What changes when we look beyond diagnosis to the realities shaping a person’s health and wellbeing?
A diagnosis can bring an extraordinary amount of support into a person’s life. Specialists and appointments. Treatment plans and allied health professionals. Family members checking in, colleagues asking what they can do, and a workplace trying to respond.
Then, over time, something changes. Treatment stabilises. Appointments become less frequent. The regular messages slow down. People understandably return their attention to their own lives.
What falls away is often not medical care itself, but the temporary flexibility around the person: the lightened workload, the cover from colleagues, the permission to be less available than usual. Life begins to resume its usual settings, while the person’s capacity, priorities or circumstances may have changed.
And a different set of questions begins.
- How do I live well with this?
- What can I realistically expect of myself now?
- Can I keep doing the work I was doing?
- What happens when my energy changes from week to week?
- How much do I tell my employer?
- What will this mean financially?
- Has this changed what I want from my career or my life?
Almost none of those questions are purely medical. They are about the conditions of a person’s life and, for many working-age adults, work is one of the most influential.
That invites us to look more closely at where health and wellness coaching has focused its attention, and what we may overlook when our frame stays too close to the consulting room.
We inherited a clinical lens.
Health and wellness coaching grew up alongside the health system, and it is understandable that we have absorbed a good deal of how that system sees.
HCANZA’s Scope of Practice describes coaching as a person-centred process built on the client’s self-determined goals and consistent with treatment plans set by a client’s doctor or allied health professional. Every part of that is appropriate. But notice what it anchors us to. It positions us in relation to clinical care and says very little about the person outside that setting.
Person-centred and individual-focused are not the same thing. We can be led entirely by the client and still focus mainly on what sits within the individual: behaviours, choices, motivation and self-management.
For chronic conditions, that can direct our attention away from some of the most influential factors. Much of what influences whether someone can live and work well is shaped by the conditions around them, not only by what they do within them.
Health promotion’s foundations were clearer about this. The Ottawa Charter, a foundational document in health promotion, put it plainly in 1986. Health is created and lived by people within the settings of their everyday life, where they learn, work, play and love. It went further. The way society organises work, it said, should help create a healthy society.
That was forty years ago.
Health is lived in the settings of everyday life
Around 15.4 million Australians, three in five of us, live with at least one chronic condition, and close to 9.7 million live with two or more. Health promotion has long taken a broader view of where health is created and sustained, and Australia’s National Strategic Framework for Chronic Conditions 2026 to 2035 continues that perspective, recognising the social, economic, environmental and structural factors that shape health and the need for action across sectors.
Those settings are plural: homes, neighbourhoods, schools, community services and workplaces. Each can shape how someone experiences and manages a chronic condition. For many working-age adults, work is especially significant because it brings together time, income, relationships, expectations, identity and flexibility.
A person managing a chronic condition may spend only a small number of hours with clinicians across a year. They spend far more of their waking life in the settings where the condition must be lived. If we ignore those settings, we may build coaching plans that make sense in the room but are difficult to carry into everyday life.
National policy has already made the case for a broader view of health. The question is whether coaching practice has caught up.
Readiness should guide the timing
A diagnosis may be an important clinical milestone, but that does not mean it is automatically the right moment for coaching.
At diagnosis, some people may be ready for a reflective, self-directed conversation. Others are simply trying to take in difficult information, manage treatment, arrange care, talk with family and get through the week. At that point, the support they need most may be medical, psychological, practical or social.
The evidence for health and wellness coaching in chronic illness is encouraging. A 2023 systematic review and meta-analysis found improvements in areas such as quality of life and self-efficacy. At the same time, the authors rated the certainty of the evidence as low or very low because interventions varied and many studies carried a risk of bias. The evidence suggests coaching can be valuable, but not that it is the right support for every person at every stage.
So, the question is not only, “Could coaching help?” It is also, “Is coaching the support this person needs right now?”
The period I pay particular attention to often comes later, after the acute response has settled and some of the support around the person has begun to fall away. This is when they may be working out how to live with changes in energy, priorities, work expectations and finances, alongside uncertainty about what comes next.
We can see this transition in Australian cancer survivorship research. Informational, practical, emotional and psychological needs can continue well beyond active treatment, and unmet needs have been linked to isolation, distress, financial burden and difficulty returning to work. Cancer is not the same as every chronic condition, but the research highlights something important: the medical crisis may ease while the work of adjusting to life continues.
This can be an important moment for coaching, not because clinical care has ended, but because the person is beginning a different kind of work: finding a way to live well in what comes next.
Good work is part of the support
One part of that wider context deserves particular attention: work.
