Introduction: Incarcerated populations are found to have higher rates and more complex physical, mental and cognitive health issues than people in the general population. However, the justice system is a complex political setting within which to enact preventative healthcare. Current justice health systems require improvement to align with the goals of health prevention, and ultimately, health equity for this marginalised population. This presentation discusses learnings from an NHMRC-funded Ideas Grant to develop a digital health screening tool for measuring age-related health decline in NSW prisons.

Methods: As part of the development phase of the screening tool, (N=8) focus groups were undertaken with multiple health staff within the NSW justice system (N=18; prison and court nurses, psychologists), as well as currently incarcerated individuals (N=20, including n=6 women, n=6 Aboriginal), to discuss their experiences of current health screening and care practices. Our critical realist synthesis of this primary data, alongside current literature and trends in prison health systems globally, reveals important themes and underlying causal mechanisms regarding the reality of preventative healthcare in Australian prisons.

Results: We identify several themes, including constraint and conflict. ‘Constraint’ highlights structural barriers to health preventative health in prisons, emphasizing staff resistance to change and an operational focus on efficiency, influenced by public discourse and funding priorities. ‘Conflict’ examines individuals’ help-seeking behaviors, revealing that past trauma and adherence to prison social norms oppose their willingness to seek care. These exist within unique a prison culture. We will present quotes and examples from participants to illustrate these concepts.

Conclusions: The justice system is an important touchpoint for preventative healthcare in the nation’s most marginalised and high-needs individuals. Broad efforts across will be needed at multiple levels of the system, staff, government and general community to enable true, strengths-based preventative health practices in this setting.

Aboriginal and Torres Strait Islander significance: There is an unacceptable overrepresentation of First Nations peoples within our justice systems. This research has been undertaken with the approval of the Aboriginal Health and Medical Research Council, and includes Aboriginal people and communities as both participants in the research and voices in an Aboriginal Reference Group.

Healthy Cities Australia is a not-for-profit organisation founded in 1987 to apply the principles of the Ottawa Charter to improve health and wellbeing, originally in the Illawarra Shoalhaven region of NSW. In 2024 Healthy Cities Australia partnered with Asthma Australia to deliver a new asthma prevention initiative utilising a systems-change approach to reduce asthma-related hospitalisations in children in the Wollongong area. The project was inspired by an earlier Asthma Australia initiative, Community Responses to Asthma in the Mid North, that used a co-design approach to develop new asthma management roles in South Australia. Asthma Australia recognised that working in a community like Wollongong would require local expertise and connections. The partnership approach adopted here reflects this understanding of the importance of place-based initiatives to the politics of prevention.

As Healthy Cities went from the funding agreement stage to recruitment and planning and scoping for a new project, we conducted a detailed survey of asthma care in the Wollongong area. In the process, we discovered the ways in which past asthma prevention initiatives have shaped the asthma care system in Wollongong, providing the building blocks for a current approach. This also highlighted how short-term funding, fragmentation of the community health system, and shifting priorities in government and local healthcare management can undermine prevention initiatives and erode corporate memory of past successful action. As we learned more about asthma care in Wollongong and the multiple factors that lead to hospitalisation, we returned to first principles in our approach to design. The Healthy Cities approach focuses on addressing the complex, multi-factorial social and economic determinants of health through policy advocacy and community development. Preventing asthma for Healthy Cities, we realised, means returning to the fundamental principles of prevention, that the greatest results can be expected from working on the social determinants of health.

Women and gender diverse people across Australia, from birth to older age, experience disproportionate levels of ill health across a range of areas; gender inequity impacts both access to health services and health outcomes more broadly. Structural systems of power that create unequal distributions of rights, resources and opportunities mean that for key groups of women the prevalence and consequences of ill health are further exacerbated. With its foundational approaches based in socio-ecological understandings of health and focus on the political, social, cultural and commercial determinants, health promotion is uniquely placed to play a key role in addressing these root causes of inequity. Queensland has one of the fastest growing populations of women, and recognising that gender is among the most influential determinants of health, the Queensland Government has recently committed to advancing the rights, interests and economic participation of women and girls through the new Women’s and Girls Health Strategy 2032.
This presentation shares the innovative approach taken by the Queensland Women and Girls’ Health Promotion Program — one key part of system reform in the Queensland Women and Girls’ Health Strategy 2032. The Program focuses on empowering women and girls, particularly those from key priority communities, to take control over and improve their health. We will share key operational principles that guide the planning, implementation and evaluation of the Program, including centring the voices of Queensland women and girls, taking a gender transformative approach, considering health across the life course, and working in collaborative and strengths-based ways. These key principles work to keep equity at the centre of all our work. We will share insights from our recent comprehensive explorations of best practice approaches for women and girls’ health promotion with priority communities, to support practitioners, policy-makers, and researchers working in prevention to embed an equity focus.

Shared language is an enabling foundation for collective action. This is especially true for prevention in health, a concept with transdisciplinary stakeholders. We reviewed academic, policy and clinical documents in Australia to understand how each disciplinary community interprets prevention.

Findings reveal considerable variation in the use of word prevention and associated terms (primordial prevention, primary prevention, population health and health promotion). This variation includes competing interpretations and overlapping concepts, which imply different perceptions about boundaries, responsibilities and leadership across all levels of prevention. This was particularly evident for primordial prevention which was poorly defined and universally implied to belong ‘elsewhere’.

