The men our health system most needs to reach are the ones who will not come when it calls, yet who would cross a city for their football club. Middle-aged, carrying more weight and blood pressure than they admit, with a GP they last saw during the Howard government, they are the demographic every prevention campaign is written for and the one it rarely reaches. Australian men still die around four years younger than women, and a large share of that gap sits in preventable, lifestyle-driven disease that announces itself, when it finally does, in an ambulance. The problem has never really been the medicine. It has been the invitation.
Clinics send the wrong one. A letter from Medicare, a reminder from a practice he is not registered with, a public campaign narrated in the earnest register of someone who has clearly never stood in an outer-suburban terrace in July, these bounce off. Behaviour change, as BJ Fogg and a generation of behavioural scientists have spent two decades establishing, runs not on information but on identity and belonging. You do the thing because it is what people like you, in the group you belong to, do. And there is precisely one institution in Australian life that commands that kind of belonging from exactly these men, week in and week out, win or lose.
The club. So let the club carry the health, and watch what moves.
This is not a hunch; it has been run as a trial and it worked. Football Fans in Training, a programme built with Scottish Premier League clubs and published in The Lancet in 2014, recruited overweight, hard-to-reach middle-aged men through their clubs, ran coaching sessions in the grounds they already loved, and produced weight loss that held at twelve months, the stubborn part that defeats almost every slimming scheme. The men came because their club asked, not because a doctor did. It has since scaled across Europe as EuroFIT and, in England, as the EFL's Fit Fans. The evidence base is a decade deep and sitting on a shelf, waiting for a country with a football obsession and a healthspan problem to pick it up. Australia is, conveniently, both.
Here is how a Longevity League would actually run, and the design choices that matter are small but load-bearing.
- The club is the venue and the channel, not the clinician. A club recruits its own supporters into coached walks, group sessions, screening and the ordinary medicine of social connection. A clinical partner carries the screening and its duty of care, because a footy club's job is loyalty, not blood tests, and the line between the two must be drawn in indelible ink.
- Aim at the at-risk, not the already-fit. The temptation will be to fill the sessions with the keen and the healthy, which inverts the entire point. The programme earns its keep only if it reaches the bloke on the couch, so recruitment is deliberately pointed at him.
- Make an employer pay upfront, not a budget in a decade. This is the move that turns a nice pilot into an instrument that lasts.
That last point is where most prevention schemes expire, usually without anyone noticing, so it is worth being concrete about who signs the cheque. The payer is a large employer, or better, a licensed workers' compensation self-insurer, paying a fixed fee per verified engagement, upfront, from a wellbeing or workers' compensation budget. In Australia the self-insurer is the cleanest payer of all, because it carries its own claims and so pockets the saving from a workforce that throws fewer backs and fewer heart attacks, directly and on its own books. The contract is an ordinary annual one, the sort that already buys flu shots and ergonomic chairs. It is not a bet on some diffuse public saving arriving in 2040, which is the structure that has killed a hundred well-meaning prevention programmes before it.
That reframing matters because, as Mariana Mazzucato keeps pointing out, the question that decides whether a good idea survives is rarely "does it work" but "whose balance sheet does the value land on". Prevention has forever been an orphan precisely because the party who pays and the party who gains are different people on different timescales. The Longevity League closes that gap to the length of a single employment relationship. The employer pays a bounded, current-year fee and is handed a healthier, more present workforce; the cost is a line item it can see this year, not a wager on savings arriving in some distant decade. The honest version is that the cost lands now and the deepest health returns land later, but it is the cost side, not the payoff, that usually decides whether a prevention programme ever begins.
The risks are real and worth naming rather than glossing. A club left to its own devices will recruit the fit, so the targeting has to be engineered in. The duty of care and the data have to sit with the clinical partner and never drift to the club's volunteer committee. And it needs a first employer or self-insurer brave enough to value its workforce's health at the price of a contract, which is a cultural leap more than a financial one. None of these is fatal. All of them are the ordinary friction of building something, the kind Atul Gawande would recognise as the gap between a thing that works in a study and a thing that works on a wet Tuesday.
And a wet Tuesday is exactly where this lives. A lifelong supporter who has not troubled a GP in six years gets a message from his club, not from Medicare, inviting him to train with a few of the club's old premiership players: a peer-led session on the same turf he has only ever watched from the terraces, a talk from a legend who has had his own health scare and come out the other side, and afterwards a weigh-in and a word with a nurse in the rooms he has stood in a thousand times. He comes because the club asked, and because the invitation flattered him a little. Somewhere in that session his blood pressure gets flagged, early, before it becomes the thing that flags him. His employer paid for his place out of the budget that buys the flu shots, and considers it money well spent against the fortnight of sick leave that now will not happen. The club reaches him where the health system cannot, and an employer, not a department, writes the cheque.