IF HEALTH PROMOTION IS EVERYBODY BUSINESS WHAT IS THE FATE OF THE HEALTH PROMOTION SPECIALIST

Health promotion specialists and health promotion services within the health service have been neglected by policy makers and medical sociol ogists. This is perhaps surprising, given the high profile of health p romotion 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 Healt h Service. The analysis draws on qualitative interviews with health pr omotion specialists, directors of public health and other health worke rs whose work involves the promotion of health. The paper argues that health promotion services do not fit easily into the purchaser provide r divide and that they have experienced considerable organisational ch ange and uncertainty. Four factors have further compounded this lack o f fit: a lack of consensus as to what health promotion specialists wor k should be about; a lack of any secure knowledge base; prevailing ima ges of health promotion and of health promotion specialists; and feeli ngs 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 whic h is characteristic of the new public management. The paper concludes by suggesting three further reasons why health promotion specialists h ave been marginalised: their insecure occupational status which in tur n is linked to a lack of jurisdiction associated with the content of t heir work; the contradictions which are inherent in the knowledge base of health promotion, and the increasing application of 'modernist' ev aluative frameworks, derived from economics, to health promotion inter ventions.