Views and Experiences of Drug and Alcohol Services by Individuals From Migrant, Non-English-Speaking Backgrounds and of Their Service Providers in South Western Sydney, Australia.

The contrasting scenarios of healthy versus unhealthy ageing in The European Commission's 2024 Ageing Report clearly demonstrate the long-term benefits of prevention, not only in improving future health and well-being but also in reducing costs and fostering economic growth []. Masters et al., reported a median return of 14 euros per euro spent on prevention projects []. However, the balance between spending on treatment and spending on prevention doesn’t reflect thorough consideration of this potential return on investment. Although 48% of non-communicable disease burden is attributed to preventable environmental, occupational, metabolic, and behavioral risk factors [], healthcare expenditure is almost exclusively addressing the consequences of these risk factors. Our record for reducing exposure to preventable harmful risks over the last three decades has been poor [], and public expenditure on health promotion and disease prevention has been under downward pressure since the 2008 economic crisis. Even though the EU’s average share of GDP spent on preventive healthcare spiked briefly from 0.38% in 2020 to 0.65% in 2021, primarily due to vaccine purchases during the COVID-19 crisis, expenditure on prevention remains low compared with treatment-focused healthcare expenditure []. In 12 EU member states, spending on preventive healthcare was less than 4% of total healthcare expenditure in 2022 []. The above figures pertain to healthcare sector spending. Population health, however, is largely determined by policies beyond the health sector such as actions to improve education and employment, economic development, living and residential environment, income, transport, and climate. The WHO refers to this as Health in All Policies (HiAP) []. HiAP is about integrated governance which promotes health and equity objectives and, at the same time, achieves mutual benefits for partnering sectors [, ]. As advocated by the OECD and the WHO council on the Economics of Health for All, it requires an integrated approach and reinforced co-ordination of effective public investments across multiple levels of government to address the main risk factors of health [, ]. The notion that improving health and well-being requires integrated cross-sectoral actions during the life course also underlies the “well-being and well-becoming wheel” of Edwards (2022), which summarizes personal, local, national and global factors that have an impact of well-being and well-becoming of individuals through the life course []. As many of the social determinants of health already cause inequalities in health and well-being in early life, even before birth, a life-course approach is necessary [].