The prevalence of diabetes continues to rise in Australia, along with the disease burden. The number of those living with diabetes in Australia has increased by nearly 220 per cent over the last 20 years and is projected to increase further. There are, however, ways to reduce the long-term effects of this illness, or prevent or delay the onset of the condition altogether in up to 58 per cent of cases. These approaches could save the Australian health system billions of dollars each year and greatly benefit people’s lives.

Diabetes is a chronic condition characterised by an inability to produce or use insulin effectively to manage blood glucose levels. Type-2 diabetes is associated with an array of complications, and many living with diabetes also have other existing health conditions, which can lead to poorer health outcomes.

The traditional medical system is struggling to cope with diabetes and its complications. We must look beyond existing healthcare delivery and responses to prevent the upstream impacts. Specifically, a whole-of-government, comprehensive and multi-level approach is needed to make a lasting impact on diabetes prevalence in the future.

The recent Australian parliamentary inquiry into diabetes made 23 recommendations and has propelled interest and action across many health organisations. Welcomed by Diabetes Australia and the Australian Medical Association, the preventative initiatives it recommends could have substantial financial benefits. These include a proposed levy on sugar-sweetened beverages that would generate $1 billion annually in government revenue. Such an initiative would follow more than 50 other countries around the world that have already implemented such taxes.

The call for greater investment in prevention and preventative health is not new. However, progress has been too slow to stem the tidal wave of rapidly rising chronic diseases like diabetes. Rather than focusing on preventing future health problems, resources are typically steered towards responding to current public health crises. There are acknowledged challenges to preventative approaches, including uncertainty, a lack of accountability and reactivity. However, forward-thinking approaches are often more effective, given that “[e]very dollar invested in preventive health saves an estimated $14.30 in healthcare and other costs”, as the 2023-2024 Federal Budget explains.

The Australian National Diabetes Strategy 2021-2030 was published in 2021 to better coordinate and target the national response to diabetes across all levels of government. Areas for action included reducing modifiable risk factors, identifying those at higher risk and considering evidence-based interventions. Three years later, we need to maintain this momentum towards greater coordination and prevention. This includes funding at a Commonwealth level to mandate the implementation of preventative health initiatives at the local level. We propose three focus areas for deeper government action.

Place-based approaches work well – if you adapt to community needs

Disease prevention means acknowledging the influence of upstream health determinants. Co-designed and place-based approaches could offer one approach for future health strategies in NSW. Place-based approaches are designed to build thriving and sustainable communities within a specific geographical location and have been employed in Queensland, Victoria and areas of NSW. These interventions require a more nuanced path that adopts different forms and aims, with key lessons learnt in order to improve effectiveness.

One such diabetes prevention program in southwest Sydney has seen tangible benefits for multi-cultural communities. Le Taeao Afua, or “the new dawn”, was a community-based diabetes prevention and management program for Australian-Samoan communities delivered through churches. It successfully addressed community needs and built on community assets to establish lifestyle-based community support. It employed a culturally-tailored peer support “train-the-trainer” method that led to a reduced risk of developing diabetes. As a result of this pilot, the Pasifika Preventing Diabetes Programme will now roll out this community model across 48 Pasifika churches in greater western and southeastern Sydney. Such programs demonstrate how vital understanding population-specific needs is for long-term impact.

In many cases, point-of-care should be delivered from community-based settings rather than general practice, where there are common cultural barriers to accessing and using the health system. Culturally-appropriate information – provided from a trusted source with respect for religious values – can make a significant difference. Education is an important component of any prevention strategy. For example, it is important to know your diabetes risk and for people to understand the signs of diabetes, particularly among children. However, such information also needs to be accessible.

Early detection and intervention can make a real impact – but prevention is even better

If findings from the Le Taeao Afua pilot study can be generalised, many people have diabetes without knowing it (12 per cent of people in the study with diabetes did not know they had it until their blood was screened within their church). Importantly, remission of type-2 diabetes is possible, particularly for those who have had the condition for a shorter duration. In addition, lifestyle-based diabetes interventions might hold significant preventative potential in Australia.

