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Ashfield Local Government Area

Health Profile

2015

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

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

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

Director, Planning

SLHD Planning Unit

Telephone: 02 9515 9517

Email: [email protected]

Date of Publication: December 2015

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

mailto:[email protected]

Ashfield Local Government Area Health Profile

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

2.1 POPULATION CHARACTERISTICS ................................................................................................. 5 2.2 BIRTHS AND MATERNAL HEALTH .................................................................................................. 8 2.3 ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE ............................................................. 9 2.4 PEOPLE FROM CULTURALLY AND LINGUISTICALLY DIVERSE BACKGROUNDS .................... 9 2.5 HUMANITARIAN ARRIVALS .............................................................................................................. 9 2.6 EDUCATION LEVELS ...................................................................................................................... 10 2.7 SOCIO-ECONOMIC CHARACTERISTICS ...................................................................................... 10 2.8 HOMELESSNESS ............................................................................................................................ 12

3 HEALTH RISKS OF THE POPULATION .....................................................................................13 4 LONG TERM CONDITIONS AND CHRONIC DISEASE ...................................................................15 5 INFECTIOUS DISEASES .........................................................................................................20

5.1 HIV ……………………………………………………………………………………………………………20 5.2 CHLAMYDIA ..................................................................................................................................... 21 5.3 GONORRHOEA ............................................................................................................................... 22 5.4 INFECTIOUS SYPHILIS ................................................................................................................... 23 5.5 HEPATITIS B .................................................................................................................................... 24 5.6 HEPATITIS C .................................................................................................................................... 25

6 HEALTH SERVICE UTILISATION ..............................................................................................26 6.1 PRIMARY CARE UTILISATION ....................................................................................................... 26 6.2 EMERGENCY DEPARTMENT PRESENTATIONS ......................................................................... 27 6.3 HOSPITAL SEPARATIONS ............................................................................................................. 28

6.3.1 DAY-ONLY HOSPITAL SEPARATIONS .................................................................................. 28 6.3.2 OVERNIGHT HOSPITAL SEPARATIONS ................................................................................ 29

6.4 AMBULATORY CASE SENSITIVE ADMISSIONS........................................................................... 30 6.5 HOME AND COMMUNITY CARE .................................................................................................... 31

7 HEALTH SERVICE PROVISION ................................................................................................33 7.1 HOSPITALS AND DAY SURGERY .................................................................................................. 33 7.2 COMMUNITY HEALTH SERVICES ................................................................................................. 34 7.3 GENERAL PRACTICE ..................................................................................................................... 35 7.4 ALLIED HEALTH .............................................................................................................................. 36 7.5 AGED CARE ..................................................................................................................................... 37

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

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LIST OF TABLES Table 1: Projected population Ashfield LGA and IWS 2006, 2011, 2016, 2021 and 2031 ........... 7 Table 2: Births to Ashfield residents and fertility rate, 2006 – 2013 ............................................ 8 Table 3: Child immunisation rates by age group; Ashfield-Strathfield-Burwood SA3, 2012-2013 8 Table 4: Preventive maternal indicators, Ashfield LGA and NSW 2011-2013 ............................. 9 Table 5: Humanitarian migration stream, settlers arriving 2009–2014: Ashfield LGA and NSW 10 Table 6: IRSD by SLA, and rank within IWS , 2011 ...................................................................10 Table 7: IRSD by suburbs within Ashfield LGA, and rank within IWS, 2011 ..............................11 Table 8: Estimates of homelessness: Ashfield, Strathfield and Burwood (SA3), 2011 ...............12 Table 9: Modelled estimates of health risk factors: Ashfield LGA, IWS and NSW, 2011-2013 ...13 Table 10: Health behaviour related hospitalisations, Ashfield LGA, 2012-13 to 2013-14 ...........14 Table 11: Health behaviors of residents: IWS and NSW, 2013 ..................................................14 Table 13: Modelled estimates of prevalence of chronic conditions, 2011-13 ............................15 Table 14: Modelled estimates of chronic disease: Ashfield, IWS and NSW, 2011-13 ...............15 Table 15: Indicators of burden of disease - hospital separations by cause, 2012-2014 .............16 Table 16: High body mass index, alcohol and smoking attributable deaths, 2011 .....................16 Table 17: Age standardised cancer incidence rates by cancer site, 2004 to 2008 ....................18 Table 18: Age standardised mortality rates by cancer site, 2004 - 2008 ...................................19 Table 19: Deaths from all causes and potentially preventable deaths: Ashfield, 2010-2011 ......19 Table 20: HIV notification rate, by LGA, IWS, 2005-2014 ..........................................................20 Table 21: Chlamydia notification rate, by LGA, 2005 to 2014 ....................................................21 Table 22: Gonorrhoea notification rate LGA, IWS, 2005-2014 ...................................................22 Table 23: Infectious syphilis notification rate by LGA, IWS, 2005 – 2014 ..................................23 Table 24: Hepatitis B age-standardised notification rate by LGA, IWS, 2005 – 2014 .................24 Table 25: Hepatitis C age-standardised notification rate by LGA, IWS, 2005 – 2014 ................25 Table 26: Primary care services, age standardised rate per 100,000, 2010 ..............................26 Table 27: Emergency department presentations by hospital: Ashfield, 2013 ............................27 Table 28: Emergency department presentations by triage, LGA, IWS and NSW, 2013 ............27 Table 29: Day-only hospital separations for Ashfield LGA Residents, 2013-2014 .....................28 Table 30: Overnight hospital separations for Ashfield LGA residents, 2013-2014 .....................29 Table 31: Potentially preventable hospitalisation separations for ACSCs by LGA, 2011-2013 .30 Table 32: HACC Client Profile % of HACC clients: Ashfield, IWS and NSW, 2012-2013 ...........31 Table 33: HACC Service Profile: Ashfield LGA, IWS and NSW, 2012-2013 ..............................32 Table 34: Community Health facilities in Ashfield, HERO database, 2015 .................................34 Table 35: Aged care facilities in Ashfield, HERO Database, 2015 .............................................38

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LIST OF FIGURES Figure 1: Population profile: Ashfield and NSW by age and gender, 2014 ................................. 5 Figure 2: Population forecasts: Ashfield LGA and NSW by age and gender, 2031 ..................... 6 Figure 3: Ashfield LGA projected population, by age group, 2011, 2016, 2021, 2026 and 2031 . 7 Figure 4: Language spoken (excludes English) at home: Ashfield LGA, IWS and NSW, 2011 ... 9 Figure 5: Comparison of SEIFA Disadvantage percentiles within Ashfield LGA, 2011...............11 Figure 6: Type of homelessness: Ashfield, Strathfield and Burwood and NSW, 2011 ...............12 Figure 7: Modelled estimates of health risk factors: Ashfield LGA, IWS and NSW, 2011-2013 ..13 Figure 8: Modelled estimates of prevalence of selected chronic conditions, 2011-2013 ...........15 Figure 9: Age-standardised incidence of selected cancers: Ashfield LGA, IWS and NSW, .......17 Figure 10: Number and rate of notifications of newly diagnosed HIV infection, 2005-2014 ........20 Figure 11: HIV notification rate, by LGA, IWS 2005-2014 ..........................................................20 Figure 12: Chlamydia notification rate, by IWS and NSW, 2010 to 2014 ...................................21 Figure 13: Gonorrhoea notification rate, by IWS and NSW, 2010 to 2014 .................................22 Figure 14: Gonorrhoea notification rate, by LGA, 2005-2014 ....................................................22 Figure 15: Infectious Syphilis notification rate, by IWS and NSW, 2010-2014 ..........................23 Figure 16: Infectious Syphilis notification rate by LGA and IWS, 2005 – 2014 ..........................23 Figure 17: Hepatitis B notification rate, by IWS and NSW 2005-2014 .......................................24 Figure 18: Hepatitis B notification rate by LGA and IWS, 2005 – 2014 .....................................24 Figure 19: Hepatitis C notification rate, by IWS and NSW, 2005-2014 ......................................25 Figure 20: Hepatitis C notification rate by LGA and IWS, 2005 – 2014 ......................................25 Figure 21: Primary care services: Ashfield LGA, IWS and NSW, 2010 ......................................26 Figure 22: Ashfield LGA residents day-only hospital separations breakdown, 2013 - 14 ...........28 Figure 23 : Ashfield LGA resident overnight hospital separations breakdown, 2013-14 .............29 Figure 24: Potentially preventable hospitalisations for ACSCs by LGA, 2011-2013 ...................30 Figure 25: HACC Client Profile: Ashfield LGA, IWS and NSW; 2012-2013 ................................31 Figure 26: HACC Service Profile: Ashfield LGA, IWS and NSW; 2012-2013 ............................32 Figure 27: General Practitioners and General Practice Services, by LGA and IWS, 2015 .........35 Figure 28: Private Allied Health Practitioners: Ashfield LGA and IWS, 2014 .............................36

