Behind Healthy Cities Australia's grassroots campaigns lies a grand goal: stopping sickness before it starts.

“We’re all about the prevention of chronic disease, which we approach by looking at the environment in which people work, live and play,” says Kelly Andrews, CEO of the Fairy Meadow-based charity, which runs programs such as Food Fairness, Breathe Better and Play Illawarra.

“With the Healthy Cities approach, we are reducing risk and preventing illness over time. We’re doing our job well if there’s a heart attack that never happened, or a hospital stay that can be avoided.”

Prevention ‘not rocket science’

The benefits of prevention for our overloaded health system – including hospitals in the Illawarra, which was diagnosed with the nation’s worst case of bed block in 2023 – could be huge.

More than a third of illness, disease and early deaths can be prevented – this fact tops Healthy Cities’ mission statement and yet chronic disease prevention is still overlooked and under-funded in Australia, Kelly says.

Less than 2 per cent of annual health expenditure spent on public health initiative – so about $130 per person each year.

“When you think of the health system, you think of ambulances and emergency departments, in fact, what keeps people healthy is everything outside the hospital. It’s all the preventative side of health, like physical activity and good food and social connection,” Kelly says.

“It’s not rocket science, but it doesn't seem to be valued enough to fund.”

A little bit of funding could go a long way to relieve pressure on the nation's health system and budget. Treatment of chronic disease in primary healthcare, for example, costs Australia more than $70 billion per year.

“Prevention is easy, we know how to do it and it’s really cost-effective,” Kelly says.

“For every dollar invested in prevention, the system ends up saving $14 in treatment costs at the other end.”

Part of a global push

Healthy Cities Australia (formerly known as Healthy Cities Illawarra) has championed the benefits of prevention locally since 1987, subscribing to the World Health Organisation’s Healthy Cities framework.

The charity collaborates with local government, universities, businesses and other community organisations to “bring people together and co-ordinate solutions”.

It’s much-needed work.

Half of Australians live with at least one chronic disease, and rates are expected to grow if prevention is not prioritised, according to The Australian Centre for Disease Control (ACDC).

“We want to make it so that healthy choices are easy choices – build healthier, more sustainable communities that address the root cause of chronic diseases,” Kelly says.

“There are two main components. A sedentary lifestyle and unhealthy food dietary intake.

“We know that obesity continues to rise, and that is a huge risk factor for chronic diseases, such as cancers, cardiovascular disease, diabetes, musculoskeletal issues and, of course, mental health.”

Healthy Cities supports physical and mental health in our community with about 10 local programs. For example, community walking groups ‘Five by Five’ and ‘Three by Three’ are of ways to “invest in health before people get sick”, Kelly says.

“We do lots of community walking programs, cycling groups, activating publicly available playgrounds and outdoor gyms. We do a lot of advocacy and promotion around active transport and playing outside – and, of course, advocacy around healthy food.”

Food for thought

Australian adults and children had similar very low rates of meeting fruit and vegetable recommendations (4.2% and 4.3%), the most recent National Health Survey (NHS), published in 2023, found. Almost one in four people (23.9%) aged 15 years and over met the physical activity guidelines, according to the NHS, an Australia-wide health survey conducted by the Australian Bureau of Statistics.

Healthy Cities’ food programs include Cook, Chill, Chat, which brings vulnerable people together for meals; the Dinner Table Project, a six-week course teaching families to cook; and Food Fairness Illawarra, which connects residents with local growers such as Popes Produce.

Kelly says: “We encourage and educate about eating more whole, unprocessed foods, reducing sugary drinks, reducing alcohol, tobacco use and vaping, reducing the intake to reduce the risk of dependence but also improving health and well-being.”

Political courage required

Healthy Cities Australia receives a small amount of core funding from NSW Health through the local health district, along with goodwill from the community.

“Prevention-based approaches are usually overlooked because you can't see them. It’s difficult to articulate when the impact isn’t always immediate and visible,” Kelly says.

The long-term approach makes funding a challenge in our three-year political cycle.

“People are really looking for ribbons to cut and buildings to open, so that's a huge barrier – trying to ensure that there’s enough political bravery to invest in long-term strategies that will improve the health of the future,” Kelly says.

“We need to understand that we may not be the direct beneficiaries of this work but it will be our kids and grandkids – that’s another barrier, that lack of long-term thinking and budgeting.”

Chronic disease on the rise

On average, Australians are now spending an eighth of their life in ill-health, but modifiable risk factors – such as smoking, obesity and being overweight, poor nutrition or social isolation – account for 38% of the burden of chronic disease.

“Chronic disease is growing more and more, and we know that the health system is currently under a huge amount of pressure,” Kelly says. “Doctors are striking, everyone is overworked and underpaid.”

Prevention has a powerful role to play in relieving these pressures.

“We reduce the burden on the healthcare system, and improve people’s quality of life,” Kelly says. “They’re happier, healthier and more connected when they’re taking preventative measures to improve and protect their health.”

Environment is vital

But it’s not all up to individuals – governments need to create the right setting for good health.

“It’s really important to create a healthy supportive environment – so we are looking at the food eco system, the transport system, the housing system – looking at all of these systems that combine together, to either facilitate good health or impede good health in the long run,” Kelly says.

“There are things that we can change to improve the health of the community.

“Things like good, healthy urban design, access to green space and blue space. Access to fresh, healthy, culturally appropriate food. Opportunities for community participation to address social isolation and obviously, making the environment safe and conducive to physical activity and movement.

“And then the other great prevention strategies are the early intervention style initiatives – things like screening for cancer and getting regular check-ups, immunisations, that sort of thing.

“Those are the strategies that most people are really familiar with, but it’s the environments that support those behaviours that make a difference.”

Visit the Healthy Cities website to read more about their programs