ABSTRACT
In the 1990s health promotion practice has had to respond rapidly to policy
initiatives and changes in health care organisation and funding. The impact on
practitioners of health promotion has been substantial both in changing ways of
working and thinking about their roles and the impact they have on health. Whilst
this had led to some demonstrable and arguably positive changes in practice, it has
not been without threat and uncertainty. In the UK these influences have been
particularly evident as the health care system within which many health promoters
work changed fundamentally in the wake of the health care reforms. These changes
were characterised most sharply by the organisational separation of purchasers
and providers of health care (DOH, 1989), a division which has not led to any
consistent pattern of organisational arrangements for health promotion services
in the UK; and subsequently by the emphasis placed on researching the evidence
base of health care through the establishment of wide-ranging mechanisms for
influencing the direction and financing of health services research (DOH, 1991).