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EXECUTIVE SUMMARY Ashfield LGA has a culturally diverse population. The major non-English speaking country of birth for Ashfield LGA residents is China (10%), followed by Italy (5%) and India (3%), while 0.6 % of residents identified as Aboriginal and Torres Strait Islander. Ashfield LGA has a high proportion of workforce-aged persons (25 to 49 years). The proportion of Ashfield LGA residents under 19 years and the fertility rate remain consistently below the state average. The projected population growth in Ashfield LGA is expected to be 23% between 2011 and 2031, which is lower than the expected population growth in the state (27.8%). Ashfield LGA’s score for socioeconomic disadvantage is 1,015; only one suburb; Ashfield has a score for socio-economic disadvantage (993) below the national average (1,000). Notably, the percentage of the homeless population that reside in a boarding house (55%) in the Ashfield, Strathfield and Burwood (SA3) is significantly higher than the state (21%).

Health Risks and Chronic Disease in Ashfield LGA The estimated prevalence of current smokers (12%) and obesity (20%) in Ashfield LGA residents is significantly lower than the state (16% and 26% respectively). Respiratory system and musculoskeletal diseases are the most prevalent chronic conditions in Ashfield LGA, although they remain below the state average. Overall, Ashfield LGA residents had significantly fewer health behaviour-related hospital separations per capita compared to the state. However, the separation ratio of alcohol- attributable hospitalisations was significantly higher in Ashfield LGA (119) compared to NSW (100). When compared to the state, the overall age-standardised rate of cancer is lower in Ashfield LGA residents, with prostate, breast, colon and lung cancer being the most common cancers in 2004-2008. There is a trend for higher incidence of liver and colon cancers in Ashfield LGA relative to the state. Whilst, the overall age-standardised rate of cancer-related deaths in Ashfield LGA (168.6 per 100,000) is not significantly different to state levels (176.9 per 100,000).

Infectious Diseases in Ashfield LGA A number of infectious diseases are more prevalent in the Inner West Sydney (IWS) catchment when compared to the state. In 2014 amongst the IWS catchment, Ashfield LGA had the second highest notification rate of Hepatitis C (59.9 per 100,000) and the fourth highest notification rate of Hepatitis B (73.8 per 100,00).

Health Service Utilisation in Ashfield LGA Ashfield LGA has one of the highest numbers of General Practitioners (GPs) per-capita of any LGA/SLA in the IWS catchment. However, GP practice nurse numbers are lower than state levels but similar to IWS. The majority of Ashfield LGA resident emergency department presentations (48%) and hospital separations are provided by the RPA Hospital. The proportion of Home and Community Care (HACC) clients with a carer (27%) in Ashfield LGA is greater than NSW (21%), and the proportion of clients that live alone (40%) is slightly higher than both the IWS catchment (39%) and NSW (39%).

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1 INTRODUCTION The Ashfield Local Government Area (LGA) Health Profile describes the characteristics of the Ashfield LGA population and compares it with the Inner West Sydney (IWS) catchment and NSW populations. The IWS catchment comprises the LGAs of Ashfield, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Strathfield and Statistical Local Areas (SLAs) of Sydney City - South and Sydney City - West. Ashfield LGA includes the suburbs of Haberfield (postcode 2045), Summer Hill (postcode 2130), Ashfield (postcode 2131) and Croydon (postcode 2132). Ashfield LGA has approximately 44,9481 residents and occupies 8.3 square kilometres; it also has a population density of 5,415 people per square kilometre, higher than that of IWS catchment as a whole.

2 POPULATION AND COMMUNITY CHARACTERISTICS 2.1 Population Characteristics Figure 1 shows that the 2014 population profile for the Ashfield LGA had a greater proportion of workforce-aged residents aged between 20 to 40 years than the overall NSW population. There was also a lower proportion of Ashfield LGA residents aged 0 to 19 years, while a substantial number of Ashfield LGA residents were aging (those aged 75 years or more) when compared to the NSW population.

Figure 1: Population profile: Ashfield and NSW by age and gender, 2014

Source: Population by Age and Sex, Regions of Australia, 2014 (cat. no. 3235.0). Australian Bureau of Statistics

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

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

0-45-9

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

85+

Ashfield Females 2014 NSW Females 2014 Ashfield Males 2014 NSW Males 2014

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Across all age groups combined, population growth in the Ashfield LGA is expected to be 23% between 2011 and 2031, which is lower than the forecasted population growth across both the IWS catchment (32.7%) and NSW (27.8%). Figure 2 further illustrates that the Ashfield LGA population growth is expected to be mixed, with higher growth in Ashfield LGA than NSW for persons aged 80 years and over and lower growth expected for persons aged between 5 to 19 years and 55 to 75 years.

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

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

Concurrent with population growth are proposed increases in the number of local homes and dwellings. The NSW Household and Implied Dwelling Projections 2011 – 2031 (2014) project an additional 4,100 dwellings from 2011 to 2031 in Ashfield LGA. Of these dwellings it is expected that 2,300 will be family households and 1,450 will be lone person households2.

The most significant future urban development will occur in the Ashfield Town Centre, Cardinal Freeman Village, the Flour Mills site and along Parramatta Road. Two of the eight strategic precincts along the Parramatta Road corridor, Taverner’s Hill and King’s Bay, are partly located in the Ashfield LGA.

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

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

0-45-9

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

85+

ASHFIELD Females NSW Females 2031 ASHFIELD Males 2031 NSW Males 2031

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Table 1 and Figure 3 illustrate the projected changes in population numbers and the number of people in different age groups in the Ashfield LGA from 2011 – 2031. These numbers are based on the estimated resident population numbers released by the NSW Department of Planning and Environment in 2014.

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


Figure 3: Ashfield LGA projected population, by age group, 2011, 2016, 2021, 2026 and 2031


0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

2011 2016 2021 2026 2031

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

Proj

ecte

d Po

pula

tion

Ashfield LGA IWS Catchment

2011 2016 2021 2026 2031 2011 2016 2021 2026 2031 Total

population 43,538 45,564 48,813 51,20

7 53,408 581,936 628,537 681,493 728,19

3 772,368

0 - 4 years 2,514 2,931 3,131 3,275 3,271 36,373 41,391 44,652 46,838 47,689

5 - 14 years 3,941 4,247 4,852 5,255 5,456 51,476 58,228 66,702 72,778 76,748

15 - 24 years 5,588 5,136 5,336 5,547 5,929 77,887 73,294 76,692 82,112 89,093

25 - 44 years 15,107 15,873 16,831 17,106

17,032 218,353 235,564 249,104 256,808

260,590

45 - 64 years 10,109 10,344 10,775 11,132

11,730 129,929 140,960 153,144 164,527

178,495

65 - 84 years 5,013 5,487 6,183 7,002 7,798 59,207 68,272 78,747 90,820 102,430

85 years + 1,266 1,546 1,706 1,889 2,191 8,711 10,829 12,453 14,309 17,323

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2.2 Births and Maternal Health Table 2 shows the number of births to Ashfield LGA residents in the period 2006 - 2013.. Across this period, the fertility rate in Ashfield LGA has been consistently below the NSW rate; however it has increased from 2006. Ashfield LGA ranked sixth within the IWS catchment for number of births in 2013. 2014 ABS Births Data has not been referred to in this document secondary to a lag in processing the 2014 Births data due to a new system introduced by the NSW registrar. The ABS has committed to revising the 2014 numbers when the 2015 data is released in October 2016.

