Prevention Isn’t More Healthcare. It’s Everything Outside It.

Written by Kelly Andrews, Healthy Cities CEO

When the NSW Government convened its recent NSW Preventive Health Summit 2026 in Parramatta last week, it declared an ambition to strengthen prevention, improve long-term health outcomes and tackle the growing burden of chronic disease. I can’t disagree with those goals. Chronic conditions account for around 70% of illness burden, obesity has overtaken tobacco as the leading contributor to disease burden, and NSW faces an ageing population with rising rates of multiple chronic conditions.

But there was an uncomfortable irony at the heart of the summit.

Healthy Cities Australia – having evolved from Healthy Cities Illawarra (est. 1987), one of the country’s longest-standing prevention organisations, was not invited.

For almost 40 years, Healthy Cities Illawarra, now Healthy Cities Australia has worked where prevention actually happens: in neighbourhoods, schools, workplaces, public spaces, local government, community organisations and social networks. Our work is built on the WHO Healthy Cities Framework and focuses on the social, environmental and commercial determinants of health. Yet somehow, when NSW gathers experts to discuss prevention, one of Australia’s most recognised prevention organisations is absent from the room.

Perhaps that says something deeper about how prevention continues to be misunderstood.

Too often, prevention is conflated with early intervention. They are not the same thing.

Early intervention means identifying problems sooner. It is important work. Helping an older person avoid hospital admission, screening for disease, or expanding access to allied health services all have value. But they occur after risk has already emerged.

Likewise, expanding scope of practice for health professionals may improve access and efficiency within the healthcare system. It may even improve health outcomes. But it is not prevention. It is healthcare.

True prevention happens much further upstream.

It happens in housing policy, urban planning, transport systems, education, employment, economic development, food systems and environmental protection. It is found in whether children can walk safely to school, whether communities have access to affordable healthy food, whether people can afford secure housing, and whether public spaces encourage connection, activity and belonging.

Even NSW Health’s own Health of the People of NSW 2026 Report recognises this reality, acknowledging that health is shaped by where people live, learn, work and age, and by their access to housing, education, employment and social connection.

So why does prevention remain largely confined to a health portfolio – it can’t continue to work this way!

If the NSW Government is serious about prevention, it needs to move beyond the idea that prevention is simply a better version of healthcare. Prevention is not something delivered by hospitals. It is something created by governments in every portfolio.

The Minister for Planning is a health minister.

The Minister for Transport is a health minister.

The Minister for Housing is a health minister.

The Minister for Education is a health minister.

Their decisions shape health outcomes every day, often far more profoundly than the healthcare system itself.

The summit’s second day reportedly considered cross-government approaches to prevention. That is encouraging.

But discussion alone won’t be enough.

NSW already has organisations embedded in communities, with decades of experience translating prevention from theory into practice. Healthy Cities Australia is one of them. That experience, knowledge and deep community networks should not be an afterthought – but it remains a hugely undervalued community asset.

If the government genuinely wants to strengthen prevention, it need not create an entirely new architecture. It could start by investing in organisations already doing the work. Compared with the billions spent treating chronic disease, the resources devoted to community-based prevention remain remarkably modest. You’ll hear much from prevention organisations in the lead up to the election sprouting that every $1 invested in prevention saves $14 in treatment.

Healthy Cities Australia has survived (just) for four decades because communities value what we do. We are minimally ministerially funded but dependant on short term grants. We are locally embedded and internationally recognised. Yet like many prevention organisations, we continue to operate on a fraction of the resources directed toward treatment.

The challenge for government is not finding evidence that prevention works or funding more research to find the unicorn prevention method neatly tied up in a bow.

The challenge is having the political courage to fund it.

Will that happen next?

After decades working in community development and health promotion, I’ve learned not to hold my breath. But if we’re serious about reducing chronic disease, improving equity and creating a healthier future for NSW, we should at least invite more prevention orgs, not just the big ones, to the table.

Read the report here: Health of the People of NSW 2026