Communities of interest

Priority Area

Health Needs Assessment 2025 - 2028

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The North Coast region is home to some of the most disadvantaged communities in NSW and Australia. These communities experience challenges in accessing appropriate healthcare services and supports.

This page contains information about several diverse communities on the North Coast:

  • culturally and linguistically diverse people
  • people experiencing homelessness
  • people exiting prison
  • LGBTQ+ people
  • people with disabilities
  • people experiencing domestic and family violence.

There are limitations in data available at the North Coast region and local government area (LGA) level, highlighting a need for further local research and consultation to understand and address the health and service needs of these communities of interest.
Many people in our region face poorer health outcomes due to a range of social, economic, and structural factors. These disadvantages are often compounded at the intersections of multiple identities and lived experiences, making it essential to design inclusive, person-centred care that responds to this complexity.

Culturally and linguistically diverse (CALD) communities in Australia face unique challenges when accessing healthcare services. These include language difficulties, lower health literacy, cultural differences and a lack of familiarity with the Australian healthcare system. The CALD people and communities can experience more complex health needs than those who are not CALD (Northern NSW Local Health District, 2024; AIHW, 2024).

Many refugees arrive with a history of trauma from conflict, persecution, or displacement, which often leads to physical and mental health issues such as post-traumatic stress disorder (PTSD), chronic diseases and undiagnosed conditions. Having experienced limited or no access to healthcare prior to their arrival, refugees may struggle with navigating Australia’s healthcare system due to language difficulties, cultural differences and a lack of health literacy. These challenges are compounded by a lack of familiarity with medical practices and potential stigma around seeking help, especially for mental health issues. In many cases, refugees’ health needs go unmet due to delays in seeking care, cultural misunderstandings, or fear of discrimination, highlighting the critical need for culturally sensitive healthcare services and community support to ensure effective care for CALD populations (Australian Government, 2022; WHO (World Health Organization), 2021).

The North Coast region is a permanent or temporary home for people from a variety of CALD communities and backgrounds including refugees, farm workers, students and professionals. A lower proportion of North Coast residents were born in non-English speaking countries compared to the state and national averages. In 2021, 4% of people on the North Coast were born in non-English speaking countries, considerably lower than NSW (19%) and Australia (16%). The top 5 non-English speaking countries of birth in the region are India, Germany, Philippines, Netherlands and Italy. In 2021, Byron (7%), Coffs Harbour (7%) and Tweed (5%) LGAs had the highest proportion of people born in non-English speaking countries. (ABS (Australian Bureau of Statistics), 2021) Fewer people on the North Coast have very low English language levels (1%) compared to NSW (4%) and Australia (3%) (ABS, 2021). These indicate the North Coast region is less linguistically diverse than other parts of Australia.

The CALD population on the North Coast region increased by 1% between 2016 and 2021. This is expected to continue to increase, driven by Australian Government policies that encourage migration to regional communities (SSI, 2023). As the CALD population continues to grow, it is essential to gather more specific and locally relevant data to better understand and address the unique needs of these communities. This is critical for developing targeted healthcare strategies and improving access to services for CALD individuals on the North Coast region.

Adequate access to affordable housing is fundamental to the health and wellbeing of people and communities, as improved housing conditions can prevent disease and increase quality of life (WHO, 2018). Housing insecurity worsens health inequities and is associated with poor physical health outcomes, increases in cardiovascular, respiratory and infectious diseases, higher rates of injuries and a higher prevalence of mental health conditions.

The North Coast faces substantial challenges in relation to homelessness and housing insecurity. In 2021, for every 1,000 residents in the region 4 were experiencing homelessness (2,102 people) and 4 were at risk of homelessness (2,029 people). Homelessness increased after the catastrophic flood events in 2022. A higher proportion of people experiencing homelessness on the North Coast are aged 65 years and over compared to NSW and Australian averages. There is a higher proportion of homeless people identifying as Aboriginal (14%) compared to NSW (5%) (ABS, 2024).

While specific regional data is limited, national and international research shows that LGBTQ+ people — particularly young people, trans and gender-diverse individuals — are overrepresented in homelessness populations. This is often due to family rejection, discrimination and violence. Without targeted support, LGBTQ+ people experiencing homelessness may face additional barriers to accessing safe and inclusive services, especially in regional and rural areas.

Accommodation for people experiencing homelessness on the North Coast differs from state and national patterns. On the North Coast, 31% of homeless people are staying temporarily with other households (compared to 10% NSW and 13% Australia) and 15% are in improvised dwellings, tents or sleeping out (compared to 2% NSW and 6% Australia). 1 in 2 of the NSW homeless people who are living in improvised dwellings, tents or sleeping rough live on the North Coast region. Tweed LGA has a notably high concentration of this group. The North Coast also has a considerably larger proportion of people at risk of homelessness living in marginal housing in caravan parks than state and national averages (37% in the region, versus 6% in the state and 9% in the country) (AIHW (Australian Institute of Health and Welfare, 2023; ABS, 2021).

