This thesis examined health promotion (HP) policy and practice in a regional health system in South Australia (SA) from a systems perspective. Leadership and governance was found to be a key theme and superordinate health system building block for HP primarily because of the clear reciprocal relationships or feedback mechanisms between HP goals and actions, federal, state and local government policy directions, and all other building blocks (financing, workforce, service delivery/practice and information). Implications from this research demand the skilful navigation of the stormy waters of power, politics and ideology that influence HP policy and practice.