Working in health promotion has given Trevor Lakey some of his biggest highs - but also some of his most devastating lows, 'particularly in terms of the battles you sometimes have to fight to achieve things', he says.

People from outside the profession, attracted by potential job opportunities created by the new NHS agenda, should be warned that it is not 'as cosy, calm and straightforward as it appears', says Dr Lakey.

'There is constant turmoil and you have responsibility for an almost impossible range of initiatives. You cope, somehow, but if anyone is looking for a quiet life, forget health promotion.'

Dr Lakey expresses 'cautious optimism' about how health promotion in Scotland will fare in the new NHS.

The optimism is fired by the fact that 'it is now OK to talk about health inequalities,' he says. 'In the past, when the term health inequalities was virtually banned, this created real tensions for practitioners who could see, at first hand, the impact of poverty on health but were not allowed to confront the issue.'

There is also 'a more open arena in which to explore these links', he adds. And health promotion specialists have no shortage of ideas, skills and enthusiasm for the task.

But he still sounds a note of caution. 'There are lots of people around who believe health promotion has no business dealing with poverty issues,' he says. 'The idea that we are all striving together for the same set of beliefs is wrong. There are all sorts of entrenched positions which will take years to shift. We ignore this fact at our peril.'

Health promotion is also a very politically weak discipline with a low political profile, that is easy to squash and raid for funds, says Dr Lakey. 'In many ways we are still trying to find our feet in putting ourselves forward.'

The sheer volume of expectations on health promotion specialists also encourages his caution.

'We are right at the centre of a lot of these new initiatives. I am glad we are being recognised, at last, for our ability to work in these areas - some of them, such as community development, were perceived to be rather wacky just a few years ago - but these initiatives are on top of everything else.

'The agenda has been doubled - we have to do the traditional health promotion things in the traditional way, plus all the new stuff. We will get there but we need more tangible support. You will get a lot more bangs for your bucks from health promotion specialists if they are properly supported.

'More important than giving us lots of extra money is to give us continuity, stability and the ability to work longer term.'