Population Health Commissioning Atlas

Population Health Commissioning Atlas the PHCAtlas population health profiling + needs assessment + commissioning an overview Western Sydney Primary Health Network [WSPHN] March 2016

Part1 Introduction to the Population Health Commissioning Atlas Concept Contents 2 Introduction to the Population Health Commissioning Atlas Concept 4 Demographics, Trends + Socio-Economic Status 6 Social Determinants of Health 7 Maternal and child health 8 Population Health + Profiling 14 WSPHN Health Domains + Primary Health Network Data Benchmarking 16 SLA Analysis 18 Potential Needs Assessed in each WSPHN Health Domain 19 Potential Needs of Specific Populations at Risk Within WSPHN 20 Needs + Commissioning Approach 20 Commissioning Recommendations for WSPHN 21 References The Western Sydney Primary Health Network acknowledges the traditional custodians of the land we walk upon today, and respect their continuing culture and the contribution they make to the life of this city and surrounding region. Introduction to the PHCAtlas This PHCAtlas brings together available information from a range of sources to create a population health profile and utilises the National Health Performance Authority (NHPA) 1 Indicators for PHNs as a starting point for analysis, highlighting variations in health status and health service utilisation. The PHCAtlas value adds where possible by drawing on additional sources (i.e. local intelligence, stakeholders and published reports) to inform the commentary. The intent is to provide an information rich and visual document for decision makers within PHNs to assist in setting priorities, as well as providing recommendations for commissioning and further in-depth analysis or planning. A broad range of data sources are used including the Australian Bureau of Statistics (ABS), Medicare Australia, the Australian Institute of Health and Welfare (AIHW), and other key reports (see references). Many of the prevalence maps generated rely on a dataset for Primary Health Networks provided by the Public Health Information Development Unit (PHIDU) using synthetic (modelled) data estimates. These estimates should be used with caution and treated only as indicative of the prevalence of each health indicator in an Statistical Local Area (SLA). In future, data from General Practices and Aboriginal Community Controlled Health Services will provide richer and a more up to date aggregated data set for analysis. The Western Sydney Primary Health Network (WSPHN) region is compared to the other 31 PHNs on a range of indicators, by ranking within a quintile range the highest ranked position having the greatest health need. A colour coding system is used for the quintiles for ease of visualisation. The darker the colour, the greater the health need, relative to other PHNs. The SLAs of highest demand are also highlighted within the region. Determinants of Health Social, environmental and economic factors play a significant role in shaping the health and wellbeing of individuals and populations and are commonly referred to as the social determinants of health (SDH) as shown in Figure 1. Evidence documenting the contribution of the SDH to population health outcomes is well established and undisputed, leading international, national and regional health authorities to act to address these factors. The links between SDH and the development of diseases such as chronic conditions are complex, although usually associated with access to opportunities and resources such as quality education, adequate and meaningful employment, safe and affordable housing, accessible transport, nutritious food, safe local environments and accessible health services. Income also plays a critical role as it provides flexibility and options, enabling people to access the SDH they need. SDH underpin health and influence the movement of individuals and populations across the Population Health disease continuum.2,4 Figure 1 Social Determinants of Health Source: Dahlgren,Whitehead 3 Figure 2 Population Health Chronic Disease Continuum Well Population At Risk Established Disease Primary Prevention > Promotion of healthy behaviours & environments across the life course > Universal & targeted approaches > Public health > Primary health care > Other sectors Health Promotion Prevent Movement To The At Risk Group Secondary Prevention/ Early Detection > Screening > Case finding > Periodic health examinations > Early intervention > Control risk factors lifestyle and medication > Primary health care > Public health Health Promotion Controlled Chronic Disease Disease Management and Tertiary Prevention > Treatment & Acute Care > Complications management > Specialist services > Hospital care > Primary health care Health Promotion Prevent Progression To Established Disease & Hospitalisation > Continuing Care > Maintenance > Rehabilitation > Self management > Primary health care > Community care Health Promotion Prevent/Delay Progression To Complications & Prevent Readmissions Source: NHPH 5 The above framework has been used to guide the development of the Population Health Commissioning Atlas. It describes the population health chronic disease continuum from a well population to the development of risk factors, through to the progression of established chronic disease patterns. It recognises the interconnections between the socio-economic and environmental conditions in which people live and their access to health and other services has a direct impact on the health status of a population. Action to improve health status needs to occur at each level of the continuum. It recognises a wide range of collaborative partnerships with multiple stakeholders and sectors will be required to achieve improved population health and well being outcomes. 5 Primary Health Networks and Hospital and Health Services are in a prime position to drive these improvements and fulfil their mandate under the National Health Reform agenda. 6 2 > Population Health Commissioning Atlas

Introduction to The Population Health Commissioning Atlas (PHCAtlas ) Concept The Challenge Walter Kmet CEO Western Sydney Primary Health Network Western Sydney is a diverse community and with this comes a range of diverse health needs and social circumstances. The Western Sydney PHN (WSPHN) region is closely analysed in this Population Health Commissioning Atlas. It is one important part of the planning and needs assessment role that WSPHN undertakes and shares with a broad range of health and human service policy makers, funders and service providers. The 2016 edition of the Altas shows that some sub-regions of western Sydney have poor health compared to those in other parts of NSW. Many communities have high rates of chronic disease (eg diabetes) and mental health issues. This is underscored by high rates of obesity and smoking, low rates of cervical and breast cancer screening, and a high impact of social determinants of health and inequity. Immunisation rates are also below average. WSPHN is committed to working with GPs, primary care providers and key stakeholders to improve health outcomes across western Sydney. With a fast growing population, prevention strategies including health promotion, better integration of care and strong cross sector partnerships are critical enablers to improved health. WSPHN is proud to have a role to play in western Sydney to achieve better outcomes and equity. Map 1 Western Sydney PHN Map and Age profile See Appendix 1 (Page 19) for detailed table Council SLA Group/No. 1 Auburn 2 Blacktown - North 3 Blacktown - South-East 4 Blacktown - South-West 5 Holroyd 6 Parramatta - Inner 7 Parramatta - North-East 8 Parramatta - North-West 9 Parramatta-South 10 The Hills Shire - Central 11 The Hills Shire - North 12 The Hills Shire - South At A Glance Boundary The Western Sydney PHN region encompasses 4 city councils and 1 shire and is located in the outer western suburbs of Sydney. The boundaries stretch from Auburn in the East to Blacktown in the West, and to the Hills in the North, covering an urban, outer urban and semi-rural population. Population 906,605 (ABS 2014) Aboriginal & Torres Strait Islander 11,496 (1.4% of WSPHN population) Socio-Economic Index for Areas (SEIFA) Index of Relative Social Disadvantage (IRSD) 944 (range 870-1105) General Practitioners 850 General Practices 330 Practice Nurses 250 Residential Aged Care Facilities 57 Public Hospitals 7 Private Hospitals 3 Pharmacies 200 Allied Health 1500 Universities 2 PHN Formation 1 July 2015 Western Sydney Population 7 City Council Population (ABS, 2014) Blacktown 332,424 The Hills Shire 187,703 Auburn 85,446 Holroyd 111,100 Parramatta 189,932 Total 906,605 Western Sydney Projected Population 33 2016 946,750 2021 988,900 2026 1,161,850 2031 1,274,700 the PHCAtlas All councils in Western Sydney are projected to have significant population increase between now and 2031. With the population of Western Sydney being over 1.2 Million people by 2031. Population Health Commissioning Atlas > 3

