Challenges: Discuss how your national policies relate to principles of health promotion and critically review the opportunities your country has, in your opinion, to deal with the urgent health problems.

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Challenges: Discuss how your national policies relate to principles of health promotion and critically review the opportunities your country has, in your opinion, to deal with the urgent health problems.

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. 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. 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. 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.

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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). 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 ...

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