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On April 13, , an , together with the Center for Resilient Health (CRH) at the Stockholm School of Economics, hosted a roundtable discussion on investment logic in prevention.

The event brought together 35 participants from government agencies, regions, municipalities, academia, civil society, industry, and innovation environments to address a central system question:

Why don't we invest more in prevention - despite knowing that it pays off?

A system designed for treatment, not prevention

The discussions highlighted a fundamental paradox. While there is strong evidence that preventive measures can reduce long-term health costs and improve outcomes, most systems remain focused on treating illness rather than preventing it.

As emphasized during the seminar, society is attempting to address long-term health challenges within structures designed for short-term care delivery. This creates a mismatch between knowledge and implementation. A key insight was the need to distinguish between health creation and healthcare systems, as they operate under different logics, time horizons, and responsibilities.

Participants at the SustainGov roundtable discussion at the Stockholm School of Economics. Photo: Sofia Fransson

Structural barriers to preventive investment

Participants broadly agreed that the main challenge is not a lack of evidence, but rather how the system is designed. Current governance structures tend to prioritize short-term, measurable outcomes, often driven by annual budget cycles and political timeframes. This makes it difficult to justify investments whose benefits materialize over longer periods.

At the same time, incentives are fragmented. Costs and benefits are distributed across different actors and time horizons, meaning that investments in prevention often do not align with individual organizational interests. This fragmentation is reinforced by unclear responsibility structures, where no single actor is accountable for the overall health outcome of individuals across their life course.

Another key issue is the lack of robust decision-making frameworks. Without clear business cases, return-on-investment models, or relevant health outcome metrics, preventive initiatives struggle to compete with immediate healthcare needs. These structural challenges are further reinforced by cultural and institutional norms, including risk aversion, limited cross-organizational learning, and a persistent focus on treatment rather than prevention.

Participants contributing perspectives on health systems and prevention. Photo: Sofia Fransson

From analysis to action: pathways forward

Rather than identifying new solutions, discussions focused on how to act on existing knowledge. Several key directions emerged:

• Establish a shared vision and measurable long-term health goals
• Reform incentives and governance structures to support preventive investments
• Strengthen the role of the individual in managing health
• Engage actors beyond healthcare, including schools, workplaces, and urban planning
• Build implementation capacity through pilots and scaling successful initiatives
• Use data more strategically to support decision-making
• A shared responsibility across sectors

A recurring theme was that the transition toward prevention requires coordinated action across sectors. The state plays a key role in setting frameworks and long-term goals, while municipalities are closest to citizens and therefore central to implementation. Regions need to strengthen the connection between healthcare and prevention, and both businesses and civil society contribute with innovation and operational capacity.

At the same time, the role of the individual was highlighted as critical. A shift toward prevention requires systems that empower individuals to take greater responsibility for their own health, supported by appropriate structures and incentives.

One of the speakers presenting at the SustainGov roundtable at SSE. Photo: Sofia Fransson

From system logic to societal shift

The roundtable demonstrated broad agreement on the nature of the challenge, as well as the urgency of moving forward. The key issue is no longer identifying what needs to be done, but how to reorganize governance, incentives, and responsibilities to enable action.

Ultimately, the challenge is to create a system where long-term investments in health become rational for each actor - not only for society as a whole.

As one participant summarized:

“Stop analyzing - start acting.”