator Population Population growth forecast (2011 – 2025) % indigenous persons Average household income Unemployment^ % Speak English in the home^ Private health insurance coverage

Sub-region Value Rank within ML 63,486 2

Medicare local

NSW

383,014

7,211,486

12.6%

2

12.9%

15.3%

0.4% $99,424 2.1% 79% 66%

4 2 2 2 2

0.9% N/A 2.7% 69.8% 56.6%

2.5% $64,324 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.

1

http://profile.id.com.au/waverley/about; accessed 28 January 2014.

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2. Population and community characteristics Headlines 

High proportion of people with private health insurance compared to the ESML catchment and NSW averages.

High proportion of speakers of languages with East Slavic origins when compared to ESML and NSW averages.

Lower levels of people over the age of 45 when compared to the ESML and NSW averages.

2.1. Population characteristics Figure 1 shows that the population profile of Waverley sub-region is broadly similar to the overall ESML catchment, but younger overall compared to NSW, with a higher proportion of residents aged 39 or below (59.7%) compared to NSW (52.8%). Persons aged 25 to 34 comprise almost one quarter of the (24.2%) overall population. 12.0% of the population are currently aged 65 or more. Figure 1: Population profile

Source: PHIDU and Australian Bureau of Statistics (2013)

Population growth forecasts for Waverley between 2011 and 2025 are provided in Figure 2. According to the Australian Bureau of Statistics (ABS), overall population growth is due to be 12.6% in Waverley compared to 12.9% in the ESML catchment and 13.6% across NSW. The figures show higher growth rates for those aged between 0 and 19 years old in Waverley compared to the average across ESML, with lower rates of growth projected for those aged 60-84. NSW Planning and Infrastructure anticipates that development will be relatively localised in this region over the coming years, with some recent approvals occurring in Bondi Junction Town Centre and Bondi Beach.

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Figure 2: Forecast population growth

Source: PHIDU and Australian Bureau of Statistics (2013)

2.2. Birth rate The birth rate in Waverley is currently 1.40 children per female. This is 6.9% higher than the average birth rate across the ESML catchment (1.31), and 22% lower than the average for NSW (1.80 children per female). Figure 3: Fertility rates

Source: PHIDU and Australian Bureau of Statistics (2013)

2.3.

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2.4. Cultural characteristics Figure 4 shows the major non English primary languages spoken at home in Waverley. The largest grouping of the population identifies English as their primary language (79%). After this the most commonly spoken languages are East Slavic dialects (2.9%), Iberian (2.6%), Middle Eastern and Semitic languages (2.2%) and Chinese (1.7%). Figure 4: Major primary languages spoken at home

Source: Australian Bureau of Statistics (2012)

Of the 1643 people who reported speaking East Slavic languages, 1628 (99%) identified Russian as the language spoken at home with the remaining 15 (1%) citing Ukrainian.

Of the 1470 people who identified Iberian as the language spoken at home 823 (56%) identified Spanish as their preferred language with the remaining 647 citing Portuguese (44%).

1245 people speak Middle Eastern and Semitic Languages in the home of which 1011 (81%) speak Hebrew, 223 (18%) Arabic and the remaining 11 (1%) Assyrian Neo Aramaic.

2.5. Aboriginal and Torres Strait islander community Indigenous Australians comprise 0.8% of the total population of Waverley, which is lower than for the ESML catchment (0.9%) and the NSW averages (2.4%). The graph below illustrates that the proportion of indigenous population is lower in Waverley for all age groups when compared with the ESML and NSW. Figure 5: Indigenous persons population profile

Source: PHIDU and Australian Bureau of Statistics (2013)

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2.6. Family structure Figure 6 shows a breakdown of predominant family structures living within Waverley, ESML and NSW. The most common family type in Waverley is a ‘couple family with no children’ (22%), which is the same as the ESML catchment (22%) and lower than the NSW average (24%). Waverley also has lower percentages of one parent families and other family types when compared to the averages across the ESML and within NSW. Figure 6: Family structure

Source: Australian Bureau of Statistics (2012)

