What we do

Culturally and linguistically diverse communities health

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

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 less than 20% of the Wingecarribee population were born outside of Australia. Between 2011 and 2016, all LGAs in south western Sydney experienced increases in the proportion of people born overseas but Campbelltown and Wingecarribee LGAs 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.  


Impacts of low English proficiency

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) (see figure ). 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 CALD 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 CALD 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;

  • Carers
  • 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 CALD 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
  • One Door employing bicultural peer support workers
  • HealthPathways – Patient factsheets in language and CALD mental health support resources
  • 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 program
  • We commission You in Mind which provides psychological therapies and peer support to underserviced groups, including CALD and Aboriginal and Torres Strait Islander populations.
  • Targeted approaches to support CALD and Aboriginal and Torres Strait Islander populations impacted by COVID.
  • We offer access to interpreters for people using our commissioned mental health services
  • We commission DAMEC to deliver a CALD alcohol and other drugs support service
  • We commission Tharawal (and will be commissioning 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 CALD 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 Assessmenttemplate to assist in performing the MBS Refugee Health Assessment Medicare Item (Items 701, 703, 705, 707)

Department of Health | Medicare Benefits Schedule (MBS) Health assessment for refugees and other humanitarian entrants

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