By Paul Lupo
Tasmanians are on the brink of the most consequential health budget in a generation. This is not a debate about spending more on treating illness, but about whether we are prepared to invest in keeping people healthy in the first place. The Tasmanian Government’s 20‑year Preventive Health Strategy represents a once‑in‑a‑generation opportunity to shift our system from crisis response to prevention – an approach that has attracted rare bipartisan support and unprecedented community backing, with more than 5,000 public submissions.
The case for significantly increased and sustained investment is clear. Tasmania’s health system is under strain like never before. Emergency departments are overcrowded, hospitals are stretched, and costs are rising faster than the economy can sustain. Continuing to pour the bulk of funding into sickness support alone is economically unsustainable and leaves too many Tasmanians missing out on timely care. Behind these pressures are real people living longer with chronic illness, and too often with a diminished quality of life. Prevention is no longer optional, it is essential.
This is the uncomfortable truth we must confront – we have built a system that manages sickness instead of enabling health.
Globally, people are living longer than ever. But McKinsey Health Institute’s latest research shows those extra years are increasingly spent in ill health. Since 2000, the average number of years lived with illness has grown from 8.7 to more than 10 years and is projected to rise again by 2050. In plain terms, every extra year of life expectancy now brings roughly six months of additional illness or disability with it.
Ask someone if they’d like to live to 100, and most will say yes. Ask them if they’d still choose that option if their final 20 years were spent managing multiple chronic conditions, and I suspect the answer would be no.
This is an especially relevant question for Tasmanians – we’re the oldest population in the country and currently the most likely to have at least one chronic condition than people in any other state or territory.
That gap between how long we live and how well we live has a name – health span. And closing the gap is one of the most important policy and economic challenges governments and communities now face. The health span challenge is visible here at home. The life expectancy gap of around 20 years between Sandy Bay and Bridgewater is not just about how long people live, but how well they live during those years.
Governments and individuals are spending record amounts on treating sickness, rather than making smarter investments to stay well in the first place. McKinsey’s global analysis found that most countries invest less than two per cent of their total health budgets in prevention, even though nearly two‑thirds of the disease burden challenging health systems are avoidable. In Tasmania, this investment varies between two and three per cent.
The economic case to turn this around is unequivocal. Scaling proven preventive interventions could add nine extra healthy years to life expectancy and deliver a four-fold return on investment, generating up to $12.5 trillion in global economic gains each year by 2050.
In Australia, health costs have and continue to grow faster than inflation. Australian Institute of Health and Welfare data shows health cost inflation exceeded general inflation in 2023–24, continuing a long‑term trend. At St Lukes, we have absorbed these pressures, holding premium increases below CPI for five consecutive years even as health inflation ran well ahead. That choice has assisted many Tasmanians during a cost‑of‑living crisis. But without systemic change, it is not sustainable.
The Federal Government’s Productivity Commission has reached the same conclusion. Its recent work calls for a national prevention investment framework, recognising that keeping people well is essential to both productivity and long‑term budget repair. Importantly, the Commission emphasises long‑term funding, clear accountability and community‑based approaches over short‑term programs that disappear before benefits are realised.
We agree, and so does every side of politics. In our discussions across the political spectrum, there is universal support for the Tasmanian Government’s 20-Year Preventive Health Strategy – something rarely seen in health policy.
Importantly, preventative health cannot succeed through government investment alone. It succeeds only when individuals are empowered to take control of their own health – supported by environments, services and communities that make healthy choices easier to make.
It requires consistency, patience and partnership, and government’s role should be clear – nose in, fingers out. Set a clear plan, measure and fund what works, and enable those closest to communities to lead the delivery.
Tasmania has a unique opportunity to lead nationally in this space. International best‑practice systems consistently suggest that if you invest more in prevention, better health outcomes result. Nation‑leading and global experts will be in Hobart for the Public Health Association of Australia Preventive Health Conference in May to share how this can be done.
St Lukes has a vision to make Tasmania the healthiest island on the planet, and we are actively studying how progressive health systems around the world measure and extend health span. We look forward to working with Public Health Tasmania and UTAS to bring those insights home.
As the State Budget approaches, we believe three health commitments matter most:
- Visible, funded commitment to the Preventive Health Strategy, matched with Treasurer‑level ownership.
- A genuine whole‑of‑government approach, recognising that health is shaped well beyond our hospitals.
- A four‑year action plan with real growth from the upcoming Budget and sustained investment in the forward estimates, not pilot‑and‑pause funding.
Health pressures can get worse, but they can also get better. The evidence is clear. The opportunity is real. What’s required now is the bravery to change course.
If Tasmania gets prevention right, the rewards will be measured not just in years added to life, but in life added to years.
Paul Lupo is CEO of Tasmania’s leading not-for-profit health and wellness organisation St Lukes.