Chapter One: Introduction

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Policy commitments to promoting health and addressing health inequalities have not been reflected in a reorientation of health systems or in policy development that addresses social determinants of health and health equity. Empirical data from an extensive research study across England illustrates the extent to which governance principles and arrangements influence local decision-making for health and wellbeing. The chapter summarises the changing context for commissioning, discusses concepts of governance, commissioning and public health, which are contested and subject to multiple interpretations and demonstrates the congruence between principles of ‘good governance’ and core values underlying public health. It argues for a critical concept of ‘public health governance’ in order systematically to assess the extent to which health and wellbeing is reflected in decision-making, priorities for investment, performance management arrangements, and in the use of incentives and contracts

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