Ensuring health services and health professionals deliver culturally responsive and equitable services and to address cultural and linguistic barriers to quality health care.
South Western Sydney communities are culturally and linguistically diverse (CALD). This is a broad term that can describe the many communities and people in our region whose languages, ethnic backgrounds, nationalities, religions, health beliefs, social structures and customs differ from the majority.
The region is characterised by its diversity, with close to half of us born overseas, home to a large proportion of all humanitarian entrants (including refugees) to NSW and just over 2% identifying as Aboriginal.
- After English, more than 90,000 people in South Western Sydney who speak a language other than English at home reported speaking English ‘not well’ or ‘not at all’. See Health Literacy below
- In 2017, almost two thirds of humanitarian entrants arriving in NSW were living in South Western Sydney and almost half of those in Fairfield. See Refugee Section below
- Aboriginal people are more likely to live in the Macarthur Region (Campbelltown, Wollondilly and Camden LGAs), where more than 1 in 25 people identify as Aboriginal. (link to Aboriginal & Torres Strait Islander page)
Diversity throughout the region
- High proportion of CALD population
- Low literacy among CALD population
- High proportion of NSW refugees settle in South Western Sydney
- Ageing population and difficulty accessing services in rural areas
- High proportion of people with disability
- Difficulties in finding and securing a home, the risk of losing their home and homelessness
- Projected increase of people aged 65 years and over
43% of the population in South Western Sydney were born overseas, compared with 34% for NSW. The overseas-born population in South Western Sydney is not evenly distributed. Almost 60% of the Fairfield population were born overseas, while fewer than 20% of the Wingecarribee population were born outside of Australia. Between 2011 and 2016, all Local Government Areas in South Western Sydney experienced increases in the proportion of people born overseas; Campbelltown and Wingecarribee Local Government Areas saw the biggest increases (4% and 3%, respectively).
Access and equity to healthcare
Responsible services are culturally safe services
A willingness to work in partnership with culturally diverse communities is a responsible service. Exploring different ways of working and engagement with our minority populations in the provision of care is being culturally responsive. Many organisations provide cultural competence training for staff to enable better understanding of cultural differences in health beliefs. This can help organisations to reduce barriers to accessing the Australian health system. Promoting equitable access and engagement for all people in our community develops health literacy in our culturally and linguistically diverse communities.
Within South Western Sydney, Fairfield LGA has the highest proportion of residents speaking a language other than English at home (71%), followed by, Bankstown and Liverpool LGAs (with 56% and 52%, respectively). After English, the most common languages spoken at home were Arabic, Vietnamese and Cantonese. In South Western Sydney, more than 92,000 people (10% of the population) reported speaking English ‘not well or not at all’. The proportion rose to 20% of people aged 65 years or older.
Data from Australian Bureau of Statistics (ABS) shows that people from culturally and linguistically diverse background have considerably lower levels of health literacy compared with the general population.
There are many reasons to this, such as:
- low English language proficiency
- unfamiliar with the health system in Australia and cultural differences in health beliefs
The impact of low health literacy on culturally and linguistically diverse population means they are:
- less likely to understand issues related to their health
- more likely to experience social isolation and at risk of mismanaging their medication.
Need for qualified health interpreters and translations
While a person may speak some conversational English, this may not be sufficient to meet the demands of a clinical interaction. People often overstate their language skills due to embarrassment and fear of stigma. Effective communication is essential for the provision of safe, high-quality care. It is linked to reduced errors, improved health outcomes and patient satisfaction, increased comprehension and adherence to clinical instructions. Conversely, ineffective communication can result in limited, delayed, inefficient care, leading to more costly treatment and intervention, as well as negatively impacting the person’s understanding of, and trust in, the healthcare system.
Research has highlighted the lack of access to and underuse of interpreters and culturally appropriate resources for migrant and refugee populations. Health service organisations have a duty of care to communicate effectively, in particular when obtaining informed consent. Organising translations or culturally appropriate resources such as surveys or guides may enhance trust within these tools, but also consolidate communication. Communication is one of the seven rights in the Australian Charter of Healthcare Rights.
Source: Australian Commission on Safety and Quality in Health Care, 2021
Migrant and refugee health priorities
According to NSW Population Health Survey data for 2014-17, when compared to all NSW residents, migrants and/or refugees from some countries have higher rates of:
- Smoking (NSW 15%; Iraq 27%, Lebanon 25%)
- Overweight or Obesity (NSW 53%; Lebanon 75%, Italy 72%, Iraq 66%)
- Diabetes (NSW 9%; Italy 23%, Lebanon 17%, Vietnam 14%, United Kingdom 12%)
- Physical Inactivity (NSW 42%; Lebanon 60%, Italy 58%, Vietnam 55%, Iraq 55%)
People from culturally and linguistically diverse communities may belong to multiple diverse minority groups which can exacerbate their vulnerability and consequently may have poorer health outcomes, such as;
- Living with complex chronic conditions, including mental illness
- People with disability
- Older people
- LGBTQIA+ people
- People in and on release from custody (prisoners)
Cultural practices, beliefs and behaviours may also have profound impacts on both physical and psychological health and wellbeing.