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

estimated resident population

Ashfield LGA births

Ashfield LGA total fertility rate

NSW total fertility rate

2006 41,269 546 1.44 1.93 2007 41,916 608 1.55 1.99 2008 42,207 638 1.61 2.05 2009 42,766 589 1.65 1.98 2010 43,038 593 1.63 2.02 2011 43,538 631 1.60 1.96 2012 43,744 663 1.64 1.93 2013 44,175 636 1.65 1.94

Source: ABS Births, Australia, 2013 Catalogue No. 3301.0

Table 3 shows the immunisation coverage rates for children aged 0 to 5 years calculated for the Ashfield-Burwood-Strathfield (SA3)3; the immunisation rates for 2 to 5 year olds in the SA3 are lower than the IWS catchment and national figures. Table 3: Child Immunisation Rates by Age Group; Ashfield-Strathfield-Burwood SA3 and National,

2012-2013 Ashfield-Burwood-Strathfield IWS Catchment National

Age Group % Fully Immunised 1 year 91% 90.5% 91.2% 2 years 90.9% 91.4% 92.5% 5 years 88% 89.6% 91.5%

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

Table 4 shows that between 2011 and 2013 the rate of smoking during pregnancy in Ashfield LGA was significantly lower than the state average, with a prevalence ratio between 43.2 and 61.9 at 95% confidence interval4 (NSW = 100). For the same period, the prevalence ratio of attendance for antenatal care prior to 14 weeks gestation ranged between 72.2 and 78.3 at 95% confidence interval4, which was significantly below the NSW prevalence ratio of 100.

3 The NHPA data for 2012-13 combine Ashfield, Strathfield & Burwood in its estimates for Statistical Area Level 3 child immunisation estimates and the results are illustrated in table 4. 4 A confidence interval is a range around a measurement that conveys how precise the measurement is.

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

Smoking in pregnancy Smoothed estimate of prevalence ratio

95% confidence interval

52.1 (43.2 – 61.9) (--) 100 First antenatal visit before 14

weeks of gestation No. of mothers per year 95% confidence interval

391 (72.2 - 78.3) (--) 100 Source: NSW Perinatal Data Collection (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health, -- significantly

lower than the state at 1% significance.

2.3 Aboriginal and Torres Strait Islander People

Ashfield LGA was originally home to the people of the Eora Nation. Aboriginal Australians now comprise a total of 0.6% of the total population of the Ashfield LGA, which was below the average for both the IWS catchment (0.9%) and NSW (2.5%).

2.4 People from Culturally and Linguistically Diverse Backgrounds

As illustrated in Figure 4, the cultural diversity of the Ashfield LGA is broad. Based on the 2011 ABS Census data, only 49% (20,340) of Ashfield LGA residents identified as speaking only English at home, with notable proportions of the population identifying their primary language as being Mandarin (9%, 3,740), followed by Italian (7%, 2,803) and Cantonese (5%, 1,846). Approximately 8% of residents indicated that they spoke another language and did not speak English well or did not speak English at all.

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

Source: Australian Bureau of Statistics (2011)

2.5 Humanitarian Arrivals Table 5 provides local and state data relating to humanitarian settlers during the period 1 January 2009 - 1 December 2014. Humanitarian arrivals settling in Ashfield LGA came from 17 different countries, with the largest number being from the People’s Republic of China.

0%

2%

4%

6%

8%

10%

12%ASHFIELD

IWS

NSW

% o

f tot

al p

opul

atio

n

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Table 5: Humanitarian migration stream, settlers arriving 2009–2014: Ashfield LGA and NSW Population characteristics Ashfield LGA NSW

Humanitarian Stream-number of settlers arriving from 2009 - 2014 62 27,450 Top 3 countries of birth for humanitarian migration stream, number of settlers arriving 2009 – 2014

Peoples Republic of China 28 Iraq 10157

Iran 10 Iran 2913 Egypt 5 Afghanistan 2502

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

2.6 Education Levels Secondary school participation data from the 2011 census showed that within the Ashfield LGA 63.5% of people aged over 15 years had completed Year 12 schooling (or equivalent). Full-time participation in secondary school at age 16 years was approximately the same in Ashfield LGA (82.7%) as the IWS catchment overall (82.3%). In 2013 the proportion of school leavers from Ashfield LGA who had higher education qualifications (48.8%) was the fourth-highest in the catchment, behind Strathfield, Burwood and Canada Bay5.

2.7 Socio-Economic Characteristics

The Socio-Economic Indexes for Areas (SEIFA) are used to rank geographic areas across Australia according to their socio-economic characteristics. The Index of Relative Socioeconomic Disadvantage (IRSD) contains indicators of disadvantage such as low income, high unemployment and low levels of education. The average across Australia was 1,000. A number below 1,000 indicates a lower socioeconomic status. Table 6 shows the index score for socio-economic disadvantage in Ashfield LGA was 1,015, the only Statistical Local Areas in SLHD with an overall score under 1,000 in 2011 were Canterbury and Burwood LGA’s.

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

average of 1000) Minimum score

for SA1s in area

Maximum score for SA1s

in area

Rank (SLAs within IWS)

Ashfield (A) 1,015 856 1,112 8 Burwood (A) 996 870 1,073 9 Canada Bay (A) - Concord 1,066 948 1,140 3 Canada Bay (A) - Drummoyne 1,068 819 1,138 2 Canterbury (C) 922 413 1,081 10 Leichhardt (A) 1,079 733 1,150 1 Marrickville (A) 1,022 498 1,135 6 Strathfield (A) 1,022 749 1,134 5 Sydney (C) - South 1,017 435 1,138 7 City of Sydney (C) - West 1,022 615 1,138 4 Sydney 1,006 413 1,150 Source: Australian Bureau of Statistics (2011)

Table 7 and Figure 5 show the variance of the index score for socio-economic disadvantage across the suburbs that make up Ashfield LGA. The suburb of Ashfield had the lowest index score for socio-economic disadvantage (993) in Ashfield LGA, indicating a greater level of disadvantage in the suburb when compared to Haberfield (1073).

5 Public Health Information Development Unit and Australian Bureau of Statistics

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Table 7: IRSD by Suburbs within Ashfield LGA, and rank within IWS, 2011 State Suburbs within Ashfield LGA Score Rank within IWS*

Rank within Australia

Most disadvantaged to Least disadvantaged Ashfield 993 21 3,458 Croydon 1,024 34 4,828 Summer Hill 1,048 43 5,981 Haberfield 1,073 51

6,337 *77 suburbs within the IWS catchment were allocated an index score for socio-economic disadvantage. Source: 2033.0.55.001-

SEIFA, 2011.

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


In 2011, Ashfield LGA had a larger proportion of high income households (those earning $2,500 per week or more) and a lower proportion of low income households (those earning less than $600 per week) when compared to NSW.

Unemployment in Ashfield LGA (4.3%) in 2011 was lower than the IWS catchment average (5.5%). Proportions of unemployment ranged from a low of 2.3% in Haberfield (North) to a high of 11.0% in Ashfield (CBD). More people in Ashfield LGA rented their home (38%) rather than fully owned it (27%) or had a mortgage (26%). Of Ashfield LGA’s renting population the majority were private renters (35%), with only 2.4% in social housing. Ashfield South had the highest percentage of social housing 4.5%.

