We need to change how we manage chronic disease

The 2025 federal election has been called a “turning point for improved access for essential healthcare”.

Both major political parties have committed to greater access to healthcare through increasing bulk-billing, growing the health workforce and reducing the cost of treatments and medicines – especially for women.

But access is only the tip of a much larger iceberg.

One of the deeper issues, hiding just below the surface, is something the incoming government will have to address as a major driver of the growing demand for healthcare services: our health system is not designed to accommodate chronic disease.

“The scale of chronic disease dwarfs our current attempts to address it.”

According to the Australian Bureau of Statistics, half of the Australian population lives with at least one chronic condition, including diabetes, arthritis, cardiovascular disease and endometriosis.

The proportion of Australians diagnosed with one or more chronic conditions is likely to increase in line with new disease emergence, climate change, improved diagnostics, growing attention to women’s health and chronic pain, and an ageing population.

Women’s health

Chronic disease disproportionately impacts women.

Endometriosis and adenomyosis affect at least one in seven people assigned female at birth. With an average time to diagnosis of seven years – which often includes multiple scans, GP appointments, specialists and emergency room visits – and a non-linear path to improved health, these conditions exemplify how poorly our current health system accommodates chronic disease.

Political parties have already committed to a range of initiatives. This includes promises to expand the network of endometriosis and pelvic pain clinics operating in Australia from 22 to 33. But while this is significant compared to historical investment in this area, it equates to around one clinic per 58,000 women affected by endometriosis.

The scale of chronic disease dwarfs our current attempts to address it.

As the women’s health agenda advances, including through the additional investment already promised by both major parties, we should expect improved diagnosis and growing demand for treatment. More funding could lead to an increase in prevalence as we improve awareness and diagnosis.

While we could continue to expand GP access, tests, scans and emergency room capacities, we should also consider how to optimise the health system for chronic disease and reduce pressures on these services as a result.

We could look below the surface of the iceberg.

Walking the tightrope

When it comes to tackling chronic disease, there is no better illustration of the challenge than the Department of Health’s infographic depicting the Australian health landscape.

In the diagram, which is used widely in health education and policymaking, four tiered layers represent acute care, primary healthcare, health promotion and disease prevention, and determinants of health. Chronic disease, meanwhile, is one of several ‘opportunities and challenges’ flying towards the established tiers from the sky.

One reason chronic disease remains an outlier is that chronic health requires a completely different mindset to our current model – where medical treatment is seen as a ‘magic bullet’, a linear patient journey through diagnosis, treatment, return to health and exit from the health system.

Instead, chronic disease calls for systems thinking. Just like a tightrope walker who must make constant adjustments to remain stable, so too must chronic disease patients and their care team make ongoing adjustments to achieve and maintain a ‘new normal’ of chronic health.

Each adjustment requires another appointment, another test, another attempted intervention, a setback, collaboration and feedback. There is no break in the cycle, no linear journey to capture in neat phases of diagnosis, treatment and exit from the health system. Exits are both frequent (as stability is reached) and impossible (as ongoing change is required).

Chronic heath patients are ‘frequent flyers’, not occasional travellers.

A looming turning point

Until now, our health system has been able to absorb the rising tide of chronic disease – shored up through measures to improve access and capacity, such as those already promised during this election campaign. But as long as chronic disease is framed as an outlier, it will continue to deliver shocks to the system. And with continued shocks, the system will creep nearer to a tipping point.

Continuing to retrofit chronic disease patients into existing health structures could fuel the growing crisis – even if the next government delivers on its election promises, it may still find outcomes worse than when it started.

Perhaps what’s needed is a new part of the Australian health landscape dedicated to chronic health, supported by the skills, services, training, mindsets and funding models which best serve it.