Socio-demographics and health

The Healthy North Coast region is a large geographical area of 32,767 square kilometres in the north-east of NSW (‘the North Coast’). This extends from Port Macquarie in the south to Tweed Heads to the north and the Great Dividing Range to the west. The Traditional Custodians of the lands are the Birpai, Bundjalung, Dunghutti, Githabul, Gumbaynggirr and Yaegl Nations. The region encompasses mountainous and rural areas through to large and small towns. The diversity of the region includes diverse populations, socio-economic disparities, high health needs for ageing, mental health, Aboriginal health and population health services. The region includes 12 local government areas (LGAs), 2 local health districts (LHDs), 174 general practices, 80 Residential Aged Care Facilities and 6 Aboriginal Community Controlled Health Services.

Northern NSW Local Health District
The Northern NSW LHD spans from Tweed Heads in the north to Tabulam and Urbenville in the west, reaching Nymboida and Grafton in the south. The Northern NSW LHD provides a range of public health care services through 8 hospitals and 4 multi-purpose services, 20 community health centres and other facilities.

Mid North Coast Local Health District
The Mid North Coast LHD extends from Port Macquarie in the south to Coffs Harbour in the north, spanning an area of 11,335 square kilometres. The Mid North Coast LHD provides a range of public healthcare through 2 base hospitals, 4 district hospitals, a multi-purpose service and 12 community health centres.

Aboriginal Community Controlled Health Services
Aboriginal Community Controlled Health Services (ACCHS) provide a range of culturally appropriate and comprehensive primary health and wellbeing services to Aboriginal peoples living in the North Coast. Each of the 6 ACCHS in the region offers different services according to local needs.

The North Coast region of NSW is home to approximately 541,000 people, almost 7% of the NSW total population (ABS, 2021). The LGAs of Tweed, Port Macquarie-Hastings and Coffs Harbour have the region’s largest populations, while Kyogle and Bellingen have the smallest populations.

The North Coast has a relatively old population. More people are aged 45 years and above (53%) compared to the rest of NSW and Australia (42%). By 2031, the North Coast region is projected to see an increase of about 5% in population. This is less than the projected 13% increase for NSW. The largest growth in the North Coast is expected for people 65 years and over, with a projected 18% increase. All North Coast LGAs are projected to see population growth, though patterns of growth vary across LGAs and age. The LGAs of Tweed, Kyogle, Lismore, Ballina and Kempsey are projected to experience an increase in people 65 years and over greater than the 18% increase for the region.

The ageing population on the North Coast is anticipated to have a substantial impact on service needs in the coming years. This demographic shift will challenge service delivery, particularly healthcare, as complex health needs requiring specialised care tend to increase with age. This may place strain on healthcare infrastructure, leading to longer wait times, higher demand for healthcare professionals and potential pressure on primary and hospital care. While the ageing population challenges the health system, it presents opportunities for community-driven solutions, improved care models and more sustainable development strategies to meet the needs of the growing older population.

In 2018, Healthy North Coast embarked on a Healthy Towns program bringing together communities, Councils and the health system, in 6 towns across the region (Casino, Evans Head, Maclean, Woolgoolga, South West Rocks, Lake Cathie). From 2025, Healthy North Coast will be engaging with towns across the region to identify the new locations for Healthy Towns – where people can live and age well, with ongoing opportunities to contribute and stay connected to community and country.

The North Coast region has a higher proportion of Aboriginal and Torres Strait Islander residents at 6% compared to NSW and Australia wide which are both at 3%. This proportion varies across LGAs, ranging from the highest in Kempsey (13%) to the lowest in Byron (2%) (ABS, 2021). The largest Aboriginal communities in the region are in Port-Macquarie-Hastings and Coffs Harbour LGAs. It is vital that health services are accessible and designed to meet the specific needs of Aboriginal peoples and communities.

The social determinants of health are non-medical factors, including income, education and socioeconomic status that can influence the health of people and communities. They play an important part in the inequalities and inequities existing in access to health care and health outcomes.

The North Coast region has a wide range of socioeconomic diversity. It includes communities that are both very disadvantaged and very advantaged. This diversity shows in different ways through different measures. These include the Index of Relative Socio-Economic Disadvantage (IRSD), personal income, family income and housing affordability. In 2021, most LGAs in the region were below the national IRSD benchmark, with Kempsey as one of the most disadvantaged areas. Income levels in the North Coast are usually less than the state and national averages. As of June 2023, unemployment rates on the North Coast differed widely among LGAs, with some areas above the NSW and Australia averages, notably Nambucca Valley and Kempsey LGAs.