According to the 2024 NSW Statewide Street Count, 967 people were rough sleepers on the North Coast region. Byron (348), which recorded the highest number of rough sleepers across all LGAs in NSW, was followed by Tweed (174) and Coffs Harbour (147). These 3 North Coast LGAs accounted for 1 every 3 (32%) of all rough sleepers counted in NSW in 2024. (NSW Government, 2024)

People in prison are some of the most disadvantaged and vulnerable within our society. On both entering and exiting the prison system they experience more chronic physical and mental health conditions than the general population. People who have spent time in prison are more likely to experience unemployment and housing insecurity including homelessness. They are more likely to smoke tobacco, partake in risky alcohol consumption and drug misuse and have infectious diseases than that found in the general population (AIHW, 2024; AIHW, 2023).

There are 2 prisons on the North Coast region, both housing male and female inmates:

  • Mid North Coast Correctional Centre in Kempsey, run by NSW Corrective Services and housing maximum, medium and minimum-security prisoners
  • Clarence Correctional Centre in Grafton (Clarence Valley LGA), run privately by Serco and housing maximum and minimum-security prisoners (Corrective Services NSW, 2023).

The Clarence Correctional Centre is the largest prison in Australia and has capacity for 1,700 persons, with 1,300 of them in maximum security (NSW Government, 2020). Data is unknown for capacity in Kempsey and for number of inmates housed at either facility.

In June 2024 there were 12,917 adults in prison in NSW, of which 5,763 were on remand (awaiting trial or sentencing). Of total prisoners, 93% were male with an average age of 39 years. A total of 31% are Aboriginal peoples (NSW Bureau of Crime Statistics and Research, 2024).

The North Coast region faces high rates of disadvantage and challenges in accessing mental health and alcohol and other drug services. These factors may contribute to difficulties for individuals leaving prison to connect with necessary support services upon release. The combination of pre-existing vulnerabilities and limited access to essential services creates additional barriers for former inmates attempting to reintegrate into society and maintain their health and well-being.

LGBTQ+ people in prison are also more likely to face stigma, abuse, and discrimination both during incarceration and post-release. These experiences can exacerbate mental health concerns and make reintegration more difficult, especially when services lack cultural competence or are not inclusive of diverse gender and sexual identities.

Disability is complex and encompasses long-term health conditions, impairments in body function or structure and limitations in daily activities lasting 6 months or more. It is influenced by personal and environmental factors, as well as individual health conditions, which collectively impact a person’s daily life.

The population of individuals living with disabilities is diverse, spanning all backgrounds and demographics, with varying disability types and levels of assistance required. The prevalence of disability increases with age and people with disabilities are more likely to experience social and economic disadvantage and report lower levels of general and mental health compared to those without disabilities (AIHW, 2024). On the North Coast, several factors may contribute to a higher number of people living with disabilities and exacerbate challenges in accessing health and social care. These include an aging population, a higher percentage of people needing assistance due to disability (7% in regional NSW compared to 6% nationally), greater socioeconomic disadvantage and lower access to healthcare services.

The need for assistance, which measures the number of people with profound or severe activity limitations requiring help in daily activities, is growing on the North Coast. In 2021, for every 1,000 residents there were 75 people needing assistance on the North Coast, higher than in NSW and Australia (both 58 per 1,000). There is variation across North Coast LGAs, with Kempsey and Nambucca Valley experiencing higher rates of people needing assistance, while Byron had the lowest rate. Notably, the need for assistance rate for young people aged 0-24 years and middle-aged people 25-44 years was higher on the North Coast compared to NSW and Australian averages.

The 2021 data suggest there is a lower need for assistance on the North Coast for people aged 65 years and older than in NSW and Australia. For every 1,000 people aged 65 and over, there are 165 in need of assistance on the North Coast, compared to 184 in NSW and 181 in Australia. However, the rate has increased by 4% on the North Coast region since 2016, matching the national increase but surpassing the 1% increase observed in NSW (ABS, 2024). This may reflect the ageing population on the North Coast and could potentially continue to rise in the future. The areas with the highest rates of need for assistance on the North Coast also tend to have the highest levels of disadvantage and unemployment, as well as the lowest levels of educational attainment and private health insurance coverage (ABS, 2023; ABS, 2021; ABS, 2022; Jobs and Skills Australia, 2023).

