Where there's a will, is there a way?: is New Zealand's publicly funded health sector able to steer towards population health?

Since 2000, the substantive focus of health policy in New Zealand has been closely aligned to the agendas of improving population health and reducing health inequalities. Health system restructuring, through the introduction of locally based and partially elected District Health Boards (DHBs), was the structural mechanism chosen for reorienting the health sector towards population health. Strategic planning at the DHB level was the key mechanism by which central government population health objectives would be translated into local action. This analysis of the early years of elected DHBs (2001-2005) sets out to answer the following broad questions: (i) did strategic planning by District Health Boards reflect an orientation to population health?; (ii) to what extent was strategic planning towards population health shaped by community participation and input?; (iii) to what extent did strategic planning lead to a re-prioritisation of resources? These questions were explored as part of a larger research project investigating the introduction and implementation of the DHB system. Data were collected from over 350 interviews of local and national stakeholders, and two surveys of DHB Members between 2002 and 2004-2005. Overall, DHBs demonstrated the 'will' to engage in strategic decision-making processes to enhance population health but have difficulty in finding the 'way'. The priorities and requirements of central government and the weight of institutional history were found to be the most influential factors on DHB decision-making and practice, with flexibility and innovation only exercised at the margins. This raises the key question of whether there is the governmental capacity at the local level to adequately address nationally determined population health policy priorities.