2.7. Private health insurance coverage Figure 7 shows that 66% of Waverley residents have private health insurance. This is higher than ESML catchment average (57%) and well above the NSW average (48%). Figure 7: Private health insurance coverage

Source: PHIDU and Australian Bureau of Statistics (2013)

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2.8. Broadband internet access Figure 8 shows that broadband internet penetration within households in Waverley (76%) is higher than the ESML catchment area (75%) and the NSW average (70%). Figure 8: Broadband internet access at home

Source: PHIDU and Australian Bureau of Statistics (2013)

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3. Social determinants of health Headlines 

Higher proportion of people earning $78,000 per annum compared to ESML and NSW averages.

Low proportion of people on income support compared to ESML and NSW averages.

Low unemployment compared to ESML and NSW levels.

3.1.

Socio-economic characteristics

The Socio-Economic Indexes for Areas (SEIFA) score for socio-economic advantage and disadvantage in nd Waverley is 1101, which ranks 2 out of the six sub regions in the ESML catchment, meaning that Waverley is one of the most advantaged areas in the catchment. The graph below highlights the respective percentile rank for both socio economic advantage and disadvantage. Figure 9: Comparison of SEIFA* Advantage and Disadvantage

Source: Australian Bureau of Statistics (2013)

3.2. Income Figure 10 shows that household incomes for people living in Waverley are broadly in step with the overall ESML catchment, and are higher on average compared to NSW. Figure 10: Average household income

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Figure 11 shows that a lower proportion of people within Waverley receive income support than within the ESML catchment as a whole and across NSW. Figure 11: Income support

Source: PHIDU and Centrelink (2013)

3.3. Employment Industry An analysis of the occupations held by residents of Waverley reveals that the top five industry sectors of employment are professional, scientific and technical services (9%), financial and insurance services (5%), health care and social assistance (5%), education and training (4%) and retail trade (4%). Together, these five industries employ 27% of the population, which is higher when compared to the ML (26%) and NSW (19%). Figure 12: 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 Waverley is 2.10%, which is lower than across ESML (2.72%) and is approximately half the unemployment rate across NSW (5.25%). Figure 13: Unemployment

Source: PHIDU and Australian Bureau of Statistics (2013)

3.4. Education levels Within Waverley 59% of people aged over 15 years have completed Year 12 schooling or equivalent. This is higher than both the ESML catchment area (58%) and NSW overall (38%). Figure 14: 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 Waverley (86%) is higher than across ESML (83%) and NSW (80%). The proportion of school leavers from Waverley that go on to pursue higher education qualifications ( 50%) is also higher than the overall ESML population (41%) and the NSW average (30%). Figure 15: Secondary school participation

Source: Australian Bureau of Statistics (2012)

3.5. Homelessness Figure 16 shows that the per-capita rate of homelessness in Waverley (0.68%) is lower than the levels across both the ESML catchment (1.14%) and NSW (0.76%). Figure 16: Homelessness

Source: Australian Bureau of Statistics (2012)

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3.6. Social cohesion / community strength Figure 17 shows that Waverley is broadly in line with the ESML and NSW when it comes to indicators of community strength. All 3 demographics feel strongly that they can get support in a time of crisis (all over 80%) with approximately 5% of the population disagreeing with the acceptance of foreign cultures. Figure 17: Indicators of community strength

Source: PHIDU and Australian Bureau of Statistics (2013)

3.7. Barriers to accessing services Figure 18 shows the major barriers to accessing services across Waverley. The figure shows that a lower proportion of Waverley residents encountered barriers to accessing services compared to both the ESML and NSW populations overall. Figure 18: Barriers to accessing services

Source: PHIDU and Australian Bureau of Statistics (2013)

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4. Health characteristics and risk factors Headlines 

Very low levels of childhood immunisation compared to the ESML and NSW averages.

Lower levels of premature mortality from chronic disease compared to ESML and NSW averages.

Low levels of preventable hospitalisations compared to ESML and NSW averaged.

Lower levels of alcohol related domestic violence compared to ESML and NSW average.