Demographics, Trends + Socio-Economic Status Demographics & trends The PHN's population has a younger profile than both Sydney and the broader NSW population. Figure 3 Population Pyramid WSPHN vs New South Wales There is a higher proportion of both males and females for all age cohorts 0-44 years of age. The 65 plus proportion of the population is low when compared to NSW. WSPHN has the tenth lowest proportion of people aged over 85 when compared to all other Primary Health Networks. Migration stats Migration statistics from the 2011 census of population and housing indicate that over a quater of the population of Western Sydney moved at least once between 2006 and 2011. 8 There was a net increase of almost 50,000 people between 2006 and 2011 in Western Sydney. Over 60,000 people moved into the western Sydney area from another country during this same time period. Figure 4 WSPHN vs Australia WSPHN vs NSW Figure 5 Migration Statistics Current residents who moved at least once between 2006 and 2011 Residents who had moved within WSPHN Migration from other parts of New South Wales 274,068 86,945 113,619 Migration to other parts of New South Wales 117,503 Migration from other parts of Australia 8,713 Migration to other parts of Australia 17,800 Migration from other countries 62,006 Source: Australian Bureau of Statistic (2011) - Profile.ID Figure 6 WSPHN Population Projection 2010-2025 Age Groups as Percentage of Total Population Population projections Similar to the overall Australian projections the population of the WSPHN region is aging with an increase in all age cohorts above 45 years of age. It is projected that by 2025 there will be a significant growth in the 65 plus population with an increase from 5.7% of the total population to 7.6% of the total population. 4 > Population Health Commissioning Atlas

Demographics, Trends + Socio-Economic Status Map 2 SEIFA Index Relative Socio-Economic Disadvantage by SLA Group Socio-Economic Index for Areas (SEIFA) The ABS 'Index of Relative Socio-Economic Disadvantage' is a useful summary indicator of disadvantage across regions. This summary measure provides an overview of many of the indicators of social inequality. These indicators include low income, low educational attainment, high unemployment, jobs in relatively unskilled occupations amongst others. SEIFA is a good predictor of a region's health. Low SEIFA scores usually are indicative of poor health outcomes for a region. Socio-Economic Analysis A low Index of Relative Social Disadvantage (IRSD) score indicates a high proportion of relatively disadvantaged people in the area as highlighted by the dark red colours on Map 2. Overall the IRSD for the WSPHN region is 994 slightly below the Australian Average (1000) and the greater Sydney Average (1011). All SLA s have great variation when considering the SA1 s within a given SLA e.g.: Blacktown South-West (890 Overall score) has SA1 s with scores of as low as 480 and a maximum of 1086. The Hills Shire North has the highest SEIFA IRSD Score (1105) but still has SA1 s within the area with scores as low as 874 (up to a maximum 1158). Figure 7 SEIFA Index Relative Socio-Economic Disadvantage WSPHN (SLAs) SEIFA Index Rank and WSPHN SLA Number Figure 8 WSPHN Aboriginal & Torres Strait Islander population per LGA 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Auburn Blacktown Holroyd Parramatta The Hills Shire the PHCAtlas Aboriginal & Torres Strait Islander Population The WSPHN region is home to the largest urban Indigenous population in Australia. The 2011 Census indicates 1.4% of the population of the WSPHN region identify as an Aboriginal or Torres Strait islander (11,492 people) with the main centre of Indigenous populations being Blacktown with 8,194 Aboriginal people. 7 Blacktown South West has the highest Indigenous proportion (4.6%), and this is the highest proportion of any community in Sydney. Over 4,500 Indigenous people live in the Mt Druitt area (Blacktown SW) which is an area with very low socioeconomic status. The Aboriginal & Torres Strait Islander Community is a transient community with sensitivity to completing the census. It is believed the Aboriginal & Torres Strait Islander Community in Western Sydney has a population closer to 13,000-15,000. Population Health Commissioning Atlas > 5

Social Determinants of Health Social Determinants of Health (SDH) The Social Determinants of Health describe the conditions that play a key role in shaping people s health and wellbeing. Importantly, the distribution of these determinants can vary across population, and thereby either increase of decrease a community s opportunities to be healthy. The unequal distribution of the SDH across populations is considered to be one of the driving factors leading to difference in health status and creating health inequities the unfair and avoidable differences seen within countries, regions and populations. 4,10 Map 3 Secondary school participation Map 4 Youth Unemployment (15-24 Yr Olds) School Participation Higher levels of education are associated with higher levels of employment and earning for individuals. Participation in schooling and/or training is an important protective factor for young people, reducing the risk of substance misuse, incarceration, social exclusion, homelessness and poverty. Evidence shows that health improves with increasing levels of educational attainment. The WSPHN region has good school participation rates overall with 80.5% of the population aged 16 attending full time secondary school. All of The Hills Shire regions have participation rates 86% and above. Conversely however, Parramatta South (69.4%) and Blacktown South West (72.4%) are two regions with participation rates well below the rest of the region. Employment and income Unemployment is a social problem and is associated with poor physical and mental health outcomes. 12 The health effects are linked to psychological consequences, financial problems (debt) and reduced life opportunities, with outcomes worse in regions where unemployment is widespread. Overall the WSPHN region has a low youth unemployment rate (4.6%) compared to the Australian average (5.4%), however it is high when compared to greater Sydney s average (3.8%). Blacktown South-East, South-West and Paramatta South all have rates of youth unemployment over 6%. In June 2013 the WSPHN region had an overall unemployment rate of 6.5%. Australian average (5.4%). Parramatta South and Blacktown SW both have unemployment rates over 11% which is more than twice the average Australian rate. These two regions also have the highest rates of total concession card holders with over a quarter of the population in each of these regions holding a centrelink concession card. The WSPHN regions have a wide range of median weekly personal incomes, ranging from $370 in Parramatta South up to $740 for people in The Hills Shire North. Figure 9 - Selected Median's from 2011 census of population and housing Median Personal Income (week) Median Household income (week) Median Mortgage Payment (month) Median rent payment (week) Average household size Source: ABS 13 Auburn Holroyd Parramatta (I) Parramatta (NE) Parramatta (NW) Parramatta (S) Blacktown (N) Blacktown Blacktown (SE) (SW) Hills (Central) Hills (North) $420 $517 $613 $564 $622 $370 $708 $527 $467 $732 $740 $671 Map 6 Concession card holders (%) Hills (South) $1160 $1209 $1308 $1368 $1463 $960 $1816 $1242 $1158 $2009 $2187 $1926 $2000 $2058 $1950 $2300 $2167 $1928 $2383 $1984 $1879 $2500 $2622 $2500 $350 $330 $340 $350 $360 $300 $370 $300 $250 $440 $495 $420 3.1 2.8 2.5 2.7 2.8 3.2 3.1 2.9 3.2 3.0 3.3 3.0 Map 5 Unemployed rate (%) 6 > Population Health Commissioning Atlas