For many adults, work is much more than a source of income. It can provide relationships, structure, purpose and a sense of identity. In 2022, 77 per cent of Australians aged 18 to 64 living with two or more chronic conditions were working or looking for work, compared with 87 per cent of people with no chronic conditions. That gap cannot tell us what is happening for any one person, but it does show why workforce participation belongs in the conversation.
The Health Benefits of Good Work initiative is built on evidence that good work can benefit health and wellbeing, while long-term work absence and unemployment can be harmful. The important word is good.
Simply keeping someone connected to work is not enough if the work itself is steadily depleting them. Safe Work Australia’s model Code of Practice identifies psychosocial hazards such as high job demands, low job control, poor support, lack of role clarity and poorly managed organisational change. Employers have a duty to eliminate these risks or minimise them so far as is reasonably practicable.
Read that list in reverse and you have a useful description of what can help someone living with a chronic condition stay well at work: manageable demands, some control over how and when work is done, supportive management, clarity about expectations and change that is handled well.
Practical adjustments can also make a significant difference, whether that is flexibility around appointments, adjusted hours or work patterns, modified duties, clearer priorities or a gradual return to work. Adjustments are most useful when they reflect what the person needs to do their job effectively and are reviewed as circumstances change.
In my work, I also see a quieter problem. An adjustment may survive on paper while the understanding behind it is lost through a management change or restructure. The employee can find themselves explaining their health again and renegotiating support that was already working. Continuity of understanding matters too.
Managers can have a significant influence on whether someone feels able to remain connected to work. They rarely need detailed clinical knowledge. They need the confidence to ask rather than assume, protect privacy, understand organisational processes and have a practical conversation about what will help the employee continue working effectively.
Psychological safety and psychosocial risk management are related, but distinct. The first is about whether people feel able to speak up without penalty. The second concerns how work is designed and managed. A team can feel safe to raise a concern and still be carrying demands that no one intends to change.
This is where coaches need to ask whether the client is facing an individual challenge, a work design problem or both. Coaching can help someone clarify what they need, prepare for a conversation, set boundaries or identify which questions belong with their doctor, manager or HR team. What coaching cannot do is fix poorly designed work or replace an employer’s responsibility to manage psychosocial hazards.
Financial wellbeing shapes choice
Financial wellbeing is not a side issue to chronic illness. It can determine which choices a person feels able to make.
Long-term illness can place pressure on finances in many ways: treatment and medication costs, travel, reduced hours, leave without pay or changes to career progression. AIHW analysis found that financial stress was more common among people living with long-term health conditions than among those without them. Cancer research has also linked job loss, reduced hours and missed workdays with greater financial strain. Behind those findings are people trying to make health, work and money decisions at the same time.
Workplaces can influence that pressure too. Paid leave, flexibility, job security, clarity about entitlements and access to available supports can all affect the choices an employee feels able to make.
This matters in coaching because money can sit underneath decisions that appear to be about motivation or confidence. A client may know they need fewer hours but feel unable to afford them. They may avoid disclosing what is happening because they fear the impact on their career. They may remain in work arrangements that are costing them physically because they see no viable alternative.
Coaches are not financial advisers. But we can create space for a client to name financial pressure without embarrassment, understand how it is shaping other decisions, and identify what they need to know and who they need to speak with.
Sometimes moving from “I can’t think about the money side of this” to “I know what I need to understand and who can help me” is a meaningful coaching outcome.
Widen the lens, not the practice
None of this asks coaches to become work health and safety practitioners, employment advisers, financial advisers or clinicians, unless they also hold relevant qualifications and are practising within that separate scope.
Our coaching scope does not change. We do not determine fitness for work or prescribe workplace adjustments. Referral is not a sign that coaching has failed. It is part of practising well.
What can change is what we notice.
When we understand that health is shaped by the conditions in which people live and work, we can ask a more useful question: what part of this challenge sits with the individual, and what part sits in the environment around them? If the demands themselves are unreasonable, coaching the person to tolerate them risks placing responsibility in the wrong place.
Widening our lens does not require us to widen our scope. It helps us recognise when coaching can help, when another professional is needed, and when the problem does not sit with the individual alone.
Chronic conditions are lived outside the consulting room. They are lived in workloads and rosters, in conversations with managers, in household finances, in relationships and in decisions about whether to say anything at all.
Our clients are already living in that wider context. The question for our profession is how much of it we are prepared to see.
Michelle Hasani is founder of Wellbeing by Design Australia. She is a strategist and coach specialising in workplace wellbeing, leadership and mental fitness.
Her work sits at the intersection of human wellbeing and organisational performance, examining how the way we work can support or erode health, wellbeing and performance. Her approach reflects a simple belief: Wellbeing at the centre. Performance by design.
References:
Australian Institute of Health and Welfare. (2025). Financial stress and mental health. AIHW.
