What's the future for health promotion in England? The views of practitioners

Specialized health promotion is an internationally recognized occupation and field of activity which has had a chequered history in England. After flourishing briefly in some areas in the early years of the New Labour government it has been in decline in most parts of the country. The last survey of practice conducted in 2005 found that the specialized health promotion workforce was unevenly distributed and much in need of advocacy and development. Since then there has been another major reorganization of primary care trusts (PCTs) and a split between commissioning and provider functions. Practitioners' views on the impact of this on health promotion were gathered in a survey in 2008-2009. Participants comprised 36 people attending a Shaping the Future workshop in the North of England and 40 practitioners studying a masters course in health promotion. The findings reveal that organizational structure has a major impact on the nature of health promotion activity: the split between commissioning and provider functions of PCTs has presented huge challenges to practitioners irrespective of the arm in which they are placed, as one of the strengths of health promotion has always been its ability to straddle both strategic and operational levels and offer a joined-up approach to tackling the causes of ill health. For the specialized health promotion workforce, there has been a loss of identity and critical mass as the discipline is increasingly reduced and fragmented, a trend that looks set to worsen following further reorganization and reductions in public sector spending introduced by the new coalition government.