Our comparison of definitions across communities revealed inconsistencies in how primordial prevention is approached: policy and clinical documents often interpret it as reducing existing risk factors, targeting individuals already exposed to health risks or experiencing ill health, whereas academic literature emphasises primordial prevention as interventions to prevent the development of risk factors among well populations.

Additionally, we observed overlapping use of terms in the policy and clinical documents, where ‘health promotion’ and ‘population-level initiatives’ are frequently used interchangeably with primordial prevention, as these terms share similar meanings with its academic definition. However, there is little clarity about who is responsible for these activities, how they are governed and coordinated, and what the roles of different stakeholders are. Instead, many ‘early prevention’ tasks have been nominally allocated as primary care responsibilities, where the workload is already overwhelming.

Understanding disciplinary definitional differences is a first step toward a shared understanding of prevention concepts. A more consistent nomenclature in Australia would be beneficial for researchers, policy makers and clinicians to have a shared sense of understanding and accountability.

Legislation is a key foundation for the creation of sustainable preventive health policy and action.
The Preventive Health SA Bill 2024, the first of its kind in South Australia, provides the legislative infrastructure for South Australia to build a sustainable prevention system for the future and help drive long-lasting, positive health and wellbeing change for current and future generations.
To ensure evidence informed preventive health action is a priority independent of political agendas, the Preventive Health SA Bill 2024 was developed, incorporating learnings from relevant legislation both nationally and internationally, as well as feedback from consultation with a broad range of stakeholders.
A Preventive Health SA Establishment Advisory Council, chaired by the Honourable Nicola Roxon, provided advice to inform drafting and included members with expertise in epidemiology, public health policy, Aboriginal and Torres Strait Islander health, health equity, preventive health strategy, government policy making and business.
The legislation establishes the agency known as Preventive Health SA, statutory functions for the Chief Executive which cover the breadth of preventive health action and the Preventive Health SA Council.
This presentation will cover the unique and innovative features of the Preventive Health SA Bill 2024 which aims to prevent and reduce the burden of non-communicable health conditions, improve health equity and support perpetuity of the prevention agenda by embedding preventive health in the legislative framework governing the State's health system. The Bill supports collaboration with government and non-government organisations, leadership and independence.
Learnings will be shared about the key milestones in the journey of legislation development, presenting reflections and insights that will be useful to other jurisdictions about optimising the political environment to embed preventive health policy, action and resourcing for health and wellbeing outcomes.
Note: At the time of submission the Preventive Health SA Bill 2024 has passed the Lower House of the South Australian Parliament and is due to be tabled in the Upper House in the coming weeks.

Public health organisations (non-government) are increasingly governors in the CDoH but little is known about how they interact with commercial actors and governments and how they manage potential conflicts of interest (COI). CDoH work often focuses on transnational corporations, but as the recent Lancet series makes clear, a range of commercial actors influence health. We conducted an exploratory study focused on NGOs active in CDoH in Australia, with a particular focus on organisations with a strong interest in the regulation of alcohol and/or ultra-processed food.

Research Questions: How do Australian health focused NGOs manage their interactions with different commercial actors as they seek to improve regulation for public health? Who do these NGOs engage with? How do they conceptualise COI? What policies or procedures are in place if any for preventing undue influence? What tensions and challenges arise?

Method: Document and website searches of 136 NGOs active in Australia on alcohol and ultra processed food governance and 30 qualitative interviews with senior leaders from select organisations.

Results: Australian health focused NGOs sit on a wide spectrum of engagement with commercial actors - from no engagement with what can be percieved as harmful commodity industry actors, to some engagement in some circumstances. Analysis of documents and interviews indicate divergent reasons for engaging (or not) with commercial actors and different tools and frameworks to determine engagement.

Introduction: Strengthening prevention within the healthcare system in Queensland is essential to optimise population health and wellbeing. A collaborative framework can provide direction, overarching principles and enabling functions to ensure prevention is effective and sustainable. Health and Wellbeing Queensland (HWQld), the state’s prevention agency, was established to drive systems change that addresses the preventable burden of disease and have developed a draft prevention framework. The aim of this study was to understand the perspectives of those working within the healthcare system in Queensland regarding the draft framework.

Methods: Mixed methods including workshops, an online survey and document submissions were used to collect data during a statewide consultation. Purposive and snowball sampling guided recruitment to ensure representation across the healthcare system. Descriptive statistics were used to summarise quantitative data. All qualitative data underwent a process of content analysis with deductive and inductive coding.

Results: 267 people participated during a 9-month consultation process (September 2023 to May 2024), representing 31 key stakeholders (16 Hospital and Health Services, seven Primary Health Networks, one state government department, six non-government, academia/research institutions or private healthcare stakeholders, and two industry stakeholders). 79% of survey respondents stated that they either ‘strongly agree’ or ‘agree’ with the vision and purpose of the proposed framework. Qualitative analysis revealed 47 codes grouped within 17 content categories, ranging from strategic alignment and integration, the source of funding and funding models, and addressing system constraints, to everyone has a role in prevention, understanding the trusted voice, and the preference for a strengths-based approach.

Conclusion: The consultation process provided clear and actionable feedback regarding the draft prevention framework. Both anticipated and unexpected results representing novel thinking indicated overall support and positivity for the framework. HWQld can now integrate this feedback into the final framework, alongside planning strategic functions to support application across Queensland.