If health promotion is everybody's business what is the fate of the health promotion specialist?

Abstract

Health promotion specialists and health promotion services within the health service have been neglected by policy makers and medical sociologists. This is perhaps surprising, given the high profile of health promotion on the health policy agenda. This paper presents the findings of an exploratory sociological study into the nature and function of health promotion services within the 'reformed' British National Health Service. The analysis draws on qualitative interviews with health promotion specialists, directors of public health and other health workers whose work involves the promotion of health. The paper argues that health promotion services do not fit easily into the purchaser provider divide and that they have experienced considerable organisational change and uncertainty. Four factors have further compounded this lack of fit: a lack of consensus as to what health promotion specialists work should be about; a lack of any secure knowledge base; prevailing images of health promotion and of health promotion specialists; and feelings of vulnerability about the future of health promotion. Furthermore, health promotion specialists are finding it difficult to shed their principles and values and take on the dominant enterprise culture which is characteristic of the new public management. The paper concludes by suggesting three further reasons why health promotion specialists have been marginalised: their insecure occupational status which in turn is linked to a lack of jurisdiction associated with the content of their work; the contradictions which are inherent in the knowledge base of health promotion, and the increasing application of 'modernist' evaluative frameworks, derived from economics, to health promotion interventions.