Based on an analytical model which defines political co-ordinates on two axes (technocratic-participative and top-bottom), the policy documents of national and regional health target programmes in countries of the European Union, Australia, Canada, New Zealand and the USA are analysed in regard to the rationale for and interest in health targets, the involvement of actors in the policy-cycle, the setting of priorities, the distribution of responsibilities and accountability as well as incentives and sanctions used. Most, if not all, target programmes are conceptualised in a 'top-down' manner by the government and its administration with little involvement of the general public or the parliament. Usually, neither necessary alliances at the grass roots level nor appropriate incentives for local or professional actors are discussed in the documents. Many target programmes are, therefore, bound to fail and finding a balance between the right balance between technocratic and participative as well as between top and bottom remains a challenge for setting successful health targets.