With health promotion high on the national agenda specialists find themselves in a positive stategic environment although much will depends on creative resource allocation. Barbara Millar looks at their expanding role

Jeff French enthusiastically describes the current NHS environment as 'about the best I've worked in for the last 20 years in terms of opportunities for health promotion specialists'.

Mr French, director of health development at North Lakeland Healthcare trust, says that the public health green papers, together with the creation of health improvement programmes, health action zones, healthy living centres and primary care groups, 'set out a rationale for a social model of health which has never before been so explicitly articulated by a British government'.

There has been a real shift in thinking, both about what it is to be healthy and what causes health and illness, he says. 'This is a significant shift as all previous UK health strategies have been determined by a model of health that stresses individual responsibility and health service interventions as the pivotal mechanisms for improving health.'

With its 'contract for health' concept and its determination to tackle the causes of ill health, the government has set in motion a potential sea change in health policy in the UK, he says. 'There is a very positive strategic environment. We have won the argument in terms of health promotion as every government policy and initiative is about bread-and-butter health promotion issues.'

However, he adds, the situation is also a little frightening. 'If health promotion specialists cannot flourish in this environment there has to be something wrong with us.'

Mr French predicts there will be 'lots' of new health promotion jobs. The new NHS agenda needs people who are experienced in building healthy alliances, in community health development and in health education work, he points out.

'Health promotion specialists have led most of the public health activity in these areas over the last few years. They have the networks and the contacts and are well geared up to deliver and co-ordinate this work. Health promotion specialists are probably some of the most important actors on the new public health stage.'

Cathie Shaw, senior associate director of public health with Redbridge and Waltham Forest health authority and a former health promotion manager, says that, for the first time, 'there is a legitimate platform to tackle a broad range of influences on health in partnership with other agencies'.

Health promotion specialists have the skills to work in these areas but have rarely been given the opportunities in the past, she says. 'They should be the prime movers in the new world, as long as health authorities understand and appreciate the opportunities on offer and are prepared to use their resources more creatively.'

Lynn Crooks, head of health promotion at South Derbyshire HA, agrees that 'the time is right' for health promotion. 'Our Healthier Nation and primary care groups are positive ways of improving health and tackling inequalities,' she says.

But, despite her general optimism, the future of health promotion in South Derbyshire is looking rather bleak. A major reorganisation of the HA has disbanded the health promotion department. Two health promotion specialist posts have disappeared completely and most of the others are to be line-managed within the primary care directorate and linked in with primary care group development support.

'Health promotion as a mass has gone,' says Ms Crooks. 'The public health agenda will be going with the individuals - they will still be working on health needs assessment and community involvement. But these single posts will be very vulnerable. What if the primary care groups decide they don't need them?'

Her post will go too. She will become a public health specialist (health promotion) but will have no managerial responsibility for health promotion specialists. This puts health promotion policy work particularly at risk, she believes. 'There will only be me and one other public health policy person to do all the strategic health promotion work in the future.'

Jeff French believes this scenario is 'a fairly isolated case'. 'I think the HA will quickly realise it has made a mistake in terms of its ability to deliver a specialist service and will make some further changes,' he says.

Steve Pintus, assistant director of social and community development with Sheffield HA and new chair of the Society of Health Education and Health Promotion Specialists, adds that over 70 SHEPS members have written to health secretary Frank Dobson warning him about the 'potentially dangerous circumstances' in South Derbyshire.

'I would be surprised if anyone else was foolish enough to act before publication of the chief medical officer's review of the public health function,' he adds.

But there could be any number of other scenarios based on 'local foibles', says Gerry Hannon, director of health promotion at Swindon health promotion service. 'There is not yet any coherent UK-wide model.'

In his area, because of very good links with the local authority, whose leadership has long championed health promotion, a joint business board could be created - with health authority, local authority and primary care group representatives - to provide the strategic steer for the work of the health promotion unit, he says.

'The recognition of a social model of health as well as a clinical model in Our Healthier Nation pumped a breath of fresh air into the health authority.' If a joint business board was created this could lead to joint appointments, secondments and tight service level agreements across departments, he adds.

In Avon, individual health promotion specialists might be linked with each of the 12 primary care groups, says Hazel Millar, community health promotion team manager with Avon health promotion service. 'We have the skills and services they will need: working with communities, group work, alliance building, project management, public awareness, as well as the risk factors and lifestyle-based health promotion which PCGs will probably feel more comfortable with at first.

'Health promotion specialists are not the be all and end all,' she adds, 'but we do have a huge list of skills and experience to offer that are not easily found elsewhere. We also have a health brief for everything we do and this distinguishes us from the others working in this field.'