Educational attainment on the North Coast is generally lower than NSW and Australia wide averages, particularly for postgraduate and bachelor’s degrees. The region has more certificate-level qualifications, which may show a greater focus on trade skills. The Index of Education and Occupation (IEO) shows large differences between LGAs. Some are among the most disadvantaged in Australia while others, like Byron, rank in the top 10% for education and jobs (ABS, 2021).

The region faces challenges with health literacy. The North Coast region has an over-representation of people that are most at risk of low health literacy. Low levels of health literacy are associated with factors such as social and economic disadvantage, lower education levels, an ageing population and a larger Aboriginal population (Northern NSW Local Health District, 2022). Community consultations revealed many residents have difficulty navigating the healthcare system and understanding health information. These challenges are most prominent for people residing in low-income areas. The survey showed a low perceived social support for mental health and general care needs in some areas. This suggests lower social capital and possibly lower health literacy. These findings highlight the need for increased health literacy programs and support systems to improve health outcomes in the North Coast region.

Housing affordability is a challenge on the North Coast. Residents often spend more of their income on mortgage payments than the NSW and Australia wide averages. Since 2021, the rental landscape has shifted markedly in the region. Environmental disasters and migration patterns have contributed to higher rental cost and more homelessness. Housing issues and the rising cost of living were key concerns raised in community surveys and consultations.

The North Coast faces substantial challenges with homelessness and housing insecurity. In 2021, for every 1,000 residents in the region 4 people were experiencing homelessness (2,102 people) and 4 were at risk of homelessness (2,029 people). Homelessness increased after the major flood events in 2022. A higher proportion of people experiencing homelessness on the North Coast are aged 65 years and older (9%) compared to state (7%) and national (6%) averages. On the North Coast region there is a higher proportion of homeless people identifying as Aboriginal peoples (14%) than in NSW (5%) but less than Australia wide (20%), where 1 in 5 homeless people is Aboriginal.

Accommodation for people experiencing homelessness on the North Coast region is different from NSW and Australia wide trends. A higher proportion are staying temporarily with other households (31% North Coast, 10% NSW) or living in improvised dwellings, tents, or sleeping out (15% compared to 2% statewide and 6% nationally). Half of the NSW homeless population living in improvised dwellings, tents, or sleeping rough are living in the North Coast region. Tweed LGA has a notably high concentration of this group. The North Coast has a larger proportion of people at risk of homelessness living in marginal housing in caravan parks than state and national averages (37% in the region, compared to 6% in the state and 9% in the country) (AIHW, 2023; ABS, 2021).

According to the 2024 NSW Statewide Street Count, 967 people were rough sleepers in the North Coast region. Byron recorded the highest number in the region and across all LGAs in NSW with 348 people, followed by Tweed with 174 people and Coffs Harbour with147 people. These 3 North Coast LGAs accounted for 1 in every 3 (32%) rough sleepers in NSW in 2024 (NSW Government, 2024).

Both the natural and built environments influence the health and wellbeing of individuals and communities. The North Coast region faces significant challenges due to climate change, which is putting people’s health at risk. Increased frequency and severity of extreme weather events, hotter temperatures, changing rainfall patterns and rising sea levels are all contributing to health challenges. The impacts of climate change are wide-ranging, affecting both physical and mental health, with certain people being more vulnerable to impacts. These include older adults, people with disabilities, LGBTQ+ individuals, Aboriginal communities and children and young people.

In recent years, the region has experienced major climate disasters. These include the bushfires in 2019-20 and the floods in 2017, 2021 and 2022.

The Northern Rivers region is known for being on one of Australia’s most active floodplains. On the 28th of February 2022, the region experienced a catastrophic flooding event that surpassed colonial historical records by nearly three meters. A second major flood occurred on 30 March 2022 compounding the initial impact. These floods affected over 40,000 people and caused widespread damage to properties and infrastructure. These disasters have had a lasting impact on the mental health and wellbeing of communities. The number of people experiencing post-traumatic stress disorder, anxiety, depression and substance abuse is reported to have increased. Children have shown signs of trauma-related stress, depression and anxiety following the 2022 floods. 