Maternal and child health Map 7 Mothers smoking while pregnant (%) Source: HealthyStats 22 Figure 10 Children developmentally vulnerable on 1 or more domains 16 14 12 10 8 6 4 2 0 Source: AEDC 18 Physical Social Emotional Language Communication Auburn Holroyd Parramatta Blacktown The Hills Shire NSW Australia Map 9 Children fully immunised at 2 years (%) Source: NPHA 34 Source: AEDC 18 Map 8 Low birth weight babies (%) Map 10 Children developmentally vulnerable on 2 or more domains (%) Maternal and child health Child health is an important indicator of the health of a community. 13 The importance of the early years and the impact they have on a child s health and development is acknowledged in the Key National Indicators Framework by AIHW. This framework brings together all of the determinants of children s health outcomes and includes safe communities and environments, family circumstances, exposure to risk and protective factors, learning and development, health child development and access to health and social services. 14 Antenatal care has been found to have a positive effect on the health outcomes for both mother and baby. Between 2009 and 2012 the WSPHN population had the highest rate of antenatal visits in Australia during the first trimester (97.7%). 15 Low birth weight is a risk factor for neurological and physical disabilities, and low birth weight babies may also be more vulnerable to illness throughout childhood and adulthood. Risk factors include maternal smoking, socio-economic disadvantage, the weight and age of the mother, poor antenatal care and illness during pregnancy. 16 The south west region of Western Sydney (Blacktown) has high proportions of mothers smoking during pregnancy. (Map7). This area also has the highest proportion of low birth weight babies. Immunisation is highly effective in reducing morbidity and mortality caused by vaccine preventable diseases. Overall immunisation rates (87.2%) at 2 years of age are below the national average (92.5%). Auburn and Parramatta have the lowest rates of immunisation (Map 9). the PHCAtlas Australian Early Development Census (AEDC) The Australian Early Development Census (AEDC) provides a snapshot of how Australian children are tracking against national benchmarks. Data is collected every three years with the teachers of children who are in their first year of school completing measures in five key domains (Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language & Cognitive Skills and Communication Skills & General Knowledge). AEDC data is collected at city council level (rather than SLA) and the data in Figure 10 and Map 10 show city council level data. 18 Two councils in the WSPHN have a higher proportion of children developmentally vulnerable on one or more domain than the Australian average. All councils (except Auburn) have shown an increase between the 2012 and 2015 surveys for children vulnerable on one or more domains. Population Health Commissioning Atlas > 7

Part2 Population Health + Profiling [1] National Health Priority Areas Risk Factors The Social Determinants of Health influence people s exposure to risk and protective factors. Figure11 shows a number of nationally selected diseases and conditions where focussed prevention and management are likely to result in significant improvements in the health of Australia s population. Communities can be supported to reduce the factors for these conditions and hence limit the need for use of hospital and ED Services. Chronic disease prevalence The Western Sydney Primary Health Network region s population has prevalence rates for chronic disease close to (and slightly below) the NSW and Australian averages. The WSPHN region population has a high rate of mortality from Coronary heart disease and stroke. Both rates are above both the NSW and Australian averages. However, the WSPHN population has a lower rate of death for all cancers. Poor Diet and excess body weight Nutritious food is fundamental to good health and disease prevention. There are significant health risks associated with poor nutrition, including the increased risk of chronic diseases such as heart disease, type 2 diabetes and some cancers. Poor nutrition also contributes to a number of chronic disease risk factors such as high blood pressure, high cholesterol and obesity. Figure 11 Selected National Health Priority Areas by risk factors 12 Disease or Condition Tobacco Smoking Physical Inactivity Chronic disease The Western Sydney Primary Health Network region s population has prevalence rates for chronic disease close to (and slightly below) the NSW and Australian averages. The WSPHN population has a high rate of mortality from Coronary heart Map 11 Adult fruit intake Risk Factor Poor Diet & Nutrition ExcessBody Weight High Blood Pressure High Blood Cholesterol Western Sydney 7 NSW 7 Aust 7 MORBIDITY ASR Per 100 Type 2 Diabetes X X X X 3.4 3.5 3.4 COPD X 2.0 2.3 2.3 Arthritis X X X 14.1 14.9 14.9 Asthma X 8.2 9.2 9.7 Hypertension X X X X X 7.6 8.4 9.2 Circulatory Disease X X X X X X 14.0 14.7 16.0 DEATHS ASR Per 100,000 Coronary Heart Disease X X X X X X 28.3 25.8 26.1 Stroke X X X X X X 9.7 9.2 8.9 COPD X 6.9 7.9 7.8 All Cancer X X X X 98.2 101.5 102.0 Colorectal Cancer X X X 9.0 9.3 9.6 Lung Cancer X 19.6 21.4 21.2 Map 12 Obese people Adults across the WSPHN region on average consume a usual daily intake of two or more serves of fruit at a rate higher than the Australian average. Only in parts of Blacktown do Adults on average consume fruit at a rate lower than the Australian average (50.1 ASR per 100). The southern part of the WSPHN are has the highest obesity rates in the region with Blacktown (South-West) and Auburn having the worst rates with over 20% of the population being obese. Diabetes While the overall prevalence rate across the WSPHN region of diabetes is consitent with the Australian average. The southern SLA s of the WSPHN region have rates higher than the Australia average (3.4 per 100 people). Ischaemic Heart Disease The WSPHN region population has a high rate of mortality from coronary heart disease with Blacktown (38.7 per 100,000) having a rate well above the Australian average (27.9 per 100,000). Map 13 Type 2 Diabetes prevalence Map 14 Deaths from IHD 8 > Population Health Commissioning Atlas