The National Disability Insurance Scheme (NDIS) provides funding to people with disability assessed as eligible for services and supports. As of March 2024, there were 17,284 NDIS participants on the North Coast, which equates to 32 people for every 1,000 residents, higher than NSW and the Australian average (23 and 24 per 1,000 people, respectively). While the number of NDIS participants in the region has increased by 22% over the past 2 years, this growth does not necessarily translate into improved access to services (NDIS, 2024). Community consultations have highlighted that, despite the higher funding and enrolment rates, many people continue to face significant challenges in accessing the services they need. Issues such as workforce sustainability, the complexity of the NDIS system and difficulties navigating the funding process continue to affect service delivery, particularly in regional and rural areas.

As the demand for services for people with disabilities increases, it is essential to address these systemic challenges to ensure that the NDIS can provide meaningful support and equitable access to individuals across the North Coast region.

Domestic and family violence is a major issue in Australia, affecting individuals, families and communities across all demographic and socioeconomic backgrounds, encompassing multiple sectors including health (Australian Institute of Health and Welfare, 2024). The domestic violence data provided in this report is the rate of domestic violence-related assault incidents recorded by NSW Police per 100,000 population (NSW Bureau of Crime Statistics and Research, 2024).

The North Coast region has experienced an increase in domestic and family violence. From April 2023 to March 2024, the region reported 575 incidents per 100,000 people, considerably higher than the NSW average of 447. This represents an 18% increase in the last 3-year period from April 2020 to March 2021, which is higher than the 13% increase for NSW. Within the North Coast the local government area (LGA) of Kempsey recorded the highest rate with 1,148 incidents per 100,000 people, almost double the regional average. Other LGAs with higher rates than the regional average are Coffs Harbour (950), Richmond Valley (772) and Clarence Valley (710).

Notably, Clarence Valley has seen the highest increase in domestic and family violence in the last 3 years, with an 82% increase in the rate. Coffs Harbour, Kempsey and Port Macquarie-Hastings follow, with increases ranging from 37% to 30%. The greatest reduction in the rate of domestic and family violence were in Nambucca Valley (14%), Tweed (13%) and Lismore (12%), with reductions also in Ballina (6%), Bellingen (5%) and Kyogle (4%) (NSW Bureau of Crime Statistics and Research, 2024).

The impact of domestic and family violence on the North Coast is further highlighted by community concerns and recent natural disasters. In the Better Health Community survey, 19% of participants identified domestic and family violence as a significant issue in their community. Research following the 2022 North Coast floods indicates an increase in family and domestic violence rates in some areas.

The LGBTQ+ is one of the acronyms used when referring to the many and diverse peoples and communities who identify as lesbian, gay, bisexual, trans/transgender, intersex, queer and other sexuality (including asexual), gender and bodily diverse” (AIHW, 2024). The diversity, non-homogenous nature and diverse needs of LGBTQ+ communities was highlighted by participants in subject matter expert and service provider consultations conducted by Healthy North Coast as part of the needs assessment.

The barriers faced by LGBTQ+ individuals in accessing healthcare are often compounded when these individuals belong to other marginalized groups. LGBTQ+ people who also identify as culturally and linguistically diverse, are experiencing homelessness, are exiting prison, have disabilities, or are facing domestic and family violence often encounter multiple layers of discrimination, stigma, and neglect in healthcare settings. These intersectional factors create unique and complex health disparities that must be addressed with tailored, culturally competent care.

The LGBTQ+ peoples on the North Coast region face significant health disparities, particularly in relation to mental health, substance use and access to inclusive healthcare. Barriers such as a lack of culturally competent care, discrimination and limited service availability in regional and rural areas further compounds these challenges. The ageing LGBTQ+ population and the high prevalence of domestic violence underscore the need for tailored services that address the unique needs of this diverse community. By improving access to healthcare services, enhancing provider competence through training and actively engaging with this community, we can ensure that LGBTQ+ peoples receive the care and support they need to thrive.

Collecting comprehensive data on health needs of LGBTQ+ peoples is challenging, given the diversity of these communities and small sample size in regional areas. However, ongoing consultation with LGBTQ+ individuals and organisations is critical to understanding their specific needs. This collaboration will ensure that healthcare services, policies and resources are better tailored to support the wellbeing of LGBTQ+ people across the North Coast.

Healthy North Coast is committed to enhancing equity for LGBTQ+ people and the implementation of the National Action Plan for the Health and Wellbeing of LGBTIQA+ People 2025-2035 (Department of Health and Aged Care, 2024) and the NSW Health LGTBIQ+ Strategy 2022-2027 (NSW Ministry of Health, 2022) in collaboration with regional partners. This includes training primary care providers in gender affirming care, collaboration with local health districts (LHDs) and ongoing collaboration with ACON, the leading provider of community health services for LGBTQ+ people in NSW.

