10 years of preventive health in Australia. Part 1 – lessons for policy and implementation

While research institutions grapple with understanding and measuring impact, in the public health field the application of evidence to preventive action is business as usual. As its title makes clear, this journal has positioned itself to support public health impact through the publication of evidence for practice and from practice. Given this ambition, it is fitting that our reflections at this 10-year mark in the journal’s life draw upon insights from researchers and actors in important centres of public health effort – Aboriginal health, primary care and tobacco control.

In their perspective, Khwanruethai Ngampromwongse and Alana Gall observe that numerous ambitious goals have been set to improve health outcomes among First Nations peoples, but the process of policy development has not adequately drawn upon First Nations peoples’ lived experiences of the social, cultural and economic drivers of health inequities.¹ They argue that these perspectives must be brought to the table to avoid the perpetuation of racism in the way that the needs of First Nations peoples are defined, and policies and programs are planned.

As Mark Harris points out, primary care remains the major direct point of contact between the population and the health system in Australia.² He describes multiple initiatives over the past decade to support the integration of primary, secondary and tertiary prevention in this context. Yet it is apparent that these efforts have been fragmented and have not sufficiently taken account of the systemic barriers to the sustained implementation of preventive care.

Becky Freeman’s perspective on tobacco control in Australia highlights that it is possible to be in a world-leading position in policy development yet still lose focus and momentum in this work.³ Even policy agendas with a compelling evidence base must advance in the face of political, bureaucratic and commercial obstacles. The fact that the nation has been able to get back on track is due to the research, advocacy and partnership capacities built in the tobacco control arena over decades.

The complexities and hurdles recounted in these perspectives demonstrate that although the logic of prevention is widely endorsed, achieving substantive and sustained progress is rarely straightforward. These realities are examined by Cairney and St Denny in ‘Why isn’t government policy more preventive?’.⁴ They argue that prevention policymaking usually stalls because decision-makers do not understand the obstacles to the realisation of their aspirations and are not prepared to use the governance, funding and organisational tools required to achieve successful implementation.

This brings us to the question of what our priorities must be for developing prevention policy and practice in Australia. Given the central importance of governance, funding and organisation, two immediate opportunities are the National Preventive Health Strategy (NPHS) and the Australian Centre for Disease Control (ACDC).

As noted previously in this journal, the NPHS (2021–2030) was prepared at a time when recognition of public health and its contribution to the day-to-day safety and wellbeing of Australians reached a high-water mark.⁵ The aims and framework for action set down in the NPHS⁶ received endorsement from all quarters. However, the NPHS is languishing, as indeed is the National Obesity Strategy 2022–2032⁷, which was also developed through extensive consultation and cross-jurisdictional engagement.⁸ This is despite its alignment with the government’s ambitions to pursue values-based, wellbeing-oriented public policy⁹ and with its ‘Measuring What Matters’ policy framework.¹⁰ The NPHS states the priorities, targets and principles for action, and the blueprint for implementation called for in the NPHS must be prepared.

Another significant development was the funding of the ACDC in 2022, for commencement in 2024. This leading agency has the potential to elevate prevention on the national policy agenda, provide guidance for strategies and facilitate coordination of actions across sectors and levels of government.¹¹ Disappointingly, the remit of the ACDC has so far been constrained to communicable disease preparedness, surveillance and prevention. Although these are critical focal points, many health authorities have highlighted that chronic diseases are the major contributors to population health in Australia.^12,13 Further, as demonstrated during the COVID-19 pandemic, people with chronic disease have greater vulnerability to severe morbidity and mortality from communicable disease infection.¹⁴ The ACDC can play a central role in supporting the implementation of the NPHS, and if it adheres to its stated commitment to listen to First Nations peoples’ voices and consider the social and economic disparities affecting their health, it can inform targets and strategies that will rightly prioritise these health needs.

The sporadic and disjointed progress in prevention policy in Australia over the past 10 years might be seen as a continuation of what has been observed in this country since the 1980s.^13,15 It is reasonable to ask whether the political and organisational complexities of this arena of policymaking are such that it will ever be thus. Perhaps, but the tradition of evidence gathering, critical reflection and learning from engagement in policy and practice will continue in the public health field. Public Health Research & Practice will remain a vital contributor to these efforts.