There has never been a better time to be involved in health promotion, says Alison Learmonth, who chairs the society of health education and promotion specialists in England.

"During the 80s and most of the 90s people involved in health promotion were trying to work in a climate that was really quite antagonistic," she says. "Now there is much more scope for health promotion. It's tremendously exciting."

With the introduction of health improvement programmes, health action zones and healthy living centres, the government has acknowledged the importance of a social model of health, according to Andrew Rogers, manager of health promotion for West Pennine health authority. The irony is that health promotion has become everybody else's business and is carried out not only by the NHS but by the voluntary sector and other agencies.

Career structure
Donald Reid, director of communications for the the UK Public Health Association, thinks "everything is in the melting pot". The breakdown of a clear career structure in health promotion started with the Conservatives' reform of the NHS in the 90s. "Previously every health authority had its own health promotion unit, but with the introduction of the purchaser-provider split some teams moved into trusts," he says. Now, with so many different health promotion and public health programmes, there is a climate of all boundaries being broken down.

While the traditional role of the health promotion unit may be under threat, the need for individuals with training and experience in health promotion or public health could not be greater. "There is a dearth of people who have the training and experience in developing partnerships needed to bring in the sort of agenda the government wants," says Learmonth.

Jeff French, director of planning and communication at the Health Development Agency, says health promotion specialists probably still make up the majority of the public health workforce. But jobs with equally important functions, such as epidemiologists, statisticians, and public health medicine consultants also exist in public health departments. Rogers has his own list of specialists: Sure Start co-ordinator, teenage pregnancy adviser, people working in HIV prevention, people working with young offending teams.

"What I think we will begin to see over the next few years is a more comprehensive and integrated career path for people working in specialist public health roles," says French.

Learmonth agrees. "It's no longer a straightforward career ladder where you would say: 'I'll do a masters degree for two years, then I'll end up in a health promotion department, then I'll become a manager.' The opportunities are exciting, but they are in primary care, in health action zones, in local government. The challenge over the next two or three years will be to get an open, fair and accountable way of accrediting people's skills."