4.1. Self-reported health status Figure 19 shows that the levels for fair or poor self-assessed health in Waverley (11.9%) are lower than the ESML catchment (12.5%) and the NSW average (16.6%). The figure also shows that the proportion of the population that are restricted in their core activities are lower in Waverley (8.7%) compared to the ESML (9.3%) and NSW (11.5%) averages. Figure 19: Self assessed health

Source: PHIDU and Australian Bureau of Statistics (2013)

4.2. Health risk factors Figure 20 shows that the health risk profile of Waverley is lower than the ESML catchment in relation to smoking, risky alcohol consumption, obese persons, physically inactive persons and the psychologically distressed. However, there is a greater proportion of the population in Waverley who are overweight in comparison to ESML and NSW averages. Figure 20 Health risk factors

Source: PHIDU and Australian Bureau of Statistics (2013)

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4.3. Immunisation, infant mortality and wellbeing Childhood immunisation Figure 21 shows the percentage of children that are fully immunised at one, two and five years of age. For all ages the percentage of children immunised in Waverley are lower than those across the ESML and NSW. At 1 year the rates for Waverley are 86% compared to 90% for ESML and 92% for NSW. At 2 years old the rate for Waverley are 88% compared with 89% for ESML and 92% for NSW. Finally, at 5 years the rates for Waverley are 81% compared to 84% for ESML and 90% for NSW. Figure 21: Percentage of children fully immunised

Source: PHIDU and Australian Childhood Immunisation Register / Medicare Australia (2013)

Pertussis The graph below shows the number of pertussis notifications in Waverley 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 increased across Waverley from 2008-2011 but have subsequently declined and in 2012 were below the 2008 levels. Figure 22: Pertussis notifications

Source: South Eastern Sydney Local Health DIstrict

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Pneumococcal The number of pneumococcal notifications in Waverley has increased from 2 in 2008 to 6 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 23: Pneumococcal presentations

Source: South Eastern Sydney Local Health DIstrict

Low birth weight babies Figure 24 shows the percentage of low birth weight babies and the percentage of mothers who smoke whilst pregnant within Waverley, ESML and NSW. Waverley has a lower rate of low birth weight babies (4.6%) than ESML (5.5%) and NSW (6.1%). The level of women who smoke whilst pregnant in Waverley is 1.4% compared with 2.5% in the ESML and 12.0% in NSW as a whole. Figure 24: Percentage of low birth weight babies and mothers who smoke whilst pregnant

Source: PHIDU and NSW Ministry of Health (2013)

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4.4. Prevalence of chronic disease Figure 25 shows that the prevalence rates for most chronic diseases within Waverley are generally in step with the prevalence rates for both the ESML and NSW. The exception to this is musculoskeletal disease, which is slightly more prevalent in Waverley (28.1%) than the ESML population overall (27.9%). Figure 25: Prevalence of selected chronic conditions

Source: PHIDU and Australian Bureau of Statistics (2013)

4.5. Cancer screening rates Figure 26 shows the percentage of people who were eligible for, and participated in bowel and cervical cancer screening programs in 2010. 30% of those eligible in Waverley participated in the bowel cancer screening program which was the same as the ESML average (30%) and lower than in NSW (35%). 67% of those eligible for the cervical cancer screening program in Waverley took part compared with 60% in the ESML catchment and 56% across NSW. No data was available regarding breast cancer screening. Figure 26: 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 27 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 5.7% in Waverley 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 5.0% in Waverley compared with 4.6% in the ESML catchment and 3.2% in NSW. The rate of high-grade cervical screening abnormalities in Waverley was 1.0% compared with 0.8% in the ESML and 0.6% in NSW.

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Figure 27: 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).