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2.8 Homelessness

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

• 25% were in severely overcrowded dwellings6 • 1% were sleeping rough • 57% of homeless people were living in boarding houses • There were less rough sleepers and more people in boarding houses than in SESLHD.

In addition to Census data, a survey of mental health inpatients in SLHD and South Western Sydney LHD indicated that 20% were affected by unstable housing, and over a quarter of these people reported rough sleeping7.

The ABS census data for 2011 combined Ashfield, Strathfield and Burwood in its estimates for ‘Statistical Area Level 3 homelessness estimates’ and the results are shown in Table 8.

Table 8: Estimates of homelessness: Ashfield, Strathfield and Burwood (SA3), 2011

Type of homelessness Number of people Persons in supported accommodation for the homeless 188 Persons staying in boarding houses 786 Persons in other temporary lodging 9 Persons living in ‘severely’ crowded dwellings 373 All homeless persons 1430


Figure 6: Type of Homelessness: Ashfield, Strathfield and Burwood and NSW, 2011


The percentage of the total homeless population that reside in a boarding house (55%) in Ashfield, Strathfield and Burwood (SA3) was notably higher than the state (21%) (Figure 6). The

6 Severely crowded dwellings in the Census are defined as a dwelling which requires 4 or more extra bedrooms to accommodate the people who usually live there. 7 Homelessness in SLHD. Public Health Observatory. Population Health. SLHD. 2014

13%

55%

26%

17% 21%

33%

0%

10%

20%

30%

40%

50%

60%

Persons in supportedaccommodation for the

homeless

Persons staying in boardinghouses

Persons living in 'severely'crowded dwellings

Ashfield,Strathfield andBurwood

NSW

% o

f tot

al h

omel

ess

popu

latio

n

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Ashfield LGA also had the third highest number of boarding houses (46) in the IWS catchment, behind Marrickville (104) and the Sydney City West SLA (75)8.

3 HEALTH RISKS OF THE POPULATION 3.1 Health Risk Factors

Figure 7 and Table 9 show that modelled estimates of the prevalence of health risk factors including current smoking, and overweight and obesity were similar in Ashfield LGA compared to the IWS catchment. In contrast, when compared to state levels, the estimated prevalence of current smokers and obesity was significantly lower in Ashfield LGA. The estimated prevalence of risky alcohol consumption, psychological distress and overweight in Ashfield LGA were similar to NSW levels.

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

Source: Public Health Information Development Unit - 2011-2013 National Health Survey. Refer to Appendix B 1.3 for definitions of Health Risk Factors described above

Table 9: Modelled estimates of health risk factors: Ashfield LGA, IWS and NSW, 2011-2013 Risk indicator Ashfield LGA IWS NSW Current Smokers 12.0 [10.6-13.3] 12.9 [12.4-13.4] 16.2 [16.1-16.4] Risk Alcohol Consumption 4.5 [3.1-5.8] 4.6 [4.2-5.0] 4.8 [4.7-4.9] Psychologically Distressed 10.6 [8.5-12.8] 10.2 [9.5-10.8] 10.5 [10.3-10.7] Overweight 32.4 [28.9-36.0] 33.4 [32.3-34.5] 34.6 [34.3-34.9] Obese 20.3 [18.0-22.6] 20.1 [19.4-20.8] 26.4 [26.2-26.6]

Source: Public Health Information Development Unit - 2011-2013 National Health Survey. Refer to Appendix B 1.3 for definitions of Health Risk Factors described above

Overall, Ashfield LGA residents had significantly fewer health behaviour-related hospital separations per capita compared to the state. However, the rate of alcohol-attributable hospitalisations was significantly higher in Ashfield LGA compared to NSW (Table 10).

8 NSW Fair Trading: Boarding House Register. http://parkspr.fairtrading.nsw.gov.au/BoardingHouse.aspx. Accessed 29.01.2015

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http://parkspr.fairtrading.nsw.gov.au/BoardingHouse.aspx.%20Accessed%2029.01.2015


Table 10: Health behavior-related hospitalisations, Ashfield LGA, 2012-13 to 2013-14

Indicator Year Smoothed number separations / year

Smoothed rate/ 100,000

sSSR9 [95% CI

Smoking attributable

2012-14 176.9 416.9 66.6[59.9-73.1] Significantly lower than the state

High body mass index attributable

2012-14 144 354 67.7 [61.1-75.3] Significantly lower than the state

High blood pressure

attributable

2012-14 235.8 894.9 67.9[62.2-74.2] Significantly lower than the state

Alcohol attributable

2012-14 393 855 119 [111.2-128.1] Significantly higher than the

state Fall-related

injury 2012-14 382 816.7 97.6 [91.2-104.5] Not significantly

different to the state

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

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

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

Indicator IWS NSW Consumes more than 2 standard alcoholic drinks per day, persons 16 years +

29.3 [25.6-33.1] 26.6 [25.5-27.8]

Adequate physical activity, persons 16 years and over 58.1 [54.0-62.1] 51.5 [50.2-52.7] Recommended vegetable consumption, persons 16 years and over 9.9 [7.2-12.5] 9.4 [8.7-10.1] Recommended fruit consumption, persons 16 years and over 52.1 [48.0-56.2] 51.8 [50.6-53.1] Vaccinated against influenza in the last 12 months, 65 years and over 64.5 [55.7-73.4] 71.0 [68.9-73.0] Vaccinated against pneumococcal disease, persons 65 years and over 44.6 [34.6-54.5] 49.9 [47.5-52.2] Source: 2013 NSW Adult Population Health Survey (SAPHaRI); NSW Ministry of Health. CI: Confidence interval10

9 The smoothed estimate of standardised prevalence and mortality ratio enables comparison with the state average set at 100. 10 A confidence interval is a range around a measurement that conveys how precise the measurement is.

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4 LONG TERM CONDITIONS AND CHRONIC DISEASE 4.1 Prevalence of Chronic Disease Figure 8 displays the estimated prevalence of a number of chronic diseases in Ashfield LGA, the IWS catchment and NSW. There is a trend for increased estimated age-standardised prevalence of type 2 diabetes in Ashfield LGA and the IWS catchment compared to NSW. The estimated prevalence of mental and behavioural disorders and circulatory system diseases was similar across Ashfield LGA, IWS and NSW. The most prevalent chronic conditions across the state were respiratory system diseases and musculoskeletal diseases. Residents of Ashfield LGA were estimated to have slightly lower prevalence of these conditions compared to the state, but not significantly so.

Figure 8: Modelled estimates of prevalence of selected chronic conditions, 2011-2013

Table 12: Modelled estimates of prevalence of selected chronic conditions, 2011-2013

Indicator Ashfield LGA Inner West Sydney New South Wales Type 2 Diabetes 7.3 [5.2-9.5] 7.4 [6.7-8.1] 5.8 [5.6-5.9] Mental and Behavioural Disorders 11.9 [10.2-13.6] 12.4 [11.8-12.9] 13.1 [13.0-13.3] Circulatory System Diseases 16.8 [14.6-18.9] 17.8 [17.1-18.5] 17.8 [17.6-17.9] Respiratory System Diseases 23.0 [19.5-26.5] 24.4 [23.3-25.5] 27.4 [27.1-27.7] Musculoskeletal Diseases 25.6 [21.6-29.6] 26.1 [24.8-27.3] 28.1 [27.8-28.5] Source: Public Health Information Development Unit - 2011-2013 National Health Survey

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

Table 13: Modelled estimates of chronic disease (ASR per 100 [95% CI]), 2011-2013 Indicator Ashfield LGA IWS NSW Fair or poor self-assessed health, > 15 years 14.7 [12.7-16.6] 14.3 [13.7-14.9] 14.3 [14.2-14.5] Asthma 6.4 [5.3-7.6] 7.2 [6.8-7.6] 9.6 [9.5-9.7] Chronic Obstructive Pulmonary Disease 2.1 [1.4-2.7] 2.3 [2-2.5] 2.6 [2.6-2.7] Hypertension, > 18 years 10.1 [8.1-12.1] 10.7 [10.1-11.4] 10.5 [10.4-10.7] Arthritis 12.8 [11.3-14.4] 13.9 [13.3-14.4] 15.3 [15.1-15.4] Source: Public Health Information Development Unit - 2011-13 National Health Survey. ASR: Age standardised rate; CI: Confidence

interval

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Overall, Ashfield LGA residents have significantly fewer hospital separations per capita compared to the state, potentially related to lower hospitalisation rates for chronic conditions such as chronic obstructive pulmonary disease, influenza and pneumonia and coronary heart disease (Table 14).

