Through mutual concerns with social justice, the human right to health and the health of populations, ‘good governance’ can be seen as inextricably linked to a public health agenda. Understanding governance in relation to public health is therefore inseparable from wider debates over governance, the extent to which underlying governance principles are reflected in practice and implications of the balance adopted across different kinds of governance arrangements. Relationships between governance and health can be considered for each of the different dimensions of governance – principles of governance, various governance arrangements and modes of governance − so that, for example, questions can be raised over the extent to which the principle of social justice is reflected in national policy, in local public health initiatives and monitored through health equity audit, or the extent to which the principle of accountability is reflected in levels of public involvement and engagement.

Relationships between governance and health can also be considered across national, regional and local levels of decision making, or in relation to global governance. Drawing on empirical research, this book illustrates the relevance of dimensions of governance for commissioning for health and wellbeing at a local level.

Much attention has been directed to ‘steering’ instruments, such as performance management regimes or the use of incentives, and their effectiveness in improving outcomes in public services. Questions include the balance to be achieved across regulatory approaches and devolved decision making, the effectiveness of incentives and the costs and benefits of different approaches to performance management. At the time of the study, steering instruments included national guidance, policy priorities, public service agreements (PSAs) and other national and local targets, all of which were reflected in the assessment activities of regulatory agencies. The study focused on the influence of such arrangements on commissioning for health and wellbeing and showed that the complex system of targets and governance arrangements which framed decision making within commissioning organisations did not meet the aims of government policies for prevention. Even where relevant policies and targets were in place, such as for addressing health inequalities, this proved little guarantee of implementation, as there were contextual influences, competing priorities, and not all targets were subjected to the same level of scrutiny.