Population Health + Profiling [2] Map 15 Current smokers Map 16 COPD Prevalence Smoking Smoking continues to be Australia s largest preventable cause of death and diseases. It increases the risk of a number of cancers (especially lung cancer), coronary heart disease, Chronic Obstructive Pulmonary Disease (COPD) and stroke. There is strong correlation between smoking rates and disadvantage, with people living in areas of most disadvantage more likely to smoke daily compared with those living in areas of lease disadvantage (23% to 10% nationally). 17 Smoking rates in the WSPHN area (18.8 per 100) are overall below the Australian average (20.3 per 100) with the Hills Shires SLA s having significantly lower rates of smoking than Australia. Conversely however Parramatta South and Blacktown South-West have rates of smoking above the Australian average (ASR 20.3 per 100). There are significantly more males (21.9 per 100) smoking than females (15.9 per 100). Map 17 Deaths from COPD Map 18 - Deaths due to Lung Cancer Figure 12 Smoking attributable deaths by sex, NSW 1997 to 2013 Rate per 100,000 population 160 140 120 100 80 60 40 20 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Source: Health Stats 23 Males Females Persons Chronic Obstructive Pulmonary Disease (COPD) COPD is currently the fourth leading cause of death worldwide and by 2020 it is estimated that it will be the third leading cause of death. 18 COPD is associated with a high level of disability and cost (including unnecessary hospital admissions). It is under-recognised and under-diagnosed and can be better managed in primary care. Prevention across the spectrum is required for COPD is a serious long term lung disease with a high level of disability. The principal risk factor for COPD is smoking, with the amount and the length of time smoking increasing the risk. The map for COPD prevalence in Western Sydney closely matches the smoking map with the highest prevalence rates in Parramatta South and Blacktown SW. Overall the rate of 2.0 per 100 people in Western Sydney is low compared to Sydney, NSW and Australian averages. Despite a high prevalence of COPD in the population of South Parramatta, between 2008-2012 there were less than 4 deaths and therefore the ASR/SDR was not calculated. The south of Blacktown had the highest rates of death from COPD with Blacktown SW having a rate 66% higher than the Australian average (7.8 per 100,000). Lung Cancer the PHCAtlas The primary cause of Lung cancer is smoking and once again Blacktown SW and SE have higher than Australian average rates (21.2 per 100,000) of premature mortality due to lung cancer. Reduce The Impact Preventing the onset of smoking and increasing the numbers of smokers who quit is the single most important strategy to reduce the prevalence of, and deaths from COPD, Lung Cancer and heart disease. Population Health Commissioning Atlas > 9

Population Health + Profiling [3] Cancer Some cancers can be prevented and population wide screening programs are the best way to ensure early detection and best possible outcomes. Bowel cancer The WSPHN populations has one of the lowest bowel screening rates (31.9%) in the country ranking 56 out 61 old MLs for participation in screening. Women have a slightly higher rate of screening (32.8%) compared to men (31.1%). The Hills Shire (South) is the only SLA with a national bowel cancer screening program participation rate above the Australian average (35.4%). Map 19 Bowel cancer screening particpipation Map 20 Deaths from Bowel Cancer All SLAs in Blacktown and Parramatta South have high rates of premature mortality due to bowel cancer, and all are above the Australian average (ASR 9.6 per 100,00). Cervical cancer Participation in cancer screening programs is influenced by a range of factors. Barriers such as different cultural backgrounds and low socio-economic status can impact on participation rates. There is a large percentage of the WSPHN population born overseas in non English speaking background countries (35%) which along with Aboriginality is often a barrier to female cancer screening programs. The WSPHN population has a low participation rate in cervical cancers screening programs. Overall only 51% of eligible women are screened compared to 56% overall in NSW. Blacktown - South-West and Inner Parramatta have very low screening particpation rates of less than 44%. Prevalence of cervical cancer is however at a lower rate in the WSPHN population than the overall NSW population. Figure 13 Cancer screening for women 2009-2010 Cancer Type Age Number Percentage NSW Average Breast 50-69 37,734 47.5% 52.7% 20-49 86,891 48.8% 55.1% Cervical 50-69 33,085 57.2 59.8 20-69 119,976 50.8 56.4 Source: Health Stats 23 Figure 14 New cases of cancer Cancer Type Age Number Rate per 100,000 people NSW rate 50-69 208 271 287 Breast (2008) All ages 407 109 113 Cervical (2004-2008) 20-69 20 (per year) 8.3 8.9 Source: Health Stats 23 Breast cancer Similarly the participation of females in the WSPHN region in breast cancer screening programs is also low (48% compared to 53% for NSW). The prevalence of breast cancer in the WSPHN population is slightly lower than for the overall NSW population. The rate of premature mortality due to breast cancer for females in western Sydney (18 per 100,000) is higher than the Australian average (17 per 100,000). Parramatta NW and Blacktown SW have very high rates - 50% more than the Australian average. Map 21 Cervical cancer screening Map 22 Deaths from Breast Cancer 10 > Population Health Commissioning Atlas

Population Health + Profiling [4] Map 23 Pyschological Distress Figure 15 GP Mental Health care Mental Health Data indicates that the population of Western Sydney has a high incidence of mental health related conditions. Psychological distress is an indicator of the mental health of a community, and is considered the best population-wide measure currently available. The WSPHN population has one of the highest rates of psychological distress in the country (12.6 per 100). Over half the SLAs in WSPHN have rates of psychological distress above the Australian average (11.7 per 100). Map 24 Hospitalisations for mental health related problems Source: Medicare Australia (July 2014-June 2015) Map 25 Deaths from suicide/self injury GP mental health care plans GP Mental Health Plans are a requirement for patient referrals to short-term psychological interventions (e.g. CBT) under the Medicare funded ATAPS Programs. Figure 15 indicates that the preparation of GP Mental Health Plans and visits to a GP for mental health services occur more than twice as often for residents of Western Sydney compared to Australia as a whole. Hospitalisation WSPHN ranks 10th in the country for hospitalisations for mental health related conditions with only Parramatta-South (1044) having rates below the Australian average (1532 per 100,000). Figure 17 Suicide rate trend (2001 to 2013) (Rate per 100,000 people) Source: Health Stats 22 Suicide and self harm Figure 16 Intential self-harm hospitalisations (2012-13) WSPHN Age Sex WSPHN Rate per NSW rate number 100,000 per 100,000 population population 15-24 All ages Source: Health Stats 21 Males 75 116.2 178.1 Females 196 339.5 502.0 Persons 272 223.6 335.8 Males 346 77.1 105.3 Females 524 119.9 181.5 Persons 869 97.7 142.7 the PHCAtlas Compared to NSW the population of Western Sydney have a lower rate or hospitalisation for intentional self harm for males and females of all ages. WSPHN ranks very low when compared to other old MLs (58th) when deaths from suicide/self injury are considered. All SLAs have ASR s below the national average (12.4 per 100,000). The rate of death from suicide has been dropping over the past 20 years in both Western Sydney and NSW overall. With Western Sydney having a rate of 6 per 100,000 people in 2013 (compared to 9 per 100,000 for NSW). Population Health Commissioning Atlas > 11

