Local health planning and governance

Abstract

We look at local government health planning as a governance challenge, rather than a mere technocratic endeavour in the hands of civil servants and bureaucrats. Planning is about the journey in policy development and implementation. We review planning history and types, and hinge the current status quo of the field on efforts in community development, urban planning and social/health planning that emerged in the last 60 years. In seeing planning as a form of governance we highlight governance arrangements for health at the local level in the United Kingdom, Germany, Victoria (Australia) and the Netherlands as proxies for the various modalities that can be found around the world. Detailed case descriptions of local health planning and governance practices are provided for Victoria where municipal health policy is required by law, based on a Healthy City-type conceptualization of four Environments for Health (E4H)—the social, built, economic and natural environment. Evaluations show that this radical step-change for local health planning has been successful, but remains dependent on good governance practices and skills and capabilities of a wide range of professionals, bureaucrats, communities and health organizations. Embracing diversity and flexibility and integral elements of good governance is important.