Table 14: Indicators of burden of disease - hospital separations by cause: Ashfield LGA, 2012-2014

Indicator Year Smoothed number

separations / year

Smoothed rate/

100,000

sSSR11 [95% CI]

Potentially preventable

2012-14 832 1,875 77 [73.3-80.6] Significantly lower than the state

Chronic obstructive pulmonary

disease

2012-14 75 1,109 74.2 [63.1-85.7] Significantly lower than the state

Coronary heart disease

2012-14 129 309.2 46.4[40.7-52.5] Significantly lower than the state

Circulatory disease

2012-14 656 1,949 72.2[68.4-76.3] Significantly lower than the state

Stroke 2012-14 70 151.4 87.6[74.4-101.4] Not significantly different to the state

Asthma 2012-14 44 106.4 61.2 [49.8-73.6] Significantly lower than the state

Influenza and pneumonia

2012-14 125 271.8 81.7[72.3-92.2] Significantly lower than the state

Source: Health Statistics NSW Centre for Epidemiology and Evidence, NSW Ministry of Health. sSSR: Smoothed estimate of standardised separation ratio; CI: Confidence interval12

The rates of high body mass index, alcohol and smoking attributable deaths in Ashfield LGA were similar to state levels (Table 15).

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

number of deaths/ year

Smoothed rate/ 100,000

sSMR11 [95% CI]

High body mass index

2011 19 38.6 99.1 [83.5-117.3] Not significantly different to the state

Alcohol 2011-12 7.1 15.9 92[73.4-113.2] Not significantly different to the state

Smoking 2012 31 68.7 94.7 [77-115.5] Not significantly different to the state

Source: Health Statistics NSW Centre for Epidemiology and Evidence, NSW Ministry of Health. sSMR: Smoothed estimate of standardised mortality ratio; CI: Confidence interval12

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

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4.2 Cancer Information on the incidence and age-standardised rates of cancer over the period 2004 to 2008 is presented in Figure 9 and Table 16.

Figure 9: Age-standardised incidence of selected cancers per 100,000 persons: Ashfield LGA, IWS and NSW,

2004 to 2008

Source: NSW Central Cancer Registry, Cancer Institute NSW

Prostate, breast, colon and lung cancer were the most common cancers in Ashfield LGA over this period. When compared to the state, the overall age-standardised rate of cancer was lower in Ashfield LGA residents, with significantly lower rates observed for melanoma, kidney and prostate cancer (Figure 9 and Table 16). There was also a trend for lower incidence of breast cancer in Ashfield LGA relative to NSW. The incidence of other prominent cancers in Ashfield LGA including lung and stomach were not significantly different to state levels. There was a trend for higher incidence of liver and colon cancers in Ashfield LGA relative to IWS and NSW (Figure 9 and Table 16).

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Table 16: Age standardised cancer incidence rate (per 100,000) by cancer site, 2004 to 2008 Cancer Site Ashfield LGA IWS Catchment NSW Count Rate Count Rate Count Rate All types 988 440.7 [413.1-469.6] 11,397 449.1 [440.8-

457.4] 177,519 483.2 [481.0-

485.5] Bladder 19 7.8 [4.6-12.4] 243 9.7 [8.5-11.0] 3,631 9.7 [9.3-10.0] Brain 15 7.2 [4.0-11.8] 166 6.3 [5.4-7.3] 2,356 6.6 [6.3-6.8] Breast 108 48.9 [40.0-59.3] 1,447 56.2 [53.3-59.1] 21,102 58.2 [57.5-59.0] Cervix 10 3.9 [1.8-7.4] 92 3.3 [2.7-4.1] 1,228 3.5 [3.3-3.7] Colon 107 48.9 [39.9-59.2] 988 39.5 [37.1-42.0] 15,072 40.6 [39.9-41.2] Head and neck 24 11.0 [7.0-16.5] 370 14.6 [13.1-16.1] 4,686 12.8 [12.5-13.2] Kidney 18 8.1 [4.8-12.9] 321 12.8 [11.4-14.3] 4,857 13.2 [12.9-13.6] Leukaemia 31 14.4 [9.6-20.6] 314 12.5 [11.1-13.9] 4,605 12.6 [12.3-13.0] Lip 7 3.2 [1.3-6.6] 44 1.8 [1.3-2.4] 1,203 3.3 [3.1-3.5] Liver 20 8.8 [5.3-13.7] 224 8.9 [7.8-10.1] 2,088 5.7 [5.4-5.9] Lung 87 37.0 [29.4-45.8] 1,157 46.5 [43.9-49.3] 15,905 43.0 [42.3-43.7] Melanoma of skin

69 30.4 [23.5-38.6] 726 27.8 [25.8-29.9] 17,716 48.8 [48.1-49.5]

Mesothelioma ** ** 56 2.2 [1.7-2.9] 1,047 2.8 [2.6-3.0] Myelodysplasia 10 4.0 [1.8-7.5] 195 7.8 [6.7-8.9] 2,817 7.5 [7.2-7.8] Non-Hodgkin’s lymphoma

33 14.7 [10.0-20.8] 485 18.9 [17.2-20.7] 6,828 18.6 [18.2-19.1]

Oesophagus 9 3.2 [1.4-6.2] 108 4.3 [3.5-5.1] 2,024 5.4 [5.2-5.7] Ovary 22 9.9 [6.2-15.1] 195 7.6 [6.6-8.8] 2,191 6.0 [5.8-6.3] Pancreas 23 10.3 [6.5-15.5] 275 11.0 [9.7-12.3] 4,062 10.9 [10.5-11.2] Prostate 152 70.2 [59.4-82.5] 1647 66.3 [63.1-69.6] 31,321 84.4 [83.4-85.3] Rectal 51 23.4 [17.3-30.8] 501 19.9 [18.2-21.8] 8,338 22.6 [22.1-23.1] Stomach 23 9.8 [6.1-14.8] 285 11.4 [10.1-12.8] 3,275 8.8 [8.5-9.1] Testis ** ** 80 2.6 [2.1-3.2] 1,084 3.2 [3.0-3.4] Thyroid 23 10.4 [6.6-15.7] 316 11.7 [10.4-13.1] 3,301 9.4 [9.1-9.8] Unspecified 45 18.8 [13.6-25.4] 364 14.4 [13.0-16.0] 6,014 16.0 [15.6-16.4] Uterus(body) 17 7.1 [4.0-11.5] 190 7.5 [6.5-8.6] 3,043 8.3 [8.0-8.6] All Others 58 26.1 [19.7-34.0] 608 23.7 [21.8-25.7] 7,725 21.3 [20.8-21.7]

Source: NSW Central Cancer Registry, Cancer Institute NSW. **Cell counts less than 5 are left blank Cancer-related mortality for Ashfield LGA, IWS and NSW is presented in Table 17. Between 2004 and 2008, cancer was the primary cause of death for 404 persons, with lung, colon, breast and prostate cancers the leading types. The overall age-standardised rate of cancer-related deaths in Ashfield LGA (168.6 per 100,000) was not significantly different to state levels (176.9 per 100,000). However, the age-standardised rates of death from melanoma and pancreatic cancer were significantly lower in Ashfield LGA relative to NSW (Table 17).

