In the United Kingdom today, many health promotion units have been incorporated into Health Improvement Directorates, within Primary Care Trusts. These are in the main led by Directors of Public Health. In some cases, this has created a tension, particularly where health promotion specialists perceive public health as having a medical agenda which is far removed from community action. Health promotion work is increasingly project based and receives short-term funding which is often conditional on demonstrating partnership working and requires rigorous monitoring and evaluation.

There is an opportunity to integrate the work of health promotion and public health specialists in to the core work of the Primary Care Trusts. However, as history has shown, this depends to a great extent on national political will and policy. The European Union will play an increasingly important role in this area and has recently produced a programme for community action in the field of public health 2003-2008 (2002).

Health promotion is a creative and cost-effective way of fostering environments supportive of health and of improving health and quality of life. i Challenges to public health and health promotion services in the United Kingdom include increasing urbanisation, demographic, environmental and other changes stimulated by globalisation of markets and communication. One of the major challenges facing the United Kingdom is to implement inter-sectoral action and integrate comprehensive approaches to promote health.

Health promotion needs to work more effectively across sectors – for example with local government e. g. in building new housing which take health as a priority e. g. by including areas where children can play safely. Another challenge for the profession is to improve the knowledge and skills of all those diverse people who are involved in health promotion. It is also necessary to define the skills and expertise required, and establish appropriate training programmes to enhance capacity. i Furthermore, it is important to look at how health promotion proves its effectiveness in an evidence-based world. Another challenge to health promotion is that it still does receive adequate political and financial support when compared to expensive curative health care. The WHO has suggested that more funds derived from excise taxes on tobacco and alcohol should go to health promotion – this has yet to be implemented in Britain. iii In 1998, a new health promotion initiative called ‘Sure Start’ was set up by the United Kingdom government.

It is aimed at children aged under 4 and their carers and provides extra funding for health, social, education and child care facilities. It is the cornerstone of the government’s drive to tackle child poverty and social exclusion. Its aims are three-fold: to cut by 20% the proportion of children re-registered on child protection registers within 12 months, to cut by 10% pregnant mothers who smoke and to cut by 5% the number of 4 year olds needing specialist help with speech and language. It was initially backed by £452 million spread over 3 years.

Funding for the 522 programmes that already exist has been assured until April 2006. But what happens after this time? A challenge for health promotion is therefore to ensure sustainability of funding. The United Kingdom is, of course, divided into 4 regions – England, Scotland, Northern Ireland and Wales, each with their own set of problems. The challenges for health promotion in Wales were set out in a national health promotion strategy: Promoting health and well-being: Implementing the national health promotion strategy (2002). v They include: helping communities to develop a shared responsibility for health and to take action to improve people’s health; promoting healthier lifestyles as part of wider action to address the social and economic factors that affect people’s health; improving communication on health issues – improved quality of information and access to it. There should also be further development of the tools, resources and skills for health promotion. Lastly, health promoters should ensure that action is effective.

This includes action to promote health and well-being being grounded in the existing evidence bases and generating new evidence where appropriate. In addition, any health promotion action should include evaluation as an essential component. The process of globalisation, resulting in the mass movement of people, goods and ideas, means that the United Kingdom is critically linked to global health measures and health resources. v Trade and foreign direct investment are basic determinants of global health.

The United Kingdom economy is more dependent on global trade and investment than any other advanced economy. Underlying this fact is the dependence of the United Kingdom on health professionals from overseas such as nursing staff from the Philippines and China. Linked with globalisation is the spread of global diseases and pathogens that can cause economic and social instability. An example of this is the recent spread of SARS from South-East Asia. Health promotion is recognised as an essential basis for economic and social development.

Policies for global health cannot be determined by individual governments alone but have to be forged in cooperation with partner countries, international organisations, multinational companies, NGOs and health professionals. The promotion of global health is a positive form of engagement with the global community and can help to mitigate some of the negative aspects of globalisation. The United Kingdom is in a strong position to deal with global health issues and future health challenges.

Britain has a buoyant economy with falling unemployment and the fastest growing health care system of any major country in Europe – five years of real terms growth averaging 7. 5% a year will take health spending in Britain beyond the European average. vi By 2008, spending on the National Health Service is set to double in real terms. However, it is unsure how much of this extra money will go to health promotion. The United Kingdom government has already taken some key steps to ensure that health is a key theme in policy. ii Firstly, a minister for public health has been appointed to coordinate health policy across government.

Secondly, the government has agreed to apply health impact assessments to its relevant key policies. The Cabinet Office has also promoted initiatives on the health impacts of trade and affordable medicines. The National Health Service, with its multinational medical staff, supports a great many twinning arrangements and exchanges and also employs a great number of staff from overseas. The United Kingdom Health Protection agency plays a major role in global disease surveillance, research and investigation.

Britain is the base for charities including the Wellcome Trust which is a world leading research centre and NGOs such as Oxfam that have taken the lead in many issues around trade and health. The schools of public health in the UK are engaged in research in health promotion and provide information training and support to many other centres throughout the world. However, although the United Kingdom has shown leadership in relation to many of the issues that are important to global health, it has failed to develop a coherent, comprehensive strategy.