4.6. Prevalence of cancer Figure 28 shows the prevalence of certain cancer types across the sub regions comprising ESML, and NSW as a whole. No data on the overall ESML catchment was available. The data suggests that the most common types of cancer in Waverley are prostate (0.75 instances per 1000 population) and breast (0.65). In the case of colon (0.33) and lung (0.37) cancers the frequencies of occurrences were lower in Waverley than all other sub regions. Figure 28: Prevalence of selected cancers, 2010

Source: Cancer Institute NSW (2010)

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4.7. Disability Profound or severe disabilities 'People with profound/severe disability are those who need some ongoing help or supervision with 2 communication, self-care and/or mobility for six months or more. Figure 29 shows the proportion of persons with profound or severe disability within the Waverley sub region, ESML and NSW. The graph shows that levels of profound or severe disability are generally lower in Waverley across all categories. Figure 29: Proportion of people with profound or severe disabilities

Source: PHIDU and Australian Bureau of Statistics (2013)

Need for assistance with core activities The proportion of people who require assistance with core activities in Waverley (2.6%) is lower than the average across the ESML catchment (3.0%), and the average across NSW (4.7%), as shown in Figure 30. Figure 30: Proportion of people who have need for assistance with core activities

Source: PHIDU and Australian Bureau of Statistics (2013)

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4.8. Mortality Premature mortality refers to deaths among people ages less than 75 years. Figure 31 presents mortality rates from chronic conditions in Waverley for persons aged between 0 and 74. The d ata shows that premature mortality is lower in Waverley for all factors noted in the graph. The prevalence of cancer is the most significant cause of mortality and is 8% lower in Waverley than the ESML average. Figure 31: 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 available health care.3 The graph below illustrates that the per-capita rate of avoidable mortality in Waverley (0.71 deaths per 1,000 persons) is 13% lower than the ESML catchment (0.82 deaths per 1,000 persons) and 22% lower than the NSW rate (0.91 deaths per 1,000 persons). Figure 32: Potentially avoidable deaths

Source: Health Statistics NSW and NSW Ministry of Health

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4.9. Alcohol-related domestic violence The graph below illustrates that the alcohol-related domestic violence rates are lower in Waverley (0.7 incidences per 1000 population) than in both the ESML (1.5) and NSW (1.4). Figure 33: Comparison of alcohol related domestic violence incidence

Source: NSW Bureau of Crime Statistics and Research (2012)

4.10. STI Rates 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 34: HIV notifications

Source: South Eastern Sydney Local Health District

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Chlamydia The graph below shows the annual number of notifications of chlamydia in Waverley 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 307 to 404 per annum in Waverley over the period representing an increase of 32%. The overall number of notifications for Eastern Sydney has increased from 1887 to 2556 per annum, representing an increase of 35%. Figure 35:Chlamydia notifications

Source: South Eastern Sydney Local Health District

Rectal Chlamydia in males The graph below shows the annual number of notifications of rectal chlamydia in males in Waverley 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 20 to 23 per annum in Waverley over the period representing an increase of 15%. The overall number of notifications for Eastern Sydney has increased from 249 to 429 per annum, representing an increase of 72%. Figure 36: Rectal chlamydia notifications

Source: South Eastern Sydney Local Health District

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Gonorrhea The graph below shows the annual number of notifications of gonorrhea in Waverley 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 44 to 91 per annum in Waverley over the period representing an increase of 107%. The overall number of notifications for Eastern Sydney has increased from 384 to 1114 per annum, representing an increase of 190%. Figure 37: Gonorrhea notifications

Source: South Eastern Sydney Local Health District

Syphilis The graph below shows the annual number of notifications of syphilis in Waverley 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 was the same in 2008 (14) as it was in 2012 (14) in Waverley. The overall number of notifications for Eastern Sydney has increased from 179 to 191 per annum, representing an increase of 6%. Figure 38: Syphilis notifications

Source: South Eastern Sydney Local Health District

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4.11. Infectious diseases Hepatitis B From 2008 – 2012 there has been a downward trend in the number of notifications in both Waverley and the Eastern Sydney region. In Waverley the number of notifications has gone from 15 in 2008 to 6 in 2012, a decrease of 60%. 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 39: Hepatitis B notifications

Source: South Eastern Sydney Local Health District

Hepatitis C The graph below illustrates the number of hepatitis C notifications in Waverley and the Eastern Sydney region annually from 2008 to 2012. The number of notifications in Waverley has decreased from 16 notifications in 2008 to 10 in 2012, a decrease of 38%. 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 40: Hepatitis C notifications

Source: South Eastern Sydney Local Health District

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5. Health service availability Headlines 

Waverley has the highest level of ATAPS providers per 100,000 population.

