Preventative health and chronic disease

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Health Needs Assessment 2025 - 2028

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Healthy Living

In 2023, 6% of adults on the North Coast used e-cigarettes, compared to 7% in NSW. The North Coast region’s vaping rate remains lower than most other Primary Health Networks (PHNs). However, since 2019-20, e-cigarette use has quickly risen in the region and NSW (NSW Government, 2024). Community consultations confirmed growing concerns about vaping, particularly among young people in the region and the potential long-term health risks associated with vaping.

The rates of current cigarette smoking amongst adults have halved in both the North Coast region and NSW since 2002. In 2023, the smoking rate on the North Coast region was 13%, similar to the NSW rate of 12%. Recent trends show stable smoking rates in Northern NSW LHD (15%) and a decrease in Mid North Coast LHD (from 16% to 11%) between 2021 and 2023 (NSW Government, 2024). At local government area (LGA) level, smoking rates among adults ranged from 14% in Port Macquarie-Hastings to 21% in Byron, with rates consistently higher for males than females across all LGAs on the North Coast (Social health Atlas of Australia, 2024). This variation highlights the importance of gaining a deeper understanding of the underlying factors contributing to smoking, in order to develop targeted prevention and quit smoking strategies that address both place-based and gender-specific needs, to reduce smoking rates and the associated health risks.

Poor diet and nutrition and physical inactivity are modifiable health risks linked to heart disease, bowel cancer, type 2 diabetes, stroke, dementia and, in females, uterine and breast cancer (AIHW, 2024).

Healthy habits formed in childhood years, such as eating well, being active and getting enough sleep can set up the foundations for better health in adulthood (Lioret, et al., 2020). Physical activity levels among children on the North Coast region are higher than the NSW average. In 2022-23, 28% of children in the Mid North Coast LHD and 38% in Northern NSW LHD met the Australian physical activity guidelines, compared to 20% for NSW. It is recommended that children do not engage in more than 2 hours of sedentary behaviour or screen time outside of school-based hours per day. In 2022-23, 52% of children aged 5-15 years old exceeded this in both LHD areas on the North Coast.

In 2023, 38% of people aged 16 and over on the North Coast region were insufficiently active, compared to 35% for all of NSW. This means they engaged in no activity or less than 150 minutes of moderate to vigorous activity per week. At LHD level, 42% of people in the Mid North Coast LHD area and 35% in the Northern NSW LHD area were insufficiently active. However, over the 10 years up to 2023, the percentage of people aged 16 and over on the North Coast engaging in insufficient physical activity has decreased from 50% (NSW Government, 2024).

In the North Coast region more people aged 16 years and over met fruit (46%) and vegetable (10%) intake recommendations compared to NSW (39% fruit and 6% vegetable) in 2022. This is the case in both LHDs in the region, which show similar results. For children aged 2-15 years there is variation across LHD areas, with more children in the Northern LHD area eating the recommended servings of fruit and vegetables (65% and 6%) than in the Mid North Coast LHD (54% and 5%) and the state average (58% and 5%).

In NSW the rate of people meeting vegetable consumption recommendations remains very low for people from all ages (NSW Government, 2024).

While there are some positive trends in healthy behaviours, there are opportunities to support initiatives that increase physical activity, boost fruit and vegetable consumption and reduce screen time and sedentary behaviour in children. These programs can help address gaps in healthy eating and physical activity, which are key to improving health outcomes and fostering healthier communities. Investing in these initiatives could lead to long-term benefits by preventing chronic diseases and enhancing overall quality of life.

The North Coast region reported an age-standardised rate of 65% for overweight or obese people in 2022, matching the Australian rate. This places the region fourth out of 10 PHNs in NSW, indicating a growing health concern with implications for chronic illnesses such as type 2 diabetes and heart disease (AIHW, 2022).

The North Coast region has consistently shown higher rates of illicit drug use compared to other areas in Australia. In 2019, the region had the highest proportion of people who used illicit drugs in the previous 12 months (23%) of all PHNs in Australia (AIHW, 2024). Methamphetamine-related hospitalisations have been increasing across NSW, likely reflecting similar trends on the North Coast region (NSW Government, 2023).

Preventative health

A GP health assessment is a thorough check of a person’s physical, psychological and social health and function. In 2021-22, the North Coast region had a higher rate of GP health assessments (6%) compared to the Australian average (4%). However, there has been a substantial decline in these assessments since 2019-20, with the North Coast experiencing a greater reduction in the last 2 years (-16%) than Australia overall (-8%). This may be due to the impact of COVID-19. Coffs Harbour and Richmond Valley-Coastal statistical area level 3 (SA3) have the lowest rates in the region (AIHW, 2022).

The North Coast region generally has higher participation rates than both NSW and Australia in cancer screening rates for bowel, breast and cervical cancers. However, recent data (2020-21) shows a slight decline in participation rates, possibly due to the impact of COVID-19.