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Table 17: Age standardised mortality rate (per 100,000) by cancer site, 2004 - 2008

Cancer Site Ashfield LGA IWS NSW Count Rate Cou

nt Rate Count Rate

All types 404 168.6 [152.1-186.4]

4,547 181.0 [175.7-186.3] 66,228 176.9 [175.5-178.2]

Bladder 11 4.8 [2.3-8.7] 106 4.2 [3.4-5.1] 1,644 4.3 [4.1-4.5] Brain 12 5.6 [2.9-9.8] 126 4.9 [4.1-5.8] 1,716 4.7 [4.5-5.0] Breast 35 14.5 [9.9-20.3] 296 11.7 [10.4-13.1] 4,693 12.6 [12.3-13.0] Cervix ** ** 28 1.1 [0.7-1.5] 415 1.1 [1.0-1.2] Colon 37 14.8 [10.2-20.5] 365 14.5 [13.0-16.0] 5,511 14.6 [14.3-15.0] Head and neck 15 6.6 [3.6-11.0] 154 6.1 [5.2-7.2] 1,762 4.7 [4.5-5.0] Kidney 7 3.4 [1.4-7.0] 87 3.4 [2.8-4.3] 1,605 4.3 [4.1-4.5] Leukaemia 17 6.6 [3.8-10.6] 148 5.9 [5.0-6.9] 2,248 6.0 [5.8-6.3] Liver 14 6.0 [3.3-10.2] 162 6.5 [5.5-7.6] 1,527 4.1 [3.9-4.3] Lung 68 28.7 [22.1-36.5] 937 37.7 [35.3-40.2] 12,781 34.4 [33.8-35.0] Non-Hodgkin’s lymphoma

11 4.5 [2.2-8.2] 176 6.9 [5.9-8.0] 2,569 6.8 [6.6-7.1]

Skin Melanoma 5 1.9 [0.6-4.5] 125 5.0 [4.1-5.9] 2,314 6.2 [6.0-6.5] Mesothelioma ** ** 56 2.3 [1.7-3.0] 947 2.5 [2.4-2.7] Myelodysplasia 6 2.5 [0.9-5.6] 74 2.9 [2.3-3.7] 1,036 2.7 [2.5-2.9] Oesophagus 9 3.5 [1.5-6.8] 92 3.6 [2.9-4.4] 1,590 4.2 [4.0-4.4] Ovary 15 6.9 [3.8-11.4] 104 4.2 [3.4-5.1] 1,394 3.7 [3.5-3.9] Pancreas 12 5.0 [2.5-8.8] 240 9.6 [8.4-10.9] 3,611 9.6 [9.3-9.9] Prostate 29 11.3 [7.5-16.4] 287 11.4 [10.1-12.8] 4,904 12.8 [12.4-13.1] Rectal 23 9.9 [6.2-14.9] 194 7.7 [6.7-8.9] 3,018 8.1 [7.8-8.4] Stomach 19 8.3 [4.9-13.1] 182 7.3 [6.2-8.4] 2,232 6.0 [5.7-6.2] Thyroid ** ** 12 0.5 [0.3-0.9] 168 0.4 [0.4-0.5] Unspecified site 27 11.2 [7.3-16.5] 287 11.4 [10.1-12.8] 4,473 11.8 [11.5-12.2] Uterus(body) ** ** 43 1.7 [1.2-2.3] 614 1.6 [1.5-1.8] All Others 20 8.4 [5.1-13.1] 263 10.5 [9.2-11.8] 3,375 9.1 [8.8-9.4]

Source: NSW Central Cancer Registry, Cancer Institute NSW. **Cell counts less than 5 are left blank

4.3 Mortality In 2007, life expectancy at birth for males and females in Ashfield LGA was 78.8 and 83.2 years, respectively, which was marginally lower than NSW estimates (80 and 85 years for males and females, respectively). The standardised mortality from all causes in Ashfield LGA in 2010-2011 was slightly higher compared to the state. However, mortality from amenable and preventable causes in Ashfield LGA was similar to NSW levels (Table 18).

Table 18: Deaths from all causes and potentially preventable deaths: Ashfield LGA, 2010-2011 Indicator Deaths per year sSMR13 [95% CI] Deaths from all causes 399 113.5 [105.8-121.9] Amenable to health care 22 99.0 [81.0-119.6] Preventable causes 33 93.1 [75.6-113.1] Amenable and preventable causes 57 97.2 [81.8-113.1]

Source: Health Statistics NSW Centre for Epidemiology and Evidence, NSW Ministry of Health. sSMR: Smoothed standardised mortality ratio; CI: Confidence interval14

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

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

Figure 10: Number and rate of notifications of newly diagnosed HIV infection in IWS, 2005-2014

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

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

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

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

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

0.0

5.0

10.0

15.0

20.0

25.0

0

20

40

60

80

100

120

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

Tota

l no

tific

atio

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/100

,000

pop

ulat

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70

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

AshfieldBurwoodCanada BayCanterburyLeichhardtMarrickvilleStrathfieldSydney*

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

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

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

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

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

051015202530354045

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

2010 2011 2012 2013 2014

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

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

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

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

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


Table 21: Gonorrhoea notification rate (per 100,000 population) LGA, IWS, 2005-2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 24.5 29.1 16.7 16.6 30.4 30.2 36.8 57.1 77.0 96.3 Burwood 18.9 21.7 9.1 30.0 23.7 35.5 58.5 72.0 59.5 119.2 Canada

28.4 24.9 21.4 22.1 23.9 23.2 47.5 59.6 67.1 54.0

Canterbury 24.7 27.4 19.0 12.2 28.2 29.2 44.1 56.5 41.6 59.9 Leichhardt 35.4 37.1 46.1 28.2 35.1 65.5 59.3 87.0 108.3 91.8 Marrickville 143.2 131.8 90.2 66.6 70.7 129.4 150.4 288.8 266.6 315.2 Strathfield 37.3 21.2 32.1 25.5 27.3 35.1 34.9 39.8 73.0 38.6 Sydney* 196.7 225.8 160.0 136.2 164.5 243.3 274.2 374.7 471.9 460.7

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

02468101214161820

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

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

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AshfieldBurwoodCanada BayCanterburyLeichhardtMarrickvilleStrathfieldSydneyRa

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

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


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


Table 22: Infectious syphilis notification rate (per 100,000) by LGA, IWS, 2005 – 2014 LGA 200

2006 2007 2008 2009 2010 2011 2012 2013 2014

Ashfield 0.0 9.7 7.2 2.4 4.7 18.6 4.6 6.9 13.6 13.4 Burwood 0.0 6.2 3.0 12.0 5.9 8.9 11.7 5.8 8.5 27.7 Canada Bay

4.5 1.5 2.8 2.8 1.3 1.3 5.0 3.6 8.2 14.9

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

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

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

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2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

AshfieldBurwoodCanada BayCanterburyLeichhardtMarrickvilleStrathfieldSydney

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

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


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

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


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

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

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

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


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


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

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6 HEALTH SERVICE UTILISATION 6.1 Primary Care Utilisation

The age-standardised rate of primary care services (per 100,000) for Ashfield LGA residents is presented in Table 25, with age-standardised ratios and statistical comparisons to national levels displayed in Figure 21. The rate of 45 year old health checks in Ashfield LGA was similar to IWS and state levels. On the other hand, the standardised rates of general practitioner (GP) health assessments (75 years or more) and GP enhanced primary care in Ashfield LGA was lower than IWS and state levels. GP practice nurse service numbers in Ashfield LGA were also lower than state levels but similar to IWS rates.