Population Health + Profiling [5] Primary Care The population of Western Sydney is well serviced by the primary care sector with the second highest number of consults per year per person (7.3) for a PHN in the country. This is well above the average of 5.4 consults per year per person. WSPHN ranks third in Australia for after hours service utilisation. Figure 18 GP consults Figure 18 shows the proportion of short, standard and long consults for the WSPHN population. Standard consults (Level B, less than 20 minutes) are the norm for GPs in the WSPHN area with 86% of the consultations fitting into this category. This rate is slightly higher than the Australian average, and rates of all other consults are slightly lower than the corresponding Australian averages. WSPHN Figures 19 and 20 show that Western Sydney has on average a higher number of consults both in rooms and per RACF bed than the overall Australian population. Hospitalisations Potentially avoidable hospitalisations are those that may have been avoided by timely and effective provision of non-hospital or primary health care including prevention. It is important to recognise that a potentially avoidable hospitalisation may have become unavoidable by the time a patient was admitted. The rate of acute and vaccine preventable hospitalisations is the lowest in the peer group. Figure 19 GP consults per bed in RACF WSPHN Source: Medicare Australia 2014-2015 AUS Source: Medicare Australia 2014-2015 Figure 21 Hospitalisations by age (2013-14) Figure 20 GP consults per year in rooms WSPHN Source: Medicare Australia 2014-2015 AUS Figure 23 shows that the only conditions that WSPHN has higher rates of hospitalisation than the NSW and Australian averages is for Pregnancy/childbirth and Mental health related conditions. All other conditions the rates of hospitalisations are below the overall state and national rates. In particular the rate of hospitalisations for cancer and musculoskeletal disease are significantly below the equivalent national and state rates. The rate of ED admissions overall is more than 20% lower than the state average, which may be attributed to the high rate of primary care services in Western Sydney. Source: Health Stats 22 Figure 22 Hospitalisations for selected diseases and conditions (2010-11) Number ASR per 100,000 NSW ASR per 100,000 Aust ASR per 100,000 ED Admissions 195,192 22,945 29,919 28,428 Dialysis 29,798 4,150 4,209 4,521 Digestive disease 28,115 3,536 3,792 4,088 Pregnancy and childbirth 20,860 4,391 4,135 4,339 Injury and poisioning 17,812 2,214 2,498 2,681 Mental health related conditions 15,724 1,882 1,684 1,532 Circulatory disease 14,331 2,040 2,216 2,643 Cancer 13,967 1,931 2,278 2,643 Respiratory disease 13,511 1,679 1,796 1,794 Genitourinary disease 12,830 1,619 1,845 1,913 Musculoskeletal disease 11,836 1,545 1,951 2,194 Infectious dieases 4,605 563 572 627 12 > Population Health Commissioning Atlas

Population Health + Profiling [6] Figure 23 Premature mortality by cause (2008-2012) Cause Number Rate per 100,000 Cancer (all) 3,268 98.2 Endocrine, nutritional and metabolic diseases 192 5.8 Circulatory system diseases 1,704 51.2 Respiratory system diseases 467 14.3 External courses 827 21.3 Other 827 n/a Total 7,943 231.4 Source PHIDU 7 Map 25 Premature mortality due to cancer (ASR per 100,000) Premature Mortality Premature mortality refers to deaths which occur at a younger age than expected and can be measured by potential years of life lost (PYLL). PYLL highlights deaths that occur at younger ages as it counts the number of years of life lost for each death before the age of 75. It can be used as an indicator of social and economic impact of premature mortality and therefore used in setting public health priorities. When compared to other peer group PHNs Western Sydney ranks as having the second lowest rate of potentially avoidable deaths per 100,000 people per year. Similarly to all peer PHNs there are more potentially avoidable deaths for males than females. Causes Cancer in the leading cause of premature mortality (98.2 per 100,000 people), followed by circulatory system diseases (51.2). While overall Western Sydney has a rate of death due to cancer slightly below the Australian average (96 compared to 100). Some parts of Western Sydney have rates well above the national average. South East and South West Blacktown have rates of death from cancer 10-35% higher than the national average. While in contrast The Hills Shire has rates 20-25% below the Australian average. Map 26 Premature mortality (all causes) ASR per 100,000 Overall premature mortality (from all causes) varies considerably across the WSPHN region with Blacktown SW and Inner Parramatta having rates of mortality 30-40% higher than the Australian average. The SLAs within The Hills Shire have mortality rates 35-40% lower than the Australian average. the PHCAtlas Population Health Commissioning Atlas > 13

