Prevention works best when it grows from the relationships, histories and lived realities of the communities it aims to support. When it does not, critical insights are lost and misunderstandings about how prevention is known, felt and experienced persist. Drawing on insights from nearly 1,000 Tasmanians and Health Consumers Tasmania’s place-based work over the past four years, this session reframes prevention as a relational ecosystem, one where trust, connection and local ownership are core infrastructure, not soft extras. To be effective and equitable, prevention policy, research, funding, design and governance must embed consumer leadership and community wisdom from the outset. On the cusp of opportunity with Tasmania’s 20 Year Preventive Health Strategy, Ellen MacDonald explores why prevention fails when lived realities are sidelined, and what becomes possible when relationships, consumer-led governance and place-based models are treated as essential foundations for prevention communities can recognise, trust and sustain.

Illness prevention in Australia cannot be sustained without confronting racism as a fundamental driver of health inequity for Indigenous peoples. Despite decades of prevention effort, profound disparities in health outcomes persist. This presentation argues that racism is not a peripheral social concern, it has always been part of a pathological State that is responsible for shaping Indigenous health risk across the life course and is a direct threat to the effectiveness and long-term sustainability of illness prevention. State enacted racism does not sit alongside the social determinants of health, it actively structures them. It shapes access to education, housing, employment, and financial security; constrains access to safe, responsive services; and drives patterns of health risk behaviour that are too often framed as individual failures rather than as logical responses to chronic exposure to discrimination and exclusion. Current prevention strategies that focus narrowly on individual behaviour change are insufficient, and at worst, are structurally harmful, when structural racism continues to produce the very risk environments that prevention seeks to address. This requires treating racism as a public health emergency; embedding anti-racism across institutions, policies, and service systems; and investing in cultural determinants as core prevention. Prevention will only endure where systems actively reduce structural harm and strengthen the cultural determinants that enable communities to thrive.

As a Pasifika woman, and community researcher, a mother, wife, daughter aunty, niece, my work is shaped by the values, responsibilities, and relationships that anchor our ways of being. In this plenary, I share insights from more than a decade of community-led research with Pasifika women in Queensland, demonstrating how prevention is strengthened—and sustained—when it is grounded in culture, collective identity, and the relational space of vā that holds our communities together. ‘Our People, Our Way’ is the lens through which I speak, work, and stand as a Pasifika woman. Drawing from lived experience, community wisdom and culturally grounded research, I challenge mainstream prevention frameworks that often overlook or misunderstand Pasifika strengths. By centring my own positionality, I explore how Pasifika communities in Australia are reframing prevention in ways that honour spirituality, family, cultural obligation and the interconnectedness that defines our wellbeing. Drawing from Talanoa, vā theory and participatory action research, I reflect on the journey of codesigning the Pasifika Women’s Diabetes Wellness Program alongside Elders, Indigenous Knowledge Holders, and the Pasifika Women’s Alliance. This work reveals how Pasifika women lead as cultural navigators, health advocates and protectors of communal wellbeing—mobilising prevention through relationships, reciprocity and cultural continuity. This presentation highlights three interconnected pillars—community, culture and connection, as essential foundations for prevention that is not only effective but sustaining. I argue that cultural ways of knowing, being and doing are central to achieving equity and shaping prevention approaches that truly serve our communities!