Implementation of “Top-Down” Government Policy: Health Promotion Case Studies in NSW

This study appraises the implementation of the health promotion components of the NSW State Plan and State Health Plan. Four case studies were conducted in a sample of Area Health Services (AHSs). Mixed methods were used and data triangulated where possible. This study found that AHSs share the state policies’ vision of a greater focus on health promotion/prevention on paper, but not in reality. Health promotion is not as important to AHSs as the acute care sector. Consequently, health promotion/prevention receives a tiny share of the budget and little attention. While this study has found some routine policy implementation failures, the overarching finding is the need for a rethink of prevention and health promotion delivery. The establishment of a separate prevention agency to deliver standard programs across the state, introduce an appropriate performance-monitoring framework, and have transparent and monitored funding tied to program delivery is the key recommendation.