Australia already knows what prevents chronic disease. The system still struggles to deliver it.
Australia does not have a prevention knowledge problem.
We have spent decades educating people about exercise, smoking, diet, stress, blood pressure and cardiovascular risk. Entire public health eras have been built around awareness campaigns. We know what healthy behaviour looks like. Most patients do too.
And yet chronic disease continues to rise.
Which raises an uncomfortable possibility.
What if prevention is not failing because people lack information?
What if prevention is failing because healthcare systems still deliver it in ways that compete with real life instead of fitting into it?
That is the challenge sitting underneath “The Great Prevention Pivot”.
Because for all the discussion about prevention, very little of the healthcare system has actually been redesigned around making prevention easy, accessible and scalable.
The system still overwhelmingly funds and operationalises in person treatment as default, while prevention remains fragmented, underfunded and difficult to access.
Cardiac rehabilitation exposes this problem in a unique way.
Few interventions in healthcare have stronger evidence than cardiac rehabilitation. We know every patient that has had a cardiac event or procedure – should get rehab. The denominator is known because treatments & procedures are tied to funding. We know CR reduces hospital readmissions. We know it improves recovery, quality of life and survival. Clinical guidelines have recognised its value for decades.
And yet most eligible patients (80%) still never complete a program.
Not because they do not care about their health.
But because no one is checking the population denominator at the point of care. The total number of patients that are missing out are invisible – falling in the cracks between hospital discharge and community dwelling, because they don’t reach the wait list.
Traditional models of care were designed for a different era, and intake their participants from a hospital referral source. If there are 10 patients on the wait list – that’s the population that is offered treatment. Meanwhile 100 patients never made it to the wait list.
They assume patients can repeatedly attend hospital or clinic-based sessions during business hours over multiple weeks. They assume proximity to services. They assume transport, flexibility, workforce capacity and time. They assume gender equity.
For most Australians, those assumptions don’t hold and haven’t for over 50 years.
Patients are balancing work, caring responsibilities, financial pressure, regional access barriers and recovery simultaneously. At the same time, health systems are confronting workforce shortages, rising chronic disease burden and growing hospital demand. People are living longer with heart disease, but with greater burden and impact.
Healthcare systems cannot continue absorbing growing chronic disease demand through labour-intensive, infrastructure-heavy models alone. The workforce required simply does not exist at the scale the system today demands, let alone the future.
That means prevention can no longer be treated as an aspirational policy ambition. It has to become operational infrastructure.
And that requires a fundamental shift in thinking.
The future of prevention is not awareness and screening campaigns alone.
It is reimbursement, digital delivery and accessibility redesign.
It is building models of care that come to people inside their lives instead of forcing people to reorganise their lives around healthcare systems.
This is where digitally enabled and virtual models of care become important – not as “innovation projects”, but as scalable infrastructure for modern healthcare delivery.
In cardiac rehabilitation, virtual and hybrid programs are already demonstrating what this can look like.
Patients can access clinically validated, structured, clinician-guided models of rehabilitation from home. Participation and completion rates improve. Readmissions and bed days reduce.
Health services can support more patients without proportionally expanding human resources, capital equipment or physical infrastructure. Clinicians can extend care beyond hospital walls while maintaining oversight and quality standards. All this can be done cost effectively, efficiently, safely with real world examples in Australia and around the world.
Importantly, this is not about replacing clinicians or traditional programs.
It is about acknowledging that 80% or patients are not accessing care, and if evidence-based care remains inaccessible to most eligible patients, then the system has not fulfilled its duty of care.
Now knowing the denominator. Now seeing guidelines and consensus statements endorse CR for all cardiac event and procedure patients – this counterfactual becomes difficult to tolerate.
Because the evidence now exists.
The technology exists.
The regulatory frameworks exist.
The clinical validation exists.
The blocker is increasingly institutional inertia, exacerbated by lack of funding to enable care.
Australia still lacks nationally consistent funding pathways for regulated digital therapeutics and scalable virtual prevention programs. Clinicians still navigate fragmented referral pathways. Prevention remains structurally harder to access than acute intervention.
That is not a technology problem.
It is a system design problem.
The prevention pivot will not happen because healthcare talks about prevention more often.
It will happen when prevention becomes embedded into standard care pathways, funding models and delivery infrastructure.
It will happen when referral to evidence-based prevention programs becomes the default, not the exception.
We do not discharge cardiac patients without medication because the evidence is clear. Increasingly, we should be asking why we discharge patients without structured referral to rehabilitation programs proven to reduce their risk of coming back.
Because prevention only works when people can actually access it.
And if healthcare systems are serious about surviving the next decade of chronic disease demand, workforce pressure and demographic change, then scaling validated digital prevention programs can no longer remain optional extras to conventional care.
The future of prevention will not be defined by what healthcare knows is possible in the clinic.
It will be defined by what healthcare is prepared to operationalise beyond the walls of hospitals and surgeries – digitally delivered in the place and time that suits the patient.
Helen Souris is the CEO and executive director of Cardihab – Australia’s first TGA-registered digital therapeutic platform for Cardiac Rehabilitation