Disasters like these hinder access to healthcare services. To address this, Healthy North Coast has worked collaboratively with primary health care and communities to implement response and recovery initiatives. Healthy North Coast has developed a plan to maintain essential health services during disasters. Community organisations play a critical role in recovery with staff and volunteers potentially facing burnout and trauma from their work and the personal effects from the flooding.

The recent environmental disasters have exacerbated the housing crisis on the North Coast. Floods, fires and storms have contributed to increased displacement, slower recovery and heightened housing stress and anxiety amongst residents. The 2023 Vital Signs report indicated that 10,000 people were displaced, 6,300 homes were damaged and 1,800 people were still living in temporary housing following recent flood events. This situation highlights the complex relationship between environmental disasters, housing insecurity and community resilience in the region (Northern River Community Foundation, 2023).

Addressing the impacts of climate change requires coordinated action from a range of stakeholders to develop strategies that help communities adapt and build resilience to future climate-related challenges.

In 2020, the life expectancy at birth in the North Coast was 83 years and 4 months. This was over 1 year less than the average for all of NSW, which was 84 years and 6 months. Over the past 2 decades, life expectancy on the North Coast has increased by 3 years. This is slower than NSW, which has increased by 4 years. There are considerable differences within the North Coast, where Tweed LGA has the longest life expectancy (85 years and 5 months) and Kempsey the shortest (82 years and 5 months) (NSW Government, 2024).

There are disparities in life expectancy based on gender and Aboriginality:

• The average life expectancy for men in the North Coast is 80 years and 7 months, which is less than the NSW average (82 years and 5 months). The average life expectancy for women in the North Coast is 86 years and 1 month, also lesser than the NSW average (86 years and 7 months).
• The gap in life expectancy between men and women on the North Coast (5 years and 6 months) is bigger than the NSW gap (4 years and 2 months).
• Aboriginal peoples live much shorter lives due to a range of health, social and economic disparities. Aboriginal men live about 8 years and 10 months less than non-Aboriginal men and Aboriginal women live about 8 years and 1 month less than non-Aboriginal women (NSW Government, 2024).

These disparities are driven by limited access to healthcare, higher rates of chronic disease and ongoing social and economic disadvantage. Historical and continued impacts of colonisation, along with intergenerational trauma, continue to affect the health and wellbeing of Aboriginal communities. Contributing factors include lower education levels, higher unemployment, inadequate housing and systemic racism within healthcare systems, all of which exacerbate poor health outcomes and reduce life expectancy for Aboriginal peoples. (Australian Government, 2024). The Healthy North Coast Partnership with the Aboriginal Medical Services has been established to improve Aboriginal health outcomes within the North Coast. The Partnership strives to work collectively to improve access and enhance program coordination within our region.

The North Coast population experiences higher mortality rates than the national average, especially in the areas of Nambucca Valley, Kyogle and Kempsey. The main causes of death are similar to the rest of Australia: heart disease, dementia, stroke, lung cancer and lung diseases.

A higher proportion of deaths for people under 75 years old in the North Coast are potentially avoidable, compared to the Australian average. In the LGAs of Richmond Valley, Nambucca Valley and Port Macquarie-Hastings this is above 50% of premature deaths. This ranges from 38% to 45% in all other LGAs in the region. This suggests opportunities for improved health promotion and early intervention strategies. Better health services and early care could help people live longer (AIHW, 2022).

• ABS. (2021). ABS (Census of Population and Housing, 2021, TableBuilder).

• ABS. (2021). Socio-Economic Indexes for Australia (SEIFA), 2021.

• ABS. (2021). TableBuilder: Census of Population and Housing: Estimating Homelessness.

• AIHW. (2022). AIHW Mortality Over Regions and Time (MORT) books.

• AIHW. (2023). AIHW Specialist Homelessness Services.

• Australian Government. (2024). Aboriginal and Torres Strait Islander Health Performance Framework – Summary report.

• Northern NSW Local Health District. (2022). Northern NSW Health Literacy Framework 2022–25.

• Northern Rivers Community Foundation. (2023). Vital Signs.

• NSW Government. (2024). 2024 NSW Statewide Street Count.

• NSW Government. (2024). HealthStats NSW – Life Expectancy.