The differences that exist within culturally and linguistically diverse communities are often not considered by our health system, which can lead to inappropriate care. Those affected can become isolated from the system and have poorer health outcomes than the broader population.
What we do
We undertake targeted work with CALD communities to ensure health services and health professionals deliver culturally responsive and equitable services and to address cultural and linguistic barriers to quality health care.
- We participate in community engagement forums including; Fairfield Health Alliance, Fairfield Health Literacy working group, Refugee Women’s Health Group
- We strive to develop our data collection methods to inform needs assessment and service provision
- We offer cultural diversity training for all staff and value a culturally diverse workforce
- We commission healthy ageing education and care navigation services for culturally and linguistically diverse older people and their carers
- We commission the Peer Support Program which employs bicultural peer support workers
- Health Resource Directory – has an additional three preferred language options (Vietnamese, Arabic and Simplified Chinese) enabling access to health information and resources for people diagnosed with a health condition. The information is developed from the clinical guidelines GPs use in South Western Sydney.
- We have implemented the Mental Health Australia, EMBRACE multicultural mental health framework
- We commission You in Mind which provides psychological therapies and peer support to underserviced groups, including culturally and linguistically diverse and Aboriginal and Torres Strait Islander populations
- Targeted approaches to support culturally and linguistically diverse and Aboriginal and Torres Strait Islander populations impacted by COVID.
- We commission Tharawal and Gandangara to deliver a Social and Emotional Wellbeing program for Aboriginal and Torres Strait Islander people in the region
- All our services are required to have the cultural competency to provide culturally safe services to culturally and linguistically diverse and Aboriginal and Torres Strait Islander communities
- We commission bi-lingual Low Intensity CBT Coaching service, under the NewAccess program delivered by One Door Mental Health.
- We commission Odyssey House to deliver a bilingual alcohol and other drugs counselling service
- We have distributed small mental health recovery grants distributed to organisations delivering targets culturally and linguistically diverse approaches e.g. Culturally and Linguistically Diverse Mental Health First Aid and other community engagement initiatives improving mental health literacy
- We have funded CALD and Aboriginal cultural competence training for our mental health and AOD commissioned service providers
- Targeted approaches to support culturally and linguistically diverse and Aboriginal and Torres Strait Islander populations impacted by COVID, such as
- Translated resources for the Novavax vaccine (in the five languages with the lowest vaccination rates)
- Translated resources from NSW Government in our holiday readiness pack
- Received small grant (Living with COVID home visits and vulnerable population funding) to increase vaccination rates in culturally and linguistically diverse communities
- ‘In-language’ pharmacy posters encouraging COVID vaccination campaign
- Collaborative Multicultural Community Wellbeing campaign promoting vaccination in language
- Multilingual workers and pharmacists in Bankstown Shopping Mall providing COVID vaccines
- Advertisement on local culturally and linguistically diverse radio stations in multiple languages, encouraging booster messaging, talk to your GP/pharmacist
- English booster advocacy posters with QR code to access landing page w. Languages Other Than English (LOTE)
- Cards printed from the Consumers Health Forum Australia booster support document in English, paid to translate into Arabic, Simplified Chinese and Vietnamese – also printed. Given to pharmacies and general practice
- Disseminated booklets in “plain English” on palliative care and from the Carers Gateway for dissemination at community forums. Successful uptake at Bankstown stall
- We are part of the SWSPHN Dementia Network Group. The group secured a SRHERE grant for an education program across South Western Sydney. These education programs will be undertaken in a variety of languages by bilingual workers
- All our services are required to have the cultural competency to provide culturally safe services to culturally diverse and Aboriginal and Torres Strait Islander communities
We have additional dedicated programs for Aboriginal and Torres Strait Islander peoples and to support refugee health (information below).
Importance of focussing on migrants and refugee health
The health and wellbeing of migrants and refugees can be affected by a range of physical and psychosocial factors both prior to and following arrival in Australia.
Poor health and complex health needs can occur pre-arrival due to limited access to appropriate health care, exposure to trauma and torture, prolonged detention, social isolation as well as housing, food and financial insecurity.
Upon arrival, physical and mental health can be further impacted by past trauma and post-migration stress, discrimination, language barriers, precarious visa status, limited availability of funds, circumscribed access to housing, work and education, family separation, lack of community support and loneliness.
Access to health care is a basic human right. At the individual level, migrants and refugees should receive healthcare that is accessible, timely, high quality and evidence-based.
Refugee Health Assessment – template to assist in performing the MBS Refugee Health Assessment Medicare Item (Items 701, 703, 705, 707)