  • Bowel cancer screening participation was 41% on the North Coast, slightly above NSW and consistent with Australia.
  • Breast cancer screening rates were notably higher at 56%, compared to 50% for both NSW and Australia.
  • Cervical cancer screening participation was 63% on the North Coast, slightly above state and national rates.

While the North Coast generally exceeds NSW and Australia in these areas, some SA3s had lower participation rates. Richmond Valley-Hinterland (38%) and Kempsey-Nambucca (39%) had bowel screening rates below both the state and national benchmarks. Kempsey-Nambucca (56%), Richmond Valley-Hinterland (60%) and Clarence Valley (60%) had cervical screening rates below the benchmarks (AIHW, 2024).

Chronic conditions

Chronic health conditions and diseases are persistent conditions with long-lasting effects. They are the leading cause of illness, disability and death in Australia and cause substantial burden of disease (Department of Health and Aged Care, 2024). People diagnosed with chronic disease are often diagnosed with 2 or more chronic conditions (multimorbidity) (AIHW, 2021). Multimorbidity could make their health more complex to manage, requiring more health services than patients with a single condition. Chronic health conditions are increasingly common within Australian society; they have significant health, social and broader economic impacts and are a priority area of action in the health sector (AIHW, 2024).

On the North Coast in 2023, the most common chronic conditions among general practice patients were anxiety (12%), osteoarthritis (10%), asthma (8%), depression (7%) and osteoporosis (7%). The prevalence of anxiety has increased by 3% since 2020 in the North Coast region, with more people experiencing anxiety across all ages. This aligns with national trends that identify anxiety as the most common mental illness among Australians. Other chronic conditions that have increased in prevalence include osteoarthritis, asthma and osteoporosis. Depression was the only chronic condition to show a reduction in prevalence in the last 3 years.

Seventeen percent of general practice patients in the region experience multimorbidity, while 13% have both multimorbidity and polypharmacy (taking five or more prescribed medications) (PATCAT, 2023). Some LGAs such as Richmond Valley and Kempsey have higher proportions of patients with multimorbidity and polypharmacy. This highlights the need for targeted healthcare strategies to manage complex health needs and improve health outcomes, especially in regions with higher rates of chronic disease, multimorbidity and polypharmacy.

A GP chronic disease management plan can help people with chronic conditions by providing an organised approach to their care. 23% of people on the North Coast region had a GP chronic disease management plan in 2021-22, higher than the Australian average of 15%. However, this has decreased by 2% since 2019-20 on the North Coast, while remaining stable nationally. The rate of GP chronic disease management plan services in the region was 64 per 100 people on the North Coast, nearly double the Australian rate of 37. Despite this higher rate, there has been a more substantial decline on the North Coast than nationally over the past two years (AIHW, 2022).

The Cancer Institute NSW 2023 report revealed that both Mid North Coast LHD and Northern NSW LHD had higher incidence for melanoma and lung cancers compared to NSW. Mortality ratios were also higher for colon, head and neck, lung and melanoma cancers in Mid North Coast LHD, while Northern NSW LHD had higher deaths from non-melanoma skin cancer (NSW Government, 2023).

The cancers with the highest aged-standardised incidence rates on the North Coast in 2021 were urogenital cancer and skin cancer. The incidence of skin cancer in the region (93 per 100,000 people) was substantially higher than the NSW average (54 per 100,000), with Byron and Ballina LGAs showing the highest rates. Like the incidence rate, the rate of deaths from cancer on the North Coast were generally slightly higher or equal to NSW rates. Respiratory cancer and upper gastrointestinal cancer had the highest death rates in the region, followed by urogenital, bowel and Lymphohaematopoietic cancer (Cancer Institute NSW, 2021).

In general practices across the North Coast, melanoma was the most common cancer in 2023, affecting 1.7% of patients. Prostate and breast cancer follow, affecting over 1% of patients. General practices in Richmond Valley, Kempsey and Tweed LGAs had the highest proportion of patients with cancer, while Byron, Coffs Harbour and Kyogle showed the lowest. All cancer groups either increased in presence or remained stable over the three-year period from 2020 to 2023, with no cancers showing a reduction in this period (PATCAT, 2023).

There is significant need for promotion and support for early detection and treatment of chronic disease. This is particularly important for people facing barriers such as geographic isolation, financial disadvantage and limited access to healthcare services. People living with socioeconomic disadvantage are more likely to experience poorer outcomes following a cancer diagnosis, with lower survival rates and higher mortality rates (AIHW, 2024). Cancer risk increases with age and incidence rates are higher among Aboriginal populations. With an ageing population, a large Aboriginal population and areas of high socioeconomic disadvantage in the North Coast, it is crucial to focus on improving access to early detection programs and tailored support services. These initiatives could enhance health outcomes and quality of life for vulnerable groups, ensuring that all individuals have the opportunity to receive timely, appropriate care and support.

The term ‘Aboriginal peoples’ is used to refer to inclusively to individuals who identify as either Aboriginal, Torres Strait Islander, or both Aboriginal and Torres Strait Islander.

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