Part3 WSPHN Health Domains + Primary Health Network Data Benchmarking DOMAIN INDICATOR (Light grey text SLA data only) All PHNs (x31) WSPHN Quintile Range Median Range Result Rank Highest Need Med-Hi Medium Need Med-Low Lowest Need LGA Range (Light grey text SLA data only) GP MBS utilisation (consults per year person) 5.5 4.0-7.6 7.4 2 ACCESS UTILISATION GP Services Waiting Times 24% 15-38% 22% 11 GP After Hours Service Utilisation 8% 4-12% 8% 13 Allied Health utilisation ( % who saw) 21 10-32 16 9 Specialist Service Utilisation 0.8.38-1.19 1.1 5 Selected Potentially Avoidable Hospitalisations 2967 1891-5342 2445 14 Smoking Prevalence (18 years and over) (%) 18.0 13.6-23.5 14.7 2 11.2-16.5 Overweight Prevalence - Males (rate/100) 42.2 40.4-45.2 41.7 9 39.6-44.6 Overweight Prevalence - Females (rate/100) 28.2 26.8-31.8 26.8 2 24.4-27.5 LIFESTYLE 1 PREVENTION Overweight Prevalance - People (%) 34.5 33.4-36.6 34.5 5 32.6-35.8 Obesity Prevalence - Males (rate/100) 27.5 23.5-33.4 26.5 7 25.3-27.5 Obesity Prevalence - Females (rate/100) 27.5 23.6-34.7 25.1 3 18.5-30.3 Obesity Prevalence - People (rate/100) 27.5 23.6-34.0 25.8 5 22.4-28.8 Alcohol Use/abuse (rate/100) 4.7 2.8-7.8 4.5 10 4.2-4.7 Physical Inactivity (rate/100) 34.8 26.4-44.2 37.0 43 29.1-46.4 Prevalence Diabetes (rate/100) 3.5 2.7-4.4 3.4 36 2.8-4.1 Prevalence COPD (rate/100) 2.4 1.9-2.9 2.0 6 1.7-2.4 CDM 2 PREVENTION Death rate IHD (rate/100,000) 28.4 12.9-70.5 28.3 36 11.9-46.3 Death rate COPD (rate/100,000) 8.7 2.9-22.7 6.9 22 1.7-13.1 GP MBS Diabetic Annual Care Plan (SIP services) No data 6931 GP MBS Asthma Care Plan (SIP services) No data 2249 Incidence IHD (rate per 100,000) No data 645.5 561.2-1068.8 Screening participation Breast Cancer 56.4% 36.0-63.8 47.5 * Incidence of Breast Cancer (female) (rate per 100,000) 99.3 73.0-123.6 Screening participation Bowel Cancer (%) 35.4% 23.3%- 42.3% 30.4 56 24.5-37.3 SCREENING Incidence of Bowel Cancer (rate per 100,000) 48.4 41.9-57.6 Death rate Bowel Cancer (rate/100,000) 9.6 4.3-11.8 9.0 10 7.1-11.5 Screening participation Cervical Cancer 56.6% 47.0-65.4 50.5 46 43.0-60.9 Cervical screening outcomes: high grade abnormality (20-69yo) (Rate/1,000) # 13.3 8.9-20.5 9.2 3 Death rate Breast Cancer (rate/100,000) 17 5.6-18.7 18.2 25 14.2-21.1 Death rate Cervical Cancer ( rate/100,000) No data Infant Mortality (rate/100,000) 21.3 7.0-45.2 17.7 26 CHILD HEALTH Life expectancy at Birth 81.5 76.1-84.6 82.4 21 4.1-8.3 Proportion babies Low Birth weight 6.6% 4.1-9.1 6.4% 23 Immunisation of 2 year old 92.9% 88.6-96.3 91.9% 48 89.6-94.4 MENTAL HEALTH Completed Suicide Rate (rate/100,000) 13.6 7.3-29.4 8.2 4 4.8-10.9 Prevalence of Depression 11.6 8.9-13.8 12.6 46 8.9-16.8 Population receiving MH Care (number) No data 31224 Proportion aged 85+ 1.9% 0.2-2.9 1.3% 10 0.7-2.3 RACF AGED Aged care beds/pop. +70 years (total care places/1,000) 86.6 8.7-140.3 85.6 28 30.2-291.2 RACF GP services utilisation (# per patient) 12.9 7-16.8 15.9 5 14 > Population Health Commissioning Atlas * only 42 ML's are contained in PHIDU for comparison (NSW, NT and Tas not included) # Positive screening test result Cervical cancer have been used as a proxy indicator for Cancer Incidence to enable comparison across MLs

WSPHN Health Domains + Primary Health Network Data Benchmarking COMMENTS (Light grey text SLA data only) Average GP Attendances per person 2013-2014 age-standardised by PHN National Health Performance Authority Healthy Communities Report Self reported: percentage of adults who felt they waited longer than acceptable for a GP appointment 2013-2014, National Performance Authority Healthy Communities Report GP After Hours Attendances per person 2011-2012, National Health Performance Authority Healthy Communities Report EPC utilisation data only, number of services per person. NO SLA data available. www.medicareaustralia.gov.au Average specialist attendances per person 2013-2014, age-standardised by PHN National Health Performance Authority Healthy Communities Report PHIDU Current Smokers, 18 years and over (2011-2013) PHIDU Overweight (not obese) males, 18 years and over (2011-2013) PHIDU Overweight (not obese) women, 18 years and over (2011-2013) PHIDU Overweight (not obese) people, 18 years and over (2011-2013) PHIDU Obese males, 18 years and over (2011-2013) PHIDU Obese females, 18 years and over (2011-2013) PHIDU Obese people, 18 years and over (2011-2013) PHIDU Alcohol levels considered high risk to health, persons aged 18 years and over (2011-2013) PHIDU Physical inactivity (synthetic prediction), persons aged 15 years and over (2007-2008) PHIDU Type 2 diabetes (synthetic prediction) (2007-2008) PHIDU Chronic Obstructive Pulmonary Disease (synthetic prediction)(2007-2008) PHIDU Deaths from IHD, 0 to 74 years (2008-2012) ave annual rate/100,000 PHIDU Deaths from COPD, 45 to 74 years(2008-2012) ave annual rate/100,000 Completion of annual cycle of care for pts with diabetes mellitus, Western Sydney ML Jan-Dec 2013. www.medicareaustralia.com.au (A18 GP attendance associated with PIP incentive payments - #2) Completion of the asthma cycle of care, Western Sydney ML Jan-Dec 2013. www.medicareaustralia.com.au (A18 GP attendance associated with PIP incentive payments - #3) NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health. (http://www.healthstats.nsw.gov.au/ Indicator/cvd_chdhos/cvd_chdhos_lhn_snap) - Range is LGA's in Western Sydney BreastScreen NSW and ABS population estimates.centre for Epidemiology and Evidence, NSW Ministry of Health. (http://www.healthstats.nsw.gov.au/indicator/can_brstscr_lhn) 2009/2010 (Western Sydney LHN) "New malignant breast cancer cases (2004-2008) (LGA Range) http://www.wslhd.health.nsw.gov.au/socialhealthatlas/ Breast cancer: new cases by LHD, latest year (2008) - 270.6 (50-69 years)" PHIDU Participation in NBCSP (persons), 2011/12 "New malignant bowel cancer cases 2004-2008 (LGA Range) http://www.wslhd.health.nsw.gov.au/socialhealthatlas/ Colorectal cancer: new cases by LHD, latest year (2008) - 57.4" PHIDU Avoidable Mortality as a result of colorectal cancer, 0-74 years (2008-20012) PHIDU Cervical cancer screening participation (females aged 20-69) - women attending over a 24mth period (2011 &2012) "PHIDU women with high grade abnormality (2011-2012) Women screened over a 24 mth period. Age standardized rate per 1,000. Cervical cancer: new cases by Local Health District, females aged 20-69 years, NSW 2004-2008 - 8.3 (rate per 100,000) http://www.healthstats.nsw.gov.au/indicator/can_cervcdth_ PHIDU Premature Mortality as a result of Breast Cancer (females), 0-74 years (2008-2012) PHIDU child mortality(<5yrs) (2003-2007) Rate average annual rate per 100,000 NHPA Website Source: ABS Causes of Death 2009 2011 and ABS Estimated Resident Population 2009 2011. PHIDU Low birth weight babies (2008-2010) "PHIDU Fully Immunised at 2 years of age 2011/12 (91.2 @ 12 Months, 90.1% @ 5 Years NHPA MHC 2012-13 (90.3 @ 12 Months and 91.7 @ 5 years" Deaths from suicide and self-inflicted injuries, 0 to 74 years (2008-2012) Average annual rate per 100,000 High/very high psychological distress levels, 18 years and over (2007-08). Group:A20 GP Mental Health Treatment, Subgroup: 1 GP Mental Health Care plans" processed from January 2013 to December 2013 - prepare mental health care plan PHIDU Persons 85 yrs and over (2012 ERP) PHIDU Residential aged care places Total residential care places per 1,000 NHPA MHC 2011/12 National Health Performance Authority Healthy 2013, Technical Supplement: Healthy Communities: Australians experiences with access to health care in 2011 12. the PHCAtlas Population Health Commissioning Atlas > 15

