This report from the Australian Primary Principals Association explores the relationship between policy, practice, and principal health. The findings demonstrate the challenges Australian principals face and offer insights into policy and practice resources that could help address these issues. The data include surveys from 929 principals and associate principals. Key findings include the decline of the health and well-being of primary principals, an increasing accountability workload, and role change priorities. The report includes implications for principals, principal associations, employers and systems, and governments. These implications include introducing healthier and more supportive practices, decreasing workload, developing a supportive leadership culture, and advocating for better policies.