Underfunded and undervalued: community-based health promotion practitioners’ experiences of Western Australia’s prevention sector

Vollständiger Abstract

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Abstract Prevention is a central policy focus of contemporary health promotion, offering cost-effective strategies to reduce disease burden and improve population well-being. Despite this, Australia allocates a small proportion of its health budget to prevention, with funding models characterized by short-term cycles and competitive tendering. While the consequences for public health are well documented, the impact on the health promotion workforce remains underexplored. Workforce health and stability are critical for program delivery, ethical practice, continuity of relationships with communities, and the capacity to sustain long-term prevention efforts. This qualitative study examined the experience of 19 community-based health promotion practitioners in Western Australia (WA), working primarily in nongovernment, local government, and private prevention settings. In-depth interviews, analyzed using codebook thematic analysis, identified four interconnected themes: persistent funding shortages and inter-agency competition; short-term, cyclical funding and administrative burden; perceived prioritization of treatment over prevention; and consequences for workforce well-being, program continuity, and ethical decision-making. Findings reveal that funding instability undermines program sustainability and creates job insecurity, stress, and attrition, while also generating ethical dilemmas and a paradox in which practitioners tasked with promoting health work under conditions that erode their own health, well-being, and professional values. This study contributes qualitative insight into how funding structures are experienced and negotiated by community-based prevention practitioners. It has the potential to inform policy and funding reforms to strengthen and support a more sustainable health promotion workforce.