This chapter considers the concept of governance and its relevance for population health and commissioning practice. It argues that governance for population health needs to be considered in relation to each of the dimensions of governance, which are briefly described. It then illustrates these dimensions through a discussion of stewardship of the health of the population, accountability arrangements, a partnership mode of governance and approaches to corporate governance, drawing on study data from interviews and focus groups. The concept of ‘public health governance’ is discussed, and returned to in the concluding chapter.

Governance: a multidimensional concept

Governance is a multidimensional and somewhat slippery concept and, as many commentators have pointed out (Rhodes, 1996; Weiss, 2000; Davies et al., 2005), it is subject to diverse interpretations. In general, it refers to the ‘totality of ways in which a society organises and collectively manages its affairs’ (Frenk and Moon, 2013: 937, drawing on discussion in United Nations Development Programme, 1997). It incorporates notions of the proper functioning of institutions, the exercise of legitimate authority and the arrangements organisations (of any kind) make for their functioning: governance arrangements are organised routes for achieving objectives, whatever the level or form of organisation involved. An underpinning document for Health 2020 (WHO, 2012a) refers to governance as ‘how governments and other social organisations interact, how they relate to citizens and how decisions are taken in a complex world’ (Kickbusch and Gleicher, 2012: 1, quoting Graham et al., 2003). Such decisions may be operationalised through market mechanisms, networks or hierarchies, sometimes referred to as ‘modes’ of governance although, in practice, these are ideal types: modes may coexist; the relative emphasis on each may fluctuate over time; and, as in the NHS, they exist in hybrid forms. Moreover, other forms of governance, such as multilevel governance, have become increasingly important given the combination of international with national and regional levels of authority. Governance may be associated with a set of principles (‘good governance’), codes of conduct in public life, the exercise of legitimate authority through law and regulation, standards and targets, and processes for ensuring accountability and managing risk within organisations.