On the North Coast, LGBTQ+ survey respondents reported mental health and alcohol and other drug concerns as more serious issues compared to the general population:

  • A large percentage (61%) of the 297 LGBTQ+ participants identified mental health as a primary concern, compared to 39% in the general population. This was supported by the Private Lives 3 survey, which revealed high rates of psychological distress (57%), depression (61%) and anxiety (47%) among LGBTQ+ peoples.
  •  A total of 47% of LGBTQ+ participants raised concerns about alcohol and drug use through the survey, more than the 31% of the general population. The Private Lives 3 survey confirmed that 17% of LGBTQ+ respondents struggled with alcohol management, while 44% used drugs for non-medical purposes.

These figures highlight the urgent need for accessible, tailored mental health and alcohol and other drug (AOD) services that can support LGBTQ+ individuals in addressing these challenges (Hill, Bourne, McNair, Carman, & Lyons, 2020).

Gay, bisexual and other men who reported male-to-male sexual contact are disproportionately affected by the human immunodeficiency virus (HIV) (CDC, 2024). People living with HIV are at an increased risk of developing dementia, a condition known as HIV-associated dementia. HIV can impact the brain, leading to cognitive decline, memory loss and other neurological impairments. While antiretroviral treatments have considerably improved the life expectancy of people with HIV, long-term HIV infection can still cause neurological damage, even in individuals with undetectable viral loads. Studies suggest that HIV-associated dementia is more common among those who have had the virus for many years, especially if they have not consistently received treatment or if treatment started later in life (Dementia Australia, 2024).

The risk of developing dementia in LGBTQ+ communities is also heightened by other factors, such as coexisting conditions like substance use, depression and social isolation – issues that are prevalent in LGBTIQ+ populations, particularly among transgender and gender-diverse individuals. When these challenges are combined with the stigma and discrimination often experienced by LGBTQ+ people, the risk for dementia, including HIV-associated dementia, becomes even more critical (AIHW, 2024). LGBTQ+ people with dementia may experience unique challenges to living with memory problems directly related to their sexual orientation and/or gender identity. This can include forgetting who knows about their sexual orientation and gender identity and being unsure about who to trust with this disclosure (AIHW, 2024).

Comprehensive and tailored healthcare services that address both the neurological and social aspects of health are essential. These services should aim to reduce risks associated with substance use, depression and isolation and improve overall quality of life for people living within the LGBTIQ+ community.

Accessing appropriate healthcare remains a significant barrier for LGBTQ+ people, especially in regional areas. Consultation participants reported negative experiences with healthcare providers due to a lack of understanding of LGBTQ+ health needs, as well as discrimination and marginalisation. This has resulted in reluctance to seek care, even when needed.

There was a broad sentiment within the communities about the need for healthcare spaces where LGBTQ+ people feel affirmed and understood. Training healthcare providers to be more inclusive and culturally competent is essential in improving care experiences and outcomes.

The ageing LGBTQ+ population faces additional challenges, especially in regional areas. Many older LGBTQ+ people lived through periods of significant social stigma and discrimination, leading to isolation and compounded mental health struggles. Older LGBTQ+ people may face unique challenges in accessing services that are inclusive of their needs, further exacerbating their vulnerability. Participants in subject matter expert and service provider consultations echoed these concerns for LGBTQ+ communities.

People from LGBTQ+ communities experience domestic and family violence (DFV) more than the general population. The survey revealed that 27% of LGBTQ+ participants ranked DFV as a major concern, compared to 19% in the general population. The Private Lives 3 survey found that LGBTQ+ people experience higher rates of abuse within intimate relationships and families, including physical, emotional and psychological violence (Hill, Bourne, McNair, Carman, & Lyons, 2020). This highlights the need for targeted support services that address domestic violence within LGBTQ+ communities, particularly in rural and remote areas where services may be scarce.

LGBTQ+ people who experience DFV may face added challenges in accessing care due to the fear of discrimination, misunderstanding, or mistreatment by healthcare providers. The reluctance to seek help is further exacerbated by a lack of safe, affirming spaces where LGBTQ+ survivors of violence can receive support without fear of judgment or rejection.

Additionally, over 60% of LGBTQ+ people will experience violence or abuse from an intimate partner or family member in their lifetime, yet 72% do not report that abuse to anyone (Private Lives 3, 2020; DVAF, 2023). This extremely low level of reporting means that victims and survivors often remain invisible and unsupported. Compounding this, many existing DFV systems and services are designed around a binary model of male perpetrator and female victim, which can exclude or misrepresent LGBTQ+ experiences. This systemic framing may discourage LGBTQ+ people from seeking help or result in services that fail to meet their specific needs. To effectively support LGBTQ+ individuals experiencing DFV, it is critical to acknowledge and address these structural barriers and ensure inclusive, identity-affirming responses across all levels of the support system.

Throughout this document ‘survey’ refers to the 2024 Better Health Community survey undertaken as part of the Health Needs Assessment 2025-28 consultation process.

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