Policy commitments for improving health and addressing inequalities are unlikely to prove successful unless reflected through governance arrangements and decision-making processes at national, regional and local levels. Governance for public health is inseparable from wider debates over governance and 'deficits' in public health can also indicate governance deficits. This chapter summarises the impact of different dimensions of governance on prevention and the importance of achieving coherence across them. A 'whole system' approach illustrates the extent to which modes of governance (such as markets and partnerships) or incentives at different levels may reflect conflicting goals. Relocating public health responsibility to local authorities is largely welcomed. However, local decision-making does not exist in isolation from the national context or from enduring questions of public health ethics. Using the governance framework described in the book can help identify whether governance principles and the arrangements which reflect them are being brought together for effective 'public health governance'.
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