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

Indicator Ashfield LGA IWS NSW 45 year old health checks^ 4,569.9 4,796.6 4,627.8 GP health assessment (75+) 11,429.1 17,377.5 20,867.4 GP enhanced primary care 1,739.1 2,147.8 2,618.4 GP practice nurse services 17,803.0 16,320.0 29,844.9 GP Mental Health care plans 8,154.4 7,625.4 8,222.3

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

Figure 21: Primary care services (age-standardised ratio): Ashfield LGA, IWS and NSW, 2010

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

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

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6.2 Emergency Department Presentations

The distribution of emergency department presentations by Ashfield LGA residents across hospitals in the IWS catchment and all other NSW hospitals is presented in Table 26. The majority of Ashfield LGA resident emergency department presentations were provided by the RPA Hospital (48.0%), constituting 6.7% of all emergency department presentations at the RPA Hospital.

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

Hospital Concord Hospital

RPA Hospital Other NSW hospitals

Total

LGA Presentations

1,454 (14.5) 1,748 (17.4) 4,814 (48.0) 2,011 (20.1) 10,027 (100)

All Presentations

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

2,557,629 (100)

Ashfield % of total

3.8 4.8 6.7 0.1 0.4

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

The rates of emergency department presentations (per 1,000 persons) by triage category are displayed in Table 27. The age-standardised rates of non-urgent, urgent, emergency and resuscitation emergency department presentations for Ashfield LGA residents were similar to IWS levels. On the other hand, the rate of semi-urgent emergency department presentations was lower in Ashfield LGA relative to the IWS catchment.

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

LGA Non-urgent Semi Urgent Urgent Emergency Resuscitation Ashfield 16.5 [15.3-17.7] 82.6 [80.0-85.2] 88.3 [85.7-90.9] 31.4 [29.8-33.0] 1.7 [1.3-2.0] Burwood 15.0 [13.7-16.3] 100.2 [97.0-103.5] 80.9 [78.0-83.8] 26.1 [24.4-27.7] 2.2 [1.8-2.7] Canada Bay 15.1 [14.3-15.9] 105.6 [103.5-107.7] 75.2 [73.4-77.0] 23.0 [22.0-24.0] 1.7 [1.4-2.0] Canterbury 22.0 [21.2-22.7] 110.0 [108.4-111.6] 115.2 [113.7-116.8] 41.7 [40.7-42.7] 2.4 [2.2-2.7] Leichhardt 17.4 [16.3-18.6] 71.5 [69.2-73.7] 92.5 [90.0-94.9] 35.0 [33.5-36.6] 1.3 [1.0-1.7] Marrickville 21.8 [20.8-22.9] 101.9 [99.7-104.1] 114.8 [112.5-117.1] 43.4 [42.0-44.8] 2.0 [1.7-2.3] Strathfield 16.4 [15.1-17.7] 114.1 [110.9-117.4] 74.4 [71.7-77.0] 23.5 [21.9-25.0] 2.2 [1.7-2.6] Sydney City 10.4 [9.7-11.0] 36.2 [34.9-37.5] 40.3 [38.9-41.7] 15.6 [14.7-16.5] 0.7 [0.5-0.8] IWS 17.4 [17.1-17.7] 90.3 [89.6-91.1] 88.6 [87.9-89.3] 31.3 [30.9-31.8] 1.8 [1.7-1.9] NSW 52.0 [51.8-52.1] 148.6 [148.3-148.8] 103.8 [103.6-104.0] 33.6 [33.5-33.7] 2.0 [2.0-2.0] Source: NSW Admitted Patient Data Collection, Centre for Epidemiology and Evidence, NSW Ministry of Health

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6.3 Hospital Separations 6.3.1 Day-Only Hospital Separations Ashfield LGA resident separations from hospital on a day-only15 basis is shown in Table 28. In 2013-14, 45% (4,027 separations) of all day-only separations were provided by SLHD hospitals, followed by private day procedure centres at 15% (1,396 separations) and other LHD hospitals at 8% (721 separations).

Table 28: Day-only hospital separations for Ashfield LGA Residents, 2013-14

Day-only hospital separations

Hospital No. of separations Percentage of total separations SLHD Hospitals 4,027 45% Private Day Procedure Centres 1,396 15% Private Hospitals 889 32% Other LHD Hospitals 721 8% Total 7,033 100%

Source: Flow-Info v 5.0

As shown in Figure 22, 45% (4,027 separations) of Ashfield LGA resident day-only separations occurred in SLHD hospitals. RPA Hospital provided for 54% of the total separations within Sydney LHD (2,175 separations), followed by Concord Hospital at 42% (1,719 separations).

Figure 22: Ashfield LGA residents day-only hospital separations breakdown, 2013 - 14


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

Private Hospitals 32% (n= 889)

Private Day Procedure Centres

15% (n=1396)

Other NSW Hospitals 8% (n=721)

Royal Prince Alfred 54% (n=2175)

Concord 42% (n=1719)

Canterbury 3% (n=133)

Sydney LHD 45% (n=4027)

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6.3.2 Overnight Hospital Separations The breakdown of Ashfield LGA resident overnight16 hospitalisations is shown in Table 29. In 2013-14, SLHD hospitals (73%; 4,710) provided the majority of overnight hospital separations for Ashfield LGA residents, followed by private hospitals at 18% (1,150) and other NSW hospitals at 9% (575).

Table 29: Overnight hospital separations for Ashfield LGA residents, 2013-2014 Overnight(s) Hospital Separations

Hospital No. of Separations Percentage of Total Separations SLHD Hospitals 4,710 73% Private Hospitals 1,150 18% Other NSW Hospitals 575 9% Total 6,435 100% Source: Flow-Info v 5.0

As shown in Figure 23, SLHD hospitals provided 73% (4,710 separations) of all Ashfield LGA resident overnight hospital separations. RPA Hospital provided 2,979 or 62% of the total overnight separations within SLHD, followed by Concord Hospital at 24% (1,154 separations).

Figure 23 : Ashfield LGA resident overnight hospital separations breakdown, 2013-14


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

Private Hospitals 18% (n=1150)

Other NSW Hospitals 9% (n= 575)

Royal Prince Alfred 62% (n=2979)

Concord 24% (n=1154)

Canterbury 9% (n=438)

Balmain 3% (n=139)

Sydney LHD 73% (n=4710)

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

Higher rates of ACSC hospitalisations may reflect indirect evidence of problems with the provision of healthcare such as difficulties in accessing primary health-care services and a lack of appropriate skills and resources. ACSCs include vaccine-preventable conditions, selected acute conditions and selected chronic conditions that are modifiable through behaviour modification and lifestyle change. The rate of ACSC separations was 1882.5 per 100,000 persons in Ashfield LGA in 2011-13, and was significantly lower than the state level.

Table 30: Potentially preventable hospitalisation separations for ACSCs by LGA, 2011-2013

LGA Separations per year Separations per 100,000 sSSR17 relationship to state levels

Ashfield 837 1,882.5 Significantly lower than the state

Burwood 631 1,847.5 Significantly lower than the state

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

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

Leichhardt 953 1,944.6 Significantly lower than the state

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

Strathfield 593 1,749.5 Significantly lower than the state

Sydney 3,010 2,222.1 Significantly lower than the state

Source: Health Statistics NSW, Centre for Epidemiology and Evidence, NSW Ministry of Health

Figure 24: Potentially preventable hospitalisations for ACSCs by LGA, 2011-2013

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

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

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6.5 Home And Community Care Figure 25 and Table 31 show the profile of Home and Community Care (HACC) clients in Ashfield LGA compared to the IWS catchment and NSW. During this reporting period, there were no Indigenous HACC clients in the Ashfield LGA. However, there was a high proportion of clients that did not speak English (42%) relative to NSW. The proportion of clients with a carer (27%) was greater than in both the overall catchment (23%) and NSW (21%), and the proportion of clients that live alone (40%) was slightly higher than both the IWS catchment (39%) and NSW (39%).

