From the late 1990s health promotion has become more closely linked with public health. Titles for jobs involving health promotion have become more varied. ‘Health improvement’ is one common example. In 2001, the Department of Health’s Chief Medical officer reviewed the public health workforce and specified three categories of workers:
Level 1: People who have a role in health improvement and reducing inequalities.Their jobs can include health promotion activities. This includes teachers, health professionals, social workers, housing officers and voluntary sector workers, for example.
Level 2: Described as the public health practitioner workforce with those involved spending more, part or all of their time in public health practice.Health promotion specialists are assigned to this level and also environmental health officers, smoking cessation advisors, some health visitors, health development workers, health trainers and more.
Level 3: Public health specialists working at a strategic level or senior management level with responsibilities including the commissioning of health promotion/ public health programmes.
A range of competencies were specified for each of the three levels. Most specialist health promotion roles are located at level two. Career pathways for health promoters have extended as it has became possible to proceed to registration with the Faculty of Public Health and secure level three posts in public health.
In response to the changing association with public health many health promotion courses added the term public health into their titles, either alongside health promotion, or they became MPH courses with specialist health promotion.
Elsewhere separate health promotion departments declined in some parts of the UK with health promotion specialists being employed in a variety of locations within the NHS. Local authorities and other agencies increasingly employed health promoters. In 2013 in England (but not the other countries of the UK) public health was transferred back from health authorities to local authorities and health promotion posts (under a variety of job titles) are mainly delivered from this sector.
Health education and promotion posts will continue to exist in primary care and in hospitals. Posts will also be found in voluntary organisations, health related charities, the leisure sector etc.