H ealth in All Policies (HiAP) traces its roots to public health's longstanding concern with health determinants while incorporating 21 st century understandings of health governance. 1 Calls for intersectoral action to achieve healthy public policy can be tracked from the Ottawa Charter for Health Promotion in 1986 and the Adelaide Recommendations on Healthy Public Policy in 1988, to the 2006 European Union promotion of HiAP. In South Australia (SA) there has been resurgence of interest and activity around integrated policy-making. 2 Most recently, Adelaide hosted an international meeting on HiAP that resulted in the Adelaide Statement on Health in All Policies. 3 Although there is consensus about the need for intersectoral approaches, previous attempts to implement this type of intervention have often failed. 4 Nevertheless, public health has continued to take on the challenge to "establish cooperation between different sectors in society to make health an issue on the agenda of all society sectors". 5 The challenges of 21 st century societies have added impetus to efforts to address health issues through policy innovations. New policy approaches based on an understanding that "health is everywhere" are required. 6 A HiAP approach is characterized by "common goals, integrated responses and increased accountability across government departments". 3 It moves beyond the boundaries of the health sector to promote "effective and systematic action for the improvement of population health, using genuinely all available measures in all policy fields". 7 INTERVENTION In 2008, the SA Government committed itself to a HiAP approach to building healthy public policy. Its introduction was promoted by Professor Ilona Kickbusch during her term as Adelaide Thinker in Residence. 8 An important factor in the adoption of HiAP was the demonstration of its applicability to a key policy driver, South Australia's Strategic Plan (SASP). 9 SASP sets targets across portfolios and makes chief executives accountable to the Premier for their achievement. This is monitored through a subgroup of Cabinet, the Executive Committee of Cabinet Chief Executives Group (ExComm CEG). Linking HiAP with SASP highlighted the interconnections between health and SASP targets, and engaged the most senior levels of government. Considerable developmental work had been undertaken to pave the way for such an approach. SA Health and the Department of the Premier and Cabinet led the creation of a number of strategies used

Primary health care (PHC) is again high on the international agenda. It was the theme of The World Health Report in 2008, thirty years after the Alma-Ata Declaration, and has been the topic of a series of significant conferences around the world throughout 2008. What have we learnt about its impact in improving population health and health equity? What more do we still need to know? These two questions frame a four-year international research/capacity-building project, 'Revitalizing Health for All' (RHFA), funded by the Canadian Global Health Research Initiative (http://www.idrc.ca/en/ev-108118-201-1-DO_TOPIC.html). The RHFA project is organised under the umbrella of the People?s Health Movement (http://www.phmovement.org/en) and the International People?s Health University (http://phmovement.org/iphu/), and involves researchers from over a dozen countries. Our project team?s understanding of PHC is of a comprehensive approach aimed at reducing health inequities that is based on meaningful community participation, multidisciplinary teams and action across sectors.

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Objectives: To identify the extent to which the Alma Ata defined Comprehensive Primary Health Care (CPHC) approach is practised and evaluated in Australia and to describe the role that GPs and other medical practitioners play in it along with implications of this for future policy in light of the Health and Hospital Reform Commission (HHRC) and Primary Health Care taskforce reports, 2009 recommendations. Methods: We conducted a narrative review of the literature (published and grey) from 1987 to mid 2007 as part of a global review carried out by teams of researchers in six regions in 2007.Results: In Australia, the CPHC approach occurs chiefly in Aboriginal Controlled Community Health Services, state funded community health and in rural/remote and inner city areas. Participation by GPs in CPHC is limited by funding structures, workforce shortages and heavy workloads. Factors that facilitated the CPHC approach include flexibility in funding and service provision, cultural appropriateness of services, participation and ownership by local consumers and communities and willingness to address the social determinants of health. Conclusions: The recent HHRC and Primary Health Care Taskforce reports recommend an expansion of CPHC services as a means of tackling health inequities. The findings of this review suggest that resources will need to be directed beyond individual treatment to population health issues, cross-sector collaboration and consumer participation in order to realise the CPHC model. Without attention to these areas PHC will not be comprehensive and its ability to contribute to reducing inequities will be severely hampered. The absence of an evaluation culture supported with resources for CPHC programs and services also hinders the ability of practitioners and policy makers to assess the benefits of these programs and how their implementation can be improved. Funding structures, workforce issues and evaluation of programs will all need to be addressed if the health sector is to contribute to the goal of reducing health inequities.

Issue addressed: This paper examines recent Australian health reform policies and considers how the primary health care (PHC) workforce experiences subsequent change and perceives its impact on health promotion practice. Methods: Health policy documents were analysed to determine their intended impact on health promotion. Interviews were conducted with 39 respondents from four State-funded PHC services to gain their perceptions of the impact of policy change on health promotion. Results: There have been a plethora of policy and strategy documents over the last decade relevant to PHC, and these suggest an intention to strengthen health promotion. However, respondents report that changes to the role and focus of PHC services have led to fewer opportunities for health promotion. Services are struggling to engage in health promotion activity, while funding and policy directions are prioritised to targeted, individual behaviour change. Conclusion:The experience of PHC workforce respondents in South Australia suggests that, despite policy intentions, health promotion practice is much reduced. Our research suggests that rigorous evaluation of health sector reforms should be undertaken to assess both intended and unintended outcomes in terms of service quality and delivery.So what? Health promoters are experiencing a contradictory policy and practice environment, and this research should assist health promoters in advocating for more government accountability in the implementation of policies in order to advance comprehensive PHC.?