High levels of high and community aged care beds per capita compared to ESML and NSW averages but below average volumes of low care beds.

5.1. Hospitals There is one hospital located within Waverley; the war memorial hospital which is located at 125 Birrell Street, Waverley. Two major public principal referral hospitals (Prince of Wales Randwick and St Vincent’s Darlinghurst) are both approximately four kilometers from the geographic centre of the Waverley LGA (Bondi Junction), and provide residents of the Waverley LGA with access to a range of specialised services and emergency care. Hospital name War Memorial Hospital

Hospital type The primary role of the hospital is rehabilitation and assessment services for people aged over 60 years.

No of beds 35

5.2. General practitioners The graph below shows that the number of GPs per 1000 population in Waverley (1.44 per 1000 population) is the third highest of the sub regions across ESML, but is lower than the average across the total Eastern Sydney ML catchment (1.77). GP availability in Waverley is also comfortably higher than the 4 accepted national benchmark figure (0.88), represented by the red line on the graph. Figure 41: GPs per 1000 population

Source: Health Workforce Australia (2013) Note: Sydney LGA includes other areas of the city besides Sydney East and Inner

4

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 Saturdays; 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 32 such practices in Waverley. Figure 42: After hours GP clinics

Source: Eastern Sydney Medicare Local

5.3. Allied health As shown in Figure 43, Waverley has below average levels of allied health providers across all areas covered, with the exceptions of podiatrists and osteopaths. This is partly due to the fact that there are significantly higher levels of allied health practitioners in the Randwick medical precinct, which has raised the average for the overall ESML catchment. Figure 43: 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 44 shows the total number of ATAPS providers by sub region, as well as calculating the number of providers per 100,000 population. The graph shows that there are 23 ATAPS providers in Waverley and 36 per 100,000 population – both of which are the highest of any sub-region across the ESML catchment. Figure 44: Number of ATAPS providers

Source: Eastern Sydney Medicare Local

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 Waverley has 3 facilities delivering community care services out of the ESML total of 59, or 5% of the total. Table 2: Community health care facilities

Source: South East Sydney Local Health District (2013) and National Health Services Directory (2013)

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5.6. Aged care Figure 45 illustrates the availability of aged care services across the Waverley sub region, ESML and NSW broken down into high, low and community-based aged care. This shows that there are higher levels of availability for high care and community aged care within the sub region compared to the ESML and NSW averages and lower levels of low care places. In terms of comparison to ESML there are 72% more community aged care places per 1000 persons, 20% more high care places and 15% fewer low care places available. Figure 45: Aged care availability, 2011

Source: PHIDU and Department of Health and Ageing (2013)

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6. Health service utilisation Headlines 

Lower levels of preventable hospitalisations compared to ESML and NSW averages.

Lowest levels of smoking related hospitalisations of the sub regions.

Higher hospitalization rates per 1000 population compared to ESML and NSW.

6.1. Primary care utilisation Figure 46 shows the per-capita number of GP health assessments for persons aged 75+, GP enhanced primary care services and practice nurse services billed to the MBS for Waverley residents were lower than both the Eastern Sydney catchment and NSW for. With regards to GP mental health plans the Waverley LGA reported a higher rate per-capita compared to NSW but lower than ESML. The reverse is true for 45 year old health checks, with Waverley showing higher levels of service provision compared to the ESML catchment but lower than the average within NSW. Figure 46: Selected primary care services

Source: PHIDU and Department of Health and Ageing (2013)

Figure 47 shows that the level of GP MBS services delivered per person per year is lower in Waverley (4.7) than in Eastern Sydney (5.1) or NSW (5.8). Figure 47: MBS GP services per person

Source: PHIDU and Department of Health and Ageing (2013)

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6.2. Hospital admission Figure 48 illustrates that annual hospitalisation rates for Waverley (409 hospitalisations per 1000 population) are 1.2% higher than the Eastern Sydney catchment (404) and 13.6% higher than NSW (360). Figure 48: Hospitalisation rate

