Integrated care that substantively impacts population health as well as provides quality care requires buy-in, engagement and commitment over time by a plethora of  government and community groups. There is considerable evidence of the complexity of care models that work such that long term commitment is required to truly impact health. These days, beyond work opportunities, most municipal government and community leaders realise that good quality health services are critical to retaining and recruiting residents, especially noteworthy as an issue in rural communities.  How do places manage bottom-up, top-down tensions as politics and control issues intervene across differrent levels of government? What sort of governmental leadership inspires community engagement versus chronic frustration?