Part4 Potential Needs of Specific Populations at Risk Within WSPHN 1 Aboriginal & Torres Strait Islander People 2 Maternal and child health The Western Sydney Primary Health Network region has the largest urban Aboriginal population in Australia (by number). Within Western Sydney Aboriginal people live mostly in areas of the lowest socio-economic status in particular the Mt Druitt area of South West Blacktown (4,500 Indigenous people). Aboriginal people within the WSPHN region have a higher burden of disease and rate of premature mortality than the non- Aboriginal population. The percentage of low birth weight Aboriginal babies in the western and south-western Sydney was 12% compared to 6% of non-aboriginal babies in the region. 31 Similarly, teenage motherhood poses significant long-term risks for both mother and child, including poorer health, educational and economic outcomes. In western Sydney, 18% of Aboriginal women giving birth were teenagers compared to 4% of non-aboriginal women in 2006. 31 Overall the population of the WSPHN region is doing well when maternal and child health is considered. Western Sydney has a higher proportion of preschool children than the rest of Australia and this is forecast to be the case into the future. While improvements could be made in some areas in regards Immunisation, the overall rate of immunisation of the WSPHN population is good. While the Parramatta, Blacktown and Auburn councils have shown improvements in their populations AEDI scores between the 2009 and 2012 surveys, they still have rates of children developmentally vulnerable on one or more domains above the national average. Similarly both Blacktown and Auburn councils have a greater proportion of children developmentally vulnerable on two or more domains than the national average. 3 Refugees, New Arrivals & Migrants Western Sydney has a large Culturally and Linguistically Diverse (CALD) population (35%) and of these a large proportion of these people are new arrivals (over 60,000 arrived from overseas between 2006 and 2011). People from CALD backgrounds may have a higher risk of developing some chronic diseases such as diabetes. There are often additional considerations needed with people from CALD backgrounds as they may have language barriers, problems with health literacy, absence of family support, financial stress, low social status and a sense of disempowerment. There hihglights a need for multilingual services to be available across the region. 4 Young People Western Sydney has an overall young population and therefore the needs of this population into the future need to be considered with Health Literacy being something which needs to be an important focus for the future. 5 Viral infections Western Sydney is one of the two Local Health Districts with the highest crude rates of Hepatitis B Virus (HBV) in NSW. 32 Untreated chronic hepatitis B leads to cirrhosis, liver failure and liver cancer with associated increased mortality, morbidity and health care costs. Auburn has the highest rate of hepatitis B infection of any LGA in NSW. 17 > Population Health Commissioning Atlas

Needs + Commissioning Approach Summary and key considerations for setting priorities and commissioning services within the Western Sydney Primary Health Network 1. Screening participation rates 2. Risk Factors for chronic diseases, including diabetes 3. Young people - health literacy required 4. Aboriginal and Torres Strait Islander population - largest urban popualtion with most living in low socioeconomic areas. 5. People from CALD backgrounds - over a third of population of Western Sydney are from overseas from primarily non english speaking countries. Commissioning Framework The commissioning cycle consists of four core components - needs assessment; service development; provider engagement and evaluation and is directly linked to both strategic and annual planning cycles. One of the key strategic objectives of MLs is to identify health needs of local areas and develop locally focussed and responsive services. This Population Health Commissioning Atlas provides a tool by which the Western Sydney Primary Health Network (WSPHN) can build a specific population health profile to inform health needs assessment, including information on the determinants of health, as a means to establishing priorities for service development. It also assists in the identification of key areas in which it can work in partnership with a wide range of stakeholders to strengthen the primary health care system. Concepts of Need Need is an important concept in public health. It is used in the planning and management of health services including health improvement, resource allocation, and equity. However, need is a multi-faceted concept with no one universal definition. The need for healthcare should be distinguished from the need for health. The need for health is broader and can include problems for which there is no known treatment. Need for healthcare exists when an individual has an illness or disability for which there is effective and acceptable treatment or care. Health economists have also distinguished need from supply and demand. Need is defined as capacity to benefit; demand is defined as what individuals ask for; and supply is defined as what is provided (i.e. the services that are available). Demand is influenced by factors such as the social and educational background of an individual, the media and the medical profession. Supply is influenced by historical patterns and public and political pressure. Finally, health systems are concerned not only with maximising health, but also with the fair distribution of health. Appendix 1 Western Sydney PHN Age profile SLA Name 0-4 5-19 20-34 35-64 65+ Auburn (C) 5,778 13,874 24,127 27,729 6,778 Holroyd (C) 8,370 18,926 26,567 37,533 12,473 Parramatta (C) - Inner 3,737 5,811 21,056 16,148 3,984 Parramatta (C) - North-East 2,954 8,690 10,316 19,263 6,699 Parramatta (C) - North-West 2,899 6,919 8,474 14,865 5,956 Parramatta (C) - South 3,145 7,756 9,833 12,346 3,703 Blacktown (C) - North 9,263 22,917 25,259 41,263 7,756 Blacktown (C) - South-East 7,745 19,834 24,377 38,133 11,382 Blacktown (C) - South-West 8,888 26,236 23,021 37,645 8,760 The Hills Shire (A) - Central 5,193 15,667 14,543 32,426 9,126 The Hills Shire (A) - North 4,026 13,945 9,602 24,286 5,579 The Hills Shire (A) - South 2,333 8,416 7,729 18,376 5,739 the PHCAtlas Population Health Commissioning Atlas > 18

