Australia’s healthcare system performs well on the world stage. However, measured in terms of societal health and accessibility, the ranking of our healthcare services drops. This mismatch between system health and societal health should prompt reflection on the direction of public spending and how it can be improved. Greater investment in prevention should be a priority, given the potential benefits for productivity, fiscal sustainability and improved quality of life.  

We take a closer look at what is working well in current health spending and suggest that prioritising prevention and positioning Australia as a leader in societal health is only possible through a national and cross-sector approach.  

The National Preventive Health Strategy 2021-2023 showed initial promise in prioritising the nation’s health. Building on this, we suggest further implementation through a “National Prevention Investment Framework” to drive implementation of the Strategy.  

Current focus on boosting service delivery

The federal and many state budgets have placed an emphasis this year on getting the basics right. At the Commonwealth level, strengthening Medicare is a key area of investment, with the government announcing an additional $7.9 billion to deliver an extra 18 million bulk-billed GP visits each year. In new services, there is also $573.3 million for a range of women’s health services, including increasing access to contraceptives, additional menopause support and 11 new endometriosis and pelvic pain clinics.  

For example, the Bulk Billing Incentive Program and changes to bulk billing incentives will come into effect on 1 November, with nine out of ten GP visits to be bulk billed by 2030. A key election issue, this reform holds promise for many Australians. However, this investment is an incentive only, with the pragmatic implementation of bulk billing visits at the discretion of each GP practice. If GPs do not bulk bill more of their patients, while remaining unconvinced of the viability for their practices, this initiative is unlikely to have the intended impact. 

Meanwhile, NSW’s 2025 budget was capital heavy, with the government committing to $12.4 billion in capital investment over the next four years to build and upgrade health infrastructure. New investments in operating funding were slim in comparison, largely focused on traditional health services. 

While such investments are essential, there must also be space for innovative thinking and holistic approaches outside of traditional healthcare. Australian governments would benefit from thinking more broadly about the future of the nation’s health, especially by investing with a prevention mindset. 

Prioritising prevention for lasting health

Chronic health issues such as obesity and diabetes contribute to health and economic burdens at all levels. The Australian health system spends more than $38.2 billion annually on caring for people with chronic conditions, which affect close to 40 per cent of the population. Productivity losses contribute further economic impacts, with lost income estimated to reach $20.5 billion by 2030. 

Given the Commonwealth’s focus on addressing Australia’s declining productivity and improving budget sustainability (a key priority in last month’s Economic Reform Roundtable), investment in preventative health to boost savings is an overlooked piece of the puzzle. 

Short political cycles and yearly budgetary processes, often siloed by portfolios, present ongoing structural barriers to long-term decision-making. Shifting the public focus to systematically consider the wellbeing implications of decisions would improve both immediate and longer-term health outcomes, focusing investment in areas needing a greater preventative focus. 

There is some promising progress being made towards prioritising long-term wellbeing. At the state level, NSW’s first Performance and Wellbeing Statement as part of the 2025-26 budget places a strong emphasis on health. Yet practical implementation remains elusive. For example, the statement highlights the proportion of adults meeting the guideline for sufficient physical activity. However, it does not stipulate the parts of the NSW budget that contribute to more people meeting these recommended guidelines.  

At the federal level, despite the Measuring What Matters framework being a key pillar of the Albanese Government’s first term, a gap has emerged between what is being funded and what is being measured. A downstream shift to a prevention mindset in service delivery is required, with tangible outcomes linked to upstream budgeting and investment strategies. An investment framework for prevention would help drive implementation of health promotion initiatives through strategic resource allocation. 

Addressing current gaps in healthcare outcomes

Beyond the fiscal implications of prevention, a cross-sectoral, whole-of-system approach is needed to maximise impact. A hybrid, holistic approach that considers the social determinants of health can generate continued improvements in societal health.  

The Productivity Commission’s interim report is a step in the right direction, with prevention featuring in one of five pillars of inquiry. The interim report recommends not only a national framework to invest in prevention, but also new governance and funding arrangements that support better collaboration across health entities, including Local Hospital Networks (LHNs), Primary Health Networks (PHNs) and Aboriginal Community Controlled Health Organisations (ACCHOs). 

In addition to calls for national reforms, there also needs to be state-level impact and implementation in health promotion practices, such as the Community of Practice trialled in NSW. There are also other promising program-level innovations across jurisdictions, such as the promotion of healthy food environments to tackle food insecurity and childhood obesity. For example, The School Food Project in NSW, the Smart Choices strategy in Queensland, Victoria’s Future Healthy Food Hubs and the junk food advertising ban in South Australia. Although there remains calls for Australia to have a coordinated school food policy. 

Although these are all positive steps in the right direction, governments need a clearer focus on policy reforms that make it easier to empower communities to invest in their health. The rise of community gardens and community-based food cooperatives, or “food hubs”, in Australia is one such example.  

Hubs such as Box Divvy, the Corner Store Network and The Community Grocer are having positive impacts. They improve food insecurity, health outcomes and community connectedness, but would benefit from the support of government to reduce red tape beyond the cooperatives national law established in 2014. In addition, recent research revealed lower body mass index (BMI), a common indicator of obesity, is associated with healthy food outlets being within walking distance, which has important implications for effective prevention-focused public policy.  

Government can also support collaboration between policymakers, researchers and academics to drive change for healthier communities through centres such as CHiAPRT. A great place to start would be to reestablish the Australian National Preventive Health Agency that was disbanded in 2014. Designed to drive national capacity in preventative health infrastructure, policies and programs, re-establishing the Agency would send a clear message that the government is willing to invest in the long-term health of the nation. 

Learning from abroad

Australia can also adopt key learnings from the health initiatives of other countries taking national and cross-sector approaches to support investment in prevention. These include: 

• Singapore’s HealthierSG, a national multiyear strategy to reform primary healthcare through prevention, innovation and trust.  

• Japan’s approach to universal healthcare and healthy ageing means it is considered a “champion for health” by the WHO. The Japanese Government has committed to implementing wellbeing evidence into policymaking, with a firm healthcare vision for the future.  

• The United Kingdom’s healthy food standard is estimated to reduce obesity by approximately 23 per cent, through united action from food retailers, government, the National Health Service and individuals, requiring continuous measures in addition to overall health targets.  

• Switzerland’s innovative urban design of Zurich’s main station for 2050 is intended to improve safety and accessibility for pedestrians and cyclists.  

More holistic approaches to health have been acknowledged abroad, such as the Healthy People 2030 strategy in the United States and mobile greengrocers in the UK. Australia can also learn and adopt bicycle-friendly urban design principles from countries like the Netherlands and Denmark, given urban cycling can help prevent premature mortality.  

So, what now?

There is a need for government to recognise the holistic nature of health and to implement clear and measurable actions. The recommendations from the Productivity Commission’s interim report, including the national framework for prevention, are a good starting point. In progressing these recommendations Australia can learn from innovative approaches within Australia and abroad to create a healthier nation.  

 Dr Cristy Brooks is a Research Associate at the Australian Public Policy Institute, an Associate Lecturer in Interprofessional Health Science at Western Sydney University and an Accredited Exercise Physiologist with Exercise and Sport Science Australia. She has a PhD in Health Science and has research interests in the prevention and management of chronic disease and chronic pain, and seeing academic research translated into real world impact to improve the lives of Australian individuals and communities.  

Hannah Lobb has worked on health system funding, reform and strategy in Australia and New Zealand and previously worked at the Australian Public Policy Institute.  

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