Figure 25: HACC Client Profile: Ashfield LGA, IWS and NSW; 2012-2013

Source: Public Health Information Development Unit (2014)

Table 31: HACC Client Profile % of HACC clients (number): Ashfield, IWS and NSW, 2012-13

Indicator Ashfield LGA Inner West Sydney New South Wales Living alone 40.3 (520) 39.1 (6499) 39.0 (106308) Living with carer 27.3 (352) 23.0 (3825) 20.7 (56385) Indigenous NA (NA) 1.4 (230) 3.8 (10268) Non-english speaking 42.0 (542) 39.0 (6484) 11.2 (30469) Source: Public Health Information Development Unit (2014)

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Figure 26 and Table 32 provide a graphical comparison of selected HACC services in Ashfield LGA, IWS and NSW. HACC clients located in Ashfield LGA received a much lower number of domestic assistance, case management, care counselling, centre-based day care and transport instances of care per 1,000 persons, compared to the IWS catchment and state levels. However, the number of care coordination services provided to Ashfield LGA residents per-capita were notably higher than across the IWS catchment and NSW.

Figure 26: HACC Service Profile: Ashfield LGA, IWS and NSW; 2012-2013

Source: Public Health Information Development Unit (2014)

Table 32: HACC Service Profile: Ashfield LGA, IWS and NSW, Instances of care per 1,000 (actual number), 2012-2013

Indicator Ashfield LGA Inner West Sydney New South Wales Allied health care 3.6 (181) 3.5 (1822) 2.3 (17549) Care counselling 2.0 (101) 2.8 (1476) 3.5 (26863) Case management 1.7 (83) 3.0 (1580) 2.0 (15261) Centre-based daycare 2.3 (115) 4.7 (2446) 2.8 (21907) Care coordination 5.3 (270) 4.1 (2096) 4.0 (30940) Domestic assistance 5.2 (266) 5.8 (2979) 7.1 (54720) Transport 5.5 (278) 8.0 (4120) 9.4 (72274) Source: Public Health Information Development Unit (2014)

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

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

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

The SLHD in collaboration with the University of Sydney, and thirteen affiliated Medical Research Institutes forms Sydney Research. The Sydney Local Health District is part of Sydney Health Partners which is an Advanced Health Research and Translation Centre of the NHMRC.

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

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

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

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

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There are also two private hospitals within the Ashfield LGA boundary; the Sydney Private Hospital, which is an acute surgical and rehabilitation facility, and the Wesley Private Hospital, a 38 bed private psychiatric facility. The St John of God Private Hospital in Burwood and Strathfield Private Hospital are 3 kilometres from the centre of Ashfield.

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

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

The services provided by Community Health include:

• Sydney District Nursing • Counseling • Sexual Health /Community HIV • Early Childhood Health • Palliative Care Nursing • Women’s Health • Multicultural Health • Youth Health • Child and Family Health • Sexual Assault Services • Community Development

• Community Nutrition • Child Protection

Community based health services are located in numerous facilities including community health centres, community clinics, schools and outreach centres. Large multidisciplinary Community Health Centres are located at Croydon, Marrickvillle, Canterbury and Redfern. Community health services located within Ashfield LGA, that are currently registered on the NSW Health Establishment Registration Online Database (HERO) include early childhood, youth health and mental health services (Table 33).

Table 33: Community Health facilities in Ashfield LGA, HERO database, 2015

Service Name Service Type Location

Ashfield Early Childhood Health Centre Child Health Services Ashfield

Croydon Early Childhood Health Centre Child Health Services Croydon

Ashfield Community Mental Health Centre Community Health Services Ashfield

Croydon Health Centre Community Health Services Croydon

Croydon Living Skills Centre Community Health Services Croydon

Ashfield Community Mental Health Centre Mental Health Services Ashfield

Croydon Health Centre Mental Health Services Croydon

Croydon Living Skills Centre Mental Health Services Croydon

Croydon Health Centre Youth Health Services Croydon

Source: NSW Health Establishment Registration Online (HERO) database. Accessed Feb 2015.

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7.3 General Practice

Selected characteristics of General Practitioners currently practicing across the IWS catchment are provided in Figure 27, which shows that the availability of GPs and GP services per capita to Ashfield LGA residents was better than in most LGAs within the IWS catchment. The number of GPs per 100,000 persons in Ashfield LGA was the second highest across the IWS catchment, behind Leichhardt. The number of GPs providing services under the Access to Allied Psychological Services (ATAPS) Scheme per 100,000 persons was also the second highest across the IWS catchment – again behind Leichhardt.

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

Source: PHN (2015).

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7.4 Allied Health

Figure 28 shows the availability of various private allied health practitioners in Ashfield LGA on a per-capita basis, compared to the IWS catchment. As illustrated, Ashfield LGA was better-served by certain allied health services; particularly Pharmacists, Occupational Therapists, Exercise Physiologists, and Speech Pathologists relative to the per-capita rate across the IWS catchment.

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

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

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

Table 34 shows that at 30 June 2014 the total number of aged care places and ratios (places per 1,000 people aged 70 years and over) in the Inner West catchment at 126.2 was higher than the state ratio (111.2 per 1,000 people over 70 years). Under the Government framework a national provision level of 125 residential and home care packages for every 1,000 people aged over 70 years or over is to be achieved by 2021-22.

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

5,580 87,913 126.2 111.2

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

Much of the health-related care for older people is provided directly by the Aged Care and Rehabilitation (AC&R) service, a core part of the Sydney Local Health District.

Other religious, charitable and community organisations also provide services throughout the IWS catchment area. Aged Care services located within Ashfield LGA, that are currently registered on the NSW Health Establishment Registration Online Database (HERO) are identified in Table 35.

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Table 35: Aged care facilities in Ashfield LGA, HERO Database, 2015

Aged care facilities Facility Location Abrina Nursing Home Ashfield

BUPA Ashbury Nursing Home Ashfield

BUPA Ashfield Ashfield

Opal Ashfield Residential Aged Care Facility Ashfield

Chandos Nursing Home Ashfield

Holy Spirit Croydon Nursing Home Croydon

Presbyterian Nursing Home Haberfield

Presbyterian Aged Care Ashfield

St Joan of Arc Villa Aged Care Facility Haberfield

Quong Tart Nursing Home Ashfield

St Ezekial Moreno Nursing Home Croydon

Summer Hill Aged Care Services - Nursing Home Summer Hill

The Willows Nursing Home Ashfield

Windermere Nursing Home Summer Hill

Winston House Nursing Home Croydon

Woodfield Nursing Home Haberfield

Wyoming Nursing Home Summer Hill

Source: NSW Health Establishment Registration Online (HERO) database (2015)

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APPENDIX A: POSTCODE TO LGA / SLA CORRESPONDENCES In a number of cases, data is only available at the postcode level, rather than an LGA or SLA level. Where this occurred, the data at the postcode level is mapped to the LGA or SLA according to the correspondences shown in Table A1. The correspondences are based upon published data sourced from the Australian Bureau of Statistics regarding postcode to SLA or LGA mappings detemined under the Australian Standard Geographical Classification.

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

Table A1 Postcode to SLA / LGA correspondences:

LGA / SLA POSTCODE % WITHIN

LGA BOUNDARY

LGA / SLA POSTCODE

% WITHIN LGA

BOUNDARY

Ashfield

2045 99.62

Leichhardt

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

Burwood

2132 59.29

Marrickville

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

Canterbury

2133 40.35 2203 100.00 2191 78.20 2204 99.96 2192 100.00

Strathfield

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

Sydney City South

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

Canada Bay

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

Sydney City West

2006 100.00 2139 100.00 2007 92.59

2008 66.38 2009 100.00 2037 100.00 2050 59.83

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APPENDIX B: DATA LIMITATIONS AND ASSUMPTIONS

B.1 Background to the LGA Health Profiles

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

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

B.1.1 PHIDU Social Health Atlas of Australia

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

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

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

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B.1.2 Other Data Sources

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

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

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

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

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

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

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

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