References Disclaimer This PHCAtlas has been developed by Healthfirst Network to provide population health information relating to the WSPHN region, including text, maps and various forms of data and information obtained from both government and non-government sources. All of the material published in this publication [or on any related website] is together referred to hereafter as "the information". In those circumstances, no responsibility is accepted for the accuracy, completeness, or relevance to the user's purpose, of the information and those using it for whatever purpose are advised to verify it with the relevant Commonwealth or State government department, local government body or other source and to obtain any appropriate professional advice. If this information has been accessed via a related website, then no warranty is given that the information is free of infection by computer viruses or other contamination, nor that access to the website or any part of it will not suffer from interruption from time to time, without notice. Any links to other websites that have been included on this website are provided for your convenience only. Healthfirst Network does not accept any responsibility for the accuracy, availability, or appropriateness to the user's purposes, of any information or services on any other website. Healthfirst Network, its officers, employees and agents do not accept liability however arising, including liability for negligence, for any loss resulting from the use of or reliance upon the information and/or reliance on its availability at any time. References 1. NHPA National Health Performance Authority (NHPA). Performance and accountability framework. 6.3 Initial indicators for Primary Health Networks [on line]. Available from: http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/ Content/PAF~PAF-Section-6~PAF-Section-6-3 (accessed 20 July 2014) 2. World Heatlh Organization (WHO). Closing the gap in a generation: health equity through action on the social determinants of health (final report of the Commission on Social Determinants of Health).Geneva: WHO, 2008 3. Dahlgren G, Whitehead M, Policies and strategies to promote social equity in health, Copenhagen: World Health Organization, 1992. 4. Social Determinants of Health: solid facts. Marmot M, Wilkinson, R (eds) Copenhagen: WHO, 2003. 5. National Public Health Partnership (NPHP). Preventing chronic disease: a strategic framework. Melbourne: NPHP,2001. 6. Department of Health and Ageing. National health reform primary care. [on line] Available from: http://www.yourhealth.gov.au/internet/yourhealth/ publishing.nsf/content/theme-primarycare#.ug7kehac-fq? (accessed 25 September 2013). 7. Public Health Information Development Unit (PHIDU). Social health atlas of Australia: Primary Health Networks published 2014. [on line]. Available from http://www.adelaide.edu.au/phidu/maps-data/medicare-local-portal/ 8. Profile.id 9. Australian Bureau of Statistics 2033.0.55.001, Technical Paper, Socio- Economic Indexes for Areas (SEIFA) 2011 10. WHO, Social Determinants of Health. http://www.who.int/social_ determinants/sdh_definition/en/index.html, accessed 1Oct 2013 11. Department of Health, Towards a fairer society: community care studies. Adelaide DH (SA) 2006 12. Harris E & Harris M, Reducing the impact of unemployment on health: revisiting the agenda for primary health care, MHA 2009; 191: 119-122 13. Australian Bureau of Statistics. 2011 Census Basic Community Profiles. In: Australian Bureau of Statistics, editor. https://www.censusdata.abs.gov.au/ datapacks/datepacks?release=2011-2013 14. UNICEF, State of the World s Children 2008, NY: Unicef, 2007 15. Australian Institute of Health and Welfare 2012. A picture of Australia s children 2012. Cat. No. PHE 167, Canberra: AIHW 16. National Health Performance Authority 2014, Healthy Communities: Child and maternal health in 2009 2012 17. Australian Health Ministers Advisory Council. Aboriginal & Torres Strait Islander Health Performance Framework 2012 Report. Canberra: AHMAC, 2012 18. The Australian Early Development Census 2015 - https://www.aedc.gov.au/ data 19. Australian Institute of Health and Welfare (AIHW), Risk Factors contributing to chronic disease. Cat No. PHE 157. Canberra: AIGW, 2012 20. Australian Bureau of Statistics, 4364.0.55.003 Australian Health Survey: First Results, 2011-12 21. World Health Organisation: www.who.int/gho/publications/world_health_ statistics/en/index.html 22. http://www.healthstats.nsw.gov.au/indicator/can_brstscr_lh 23. Australian Institute of Health and Welfare (AIHW), Mental health related indicators. [on line]. Available from: http://mhsa.ahigw.gov.au/home/ (accessed 13 August 2014) 24. Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (insert date of access). 19 > Population Health Commissioning Atlas

References References 25. Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (insert date of access). 26. National Health Performance Authority 2013, Healthy Communities: Selected potentially avoidable hospitalisations in 2011 12. 27. Australian Institute of Health and Welfare, Premature mortality from chronic disease, Bulletin 84. Canberra: AIHW, 2010 28. National Health Performance Authority 2013, Healthy Communities: Avoidable deaths and life expectancies in 2009 2011. 29. AIHW 2012. Risk factors contributing to chronic disease. Cat. no. PHE 157. Canberra: AIHW. Viewed 2 September 2014 <http://www.aihw.gov.au/publication-detail/?id=10737421466>. 30. Australian Primary Health Networks Alliance (AMLA). Commissioning support tools. [on line]. Available from: http://www.amlalliance.com.au/medicarelocal-support/organisational-development/commissioning-support-tools. (accessed 18 August 2013). 31. Centre for Epidemiology and Research (2012); Health Statistics New South Wales. Sydney: NSW Ministry of Health,retrieved February 08 2012 from;www.healthstats.doh.health.nsw.gov.au. 32. WSLHD Public Health Unit report Hepatitis B Burden in western Sydney (Nov 11) 33. Department of Planning and Environment (2014) New South Wales State and Local Government Area Populations: 2014 Final Copyright This Publication is Copyright. Other than for the purposes of and subject to the conditions prescribed under the Copyright Act 1968, no part of it may in any form or by any means [electronic, mechanical, microcopying, photocopying, recording or otherwise] be reproduced, stored in a retrieval system or transmitted without prior written permission. Inquiries should be addressed to the Healthfirst Network. Acknowledgements PHCAtlas [Population Health Commissioning Atlas ] is a trademark of Healthfirst Network. The Healthfirst Global Team: Public Health Physician / GP - Dr Peter Del Fante Health Data Manager - Debbie Stratford Telehealth Support & ehealth Officer - Ross Vivian Funding This version of the PHCAtlas was prepared for and funded by the Western Sydney Primary Health Network. 34. National Health Performance Authority: http://www.myhealthycommunities. gov.au/interactive/immunisation the PHCAtlas Population Health Commissioning Atlas > 20

A service brought to you by Healthfirst Global a business unit of Healthfirst Network inspiration.intelligence.innovation Healthfirst Network a 50 Woodville Road Woodville South 5011 South Australia AUSTRALIA p 08 8408 1600 f 08 8408 1699 e contact@healthfirst.org.au a Locked Bag 13 Regency Park Private Boxes SA 5942 www.healthfirst.org.au