Source: Health Statistics NSW and NSW Ministry of Health (2011)

6.3. Top 10 causes of hospital admission The graph below shows the top ten causes of hospitalisation within Waverley by DRG along with the number of separations. It shows that same day rehabilitation services are the largest cause of hospitalisation in the sub region. Figure 49 Top 10 causes of hospitalisation

Source: South Eastern Sydney Local Health District Note: 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 Waverley LGA: 2022, 2024, 2026, 2029 and 2030

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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 that the levels of preventable hospitalisation for ambulatory care sensitive conditions in Waverley (20.2 per 1000 population) are 2% lower than Eastern Sydney (20.7) catchment and 15% lower than NSW (23.8). Figure 50: Preventable hospitalisations for ambulatory-care sensitive conditions

Source: NSW Ministry of Health and Health Statistics NSW (2012

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 50 shows that the number of stroke-related hospitalisations in Waverley (1.12 per 1000 population) is the lowest of any sub regions within ESML, and is also below the NSW average. Unfortunately, no data is available for the overall ESML catchment. Figure 51: 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 51 shows that hospitalisations from coronary heart disease in Waverley (6.2 per 1000 population) rd are the 3 highest amongst the sub regions and are also above the per capita rate across NSW. Figure 52: 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 and East

Diabetes Figure 53 shows that the levels of diabetes-related hospitalisations within Waverley fall within the midrange of the sub regions and are approximately level with the NSW average. Figure 53: Diabetes related hospitalisations

Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner and East

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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 54 shows that Waverley (9.4 per 1000 population) has the third highest levels of alcohol-related hospitalisations compared to other LGA’s in the ESML catchment and a higher per-capita rate than the NSW average. Figure 54: 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 55 shows that the levels of smoking-related hospitalisations within Waverley are the lowest of the sub regions (5.9 per 1000 population) within the ESML catchment. Nonetheless, smoking-related hospitalisations in Waverley are above the NSW average (5.7) per-capita. Figure 55: Smoking related hospitalisations

Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner and East

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High body mass Figure 56 illustrates that the levels of hospitalisation related to high body mass are 4% lower in Waverley (4.01 per 1000 population) than in NSW (4.41). This is in spite of a higher proportion of Waverley residents being overweight, as identified in Section 4.2. Figure 56: 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 and East

Falls Waverley sub region has the second lowest level of fall-related hospitalisations for those aged 65 years and over in ESML catchment (34.18 per 1000 population), behind only Woollahra (32.83). All ESML sub regions have higher rates of fall-related hospitalisation than the NSW average of 31.29 per 1000. Figure 57: Fall related hospitalisations

Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney Inner and East

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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 Waverley has 18% of the residents in ESML and provides 17% of the total ATAPS referrals across the ESML catchment. Figure 58: Percentage of ATAPS referrals by sub region

Source: Eastern Sydney Medicare Local

6.8. Home and Community Care (HACC) Figure 59 shows characteristics of HACC consumers in Waverley, compared to the ESML catchment and NSW. The greatest variances between Waverley, ESML and NSW in terms of HACC consumers are: 

Clients living alone (49.3% compared to 46.1% across ESML and 38.6% in NSW);

Total clients per 1,000 population (30.6% compared to 33.7% across ESML and 36.7% in NSW); and

Non-English-speaking clients (16.3% compared to 19.5% across ESML and 10.6% in NSW). Figure 59: Characteristics of HACC clients

Source: PHIDU and Department of Health and Ageing (2013)

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Figure 60 presents the number of instances of care for selected HACC services across Waverley, which shows that Waverley 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 (7.2 instances per 1000 compared to 8.1 across ESML and 8.9 in NSW);

Allied Health care at home (3.7 instances per 1000 compared to 4.2 across ESML and 2.6 in NSW); and

Care coordination (1.2 instances per 1000 compared to 3.1 across ESML and 4.3 in NSW). Figure 60: Utilisation of HACC services

Source: PHIDU and Department of Health and Ageing (2013)

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Waverley sub regional profile final 20140502