Developing education tools and resources was recommended in the Australian parliamentary inquiry, with the suggestion of a school-based diabetes program. However, a specific diabetes education program for children is not necessarily the answer. Instead, a better approach is a holistic health focus, with specific implementation of nutrition and physical activity programs. These are most likely to be effective by ensuring children from a young age are taught what a healthy lifestyle entails. For instance, programs such as Crunch&Sip, Go4Fun, Mighty Bites or AMPED could be scaled up.

Collaborative and coordinated government action could help stem the tide

The parliamentary inquiry also recommended a more collaborative and coordinated approach to diabetes research with oversight from an Australian Centre for Disease Control (CDC), which would liaise with peak diabetes bodies. While not yet fully established, the interim Australian CDC will need to shift its focus onto preventative health strategies to tackle the growing concern over diabetes in Australia. This would have tremendous economic benefits, despite the upfront investments needed in preventative health. Moreover, with the CDC’s initial two-year funding due to expire, it remains unclear the extent to which the institution will be consolidated with ongoing Commonwealth support.

There is some promising action, however, with the NSW Government announcing a new $55 million medical research facility to create intentional, collaborative and innovative solutions to health challenges, including the growing diabetes problem. Coordinated strategies, such as partnerships between research institutions and government, indicate the kind of enduring approach needed. For instance, Diabetes Australia and the Australian Centre for Accelerating Diabetes Innovation recently announced an initiative to increase the number of clinical trials funded and conducted in Australia.

Regardless of calls for action and promising local initiatives, there may be limited positive change without systemic shifts – especially if current budget projections come to pass. Preventative health does not appear to be a major future priority at the federal level: projected health expenditure to 2027-28 sees no new major initiatives, while some other preventative measures have been discontinued. Likewise, the NSW Health Budget also omits specific mention of preventative health, diabetes, disease and medical subsidies (though NSW Health does invest in preventative measures).

To focus government attention on preventative health, UK think tank NESTA has proposed a new category of public spending for prevention. For meaningful and lasting change in population health improvement, there needs to be a sustainable and secure source of finance to support strategies and pragmatic activities to prevent ill health in the first instance. A prevention investment challenge to develop sustainable financing models could be one option. Another is implementing more programs such as “My health for life”, a free program run in Queensland.

Prevention and productivity must go together, meaning the health system will need to work differently. ANZSOG’s Early Intervention Investment Framework (EIIF) has demonstrated that cross-departmental approaches, rather than department-specific initiatives, may be more effective for pre-emptive prevention of societal issues before they become acute problems. The current state of diabetes in Australia has become an acute problem that will continue to grow unless efficient fiscal management and cross-departmental integrated responses are effectively implemented. The EIIF has now been embedded in the Victorian budget with an investment of $2.7 billion to date, which shows that this model could be replicated across other Australian governments.

Where to from here?

While positive ideas have come out of the parliamentary inquiry on diabetes, there is much to be done to see tangible outcomes. Ongoing evaluation of preventative health strategies will be an important element. The proposed NSW Performance and Wellbeing Framework put forward for the 2025-26 Budget should involve community input to strengthen the link between government policy and programs.

As RACGP president, Dr Nicole Higgins, has said, “Investing in care in the community, including prevention, will not only result in better health outcomes, it will mean fewer people end up in hospital, which will save the health budget in the long run.” The takeaway for government is simple: prevention is better than cure. It is achievable, but it must be done effectively, intelligently and collaboratively – considering the unique needs of community – to see real and lasting change.

Dr Cristy Brooks is a Research Associate at the James Martin Institute for Public Policy, 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.

Professor Freya MacMillan is Associate Pro Vice-Chancellor (Research) at Western Sydney University and an International Union for Health Promotion and Education Registered Health Promotion Practitioner in Australia. She has a PhD in Physical Activity for Health and has research interests in health promotion, the prevention of chronic disease (particularly diabetes), and prevention of road traffic mortality and injury in young people. She utilises community-engaged approaches to co-design, implement, evaluate and translate programs for individuals and communities most impacted by the wicked problems her research addresses.

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