Western Australia does not lack a plan for the future of public health. It lacks the follow-through. The Sustainable Health Review handed government an unusually clear map back in 2019. Eight enduring strategies. Thirty recommendations. The next decade is about whether we actually deliver them.
The case for change was blunt then and it has aged well. Without a shift in direction, the Review warned that health spending would approach 38 per cent of the entire state budget by 2026-27. That growth comes at the expense of schools and housing and everything else a government funds. We are now living inside that forecast window.
The 2025-26 state budget put $14.2 billion into running the health system, with a $1.4 billion boost on top. A large slice of that is firefighting. There is $110 million aimed squarely at emergency departments and ambulance ramping. Necessary spending. Also a tell. When the marginal dollar keeps flowing to the front door of the hospital, the system is treating symptoms of its own design.
The real future is upstream
Here is the number that should frame every conversation about WA's health future. The Sustainable Health Review found that only 1.6 per cent of total health spending goes to prevention. The Review set a target to lift that to 5 per cent by 2029. We are most of the way through that timeline and nowhere near the goal.
This matters because the demand is chronic, in both senses. Chronic disease drives the bulk of avoidable hospital load, and it is built over years by the things that happen well before anyone presents at triage. A system that spends 1.6 per cent on stopping illness and the rest on treating it is on a treadmill that only gets faster.
The equity gap makes this sharper. The life expectancy gap between Aboriginal and non-Aboriginal Western Australians remains among the widest in the country, and the national Closing the Gap targets on long and healthy lives are not on track for 2031. Prevention and equity are the same project. You cannot fund one seriously and ignore the other.
Digital is the enabler
WA has done real work here. The Digital Strategy 2020-2030 answered the Review's call for a phased ten-year plan. In August 2025 the state finished rolling out single sign-on and a digital medical record across the system, part of a $247 million program. Forty-four million documents digitised. Tens of thousands of clinicians logging in with a tap.
That is genuine progress. It is also plumbing. A digitised record is only the floor. The full electronic medical record is still years away, and the value arrives when the data underneath it changes how care gets planned and delivered. Digitising a broken workflow just gives you a faster broken workflow.
The same logic applies to virtual care, where WA is genuinely ahead. The WA Virtual Emergency Department now sees metropolitan patients from home, building on the country Emergency Telehealth Service that has run for years. For a state this vast, virtual care is essential. It is how you keep a clinician within reach of a town that will never have its own specialist. The deeper fix is a model of care that does not assume every answer lives inside a tertiary hospital in Perth.
Then there is the slower emergency. A 2024 WA Health study projected that heat-related deaths in Perth could rise by around 61 per cent by the 2050s, adding roughly $30 million a year in healthcare costs. Extreme heat summers that once hit every fifty years are on track to arrive every decade. Climate is now a health planning input, and the systems we build this decade need to assume it.
None of this is a technology problem waiting for a vendor. It is a delivery problem. WA already has the strategy and the budget envelope, and the digital backbone is increasingly there too. What gets undercooked is the work in between. Turning a recommendation into a funded model. Turning a pilot into something that survives contact with a real ward.
So here is the question we would put to anyone shaping public health in this state. If the plan is already written and the money is already moving, what is actually stopping prevention and equity from becoming business as usual?
That is the problem we work on. If you are inside WA public health or a digital health company and you are wrestling with the gap between the strategy on paper and the system on the ground, talk to Coterie Health. We would like to compare notes.