Specialist health promotion as a career choice in public health

Abstract

Health promotion is a young discipline and area of practice that has struggled to establish a discrete identity but which is becoming consolidated as a specialist field of practice through the establishment of occupational standards, a voluntary register (UKVR) and a multidisciplinary public health career framework. This study sought to explore current health promotion managers' career pathways into health promotionand their perceptions of their career future within a public health workforce. This exploratory study used semi-structured interviews, a stimulus vignette and a standardized questionnaire to explore the career pathways and motivations of specialist health promotion managers at this time of considerable change in the professional project of public health and health promotion in the United Kingdom. Specialist health promotion managers express a lack of role clarity and loss of control over the developments of their profession. This is compounded by a perceived lack of external credibility of health promotion and by the difficulties health promotion has in justifying itself in modern economic evaluative frameworks and establishing its legitimacy as an equal partner service within public health organizations. Recent moves to professionalize health promotion within the regulation of the public health workforce were not embraced by these participants for whom the consequent occupational closure was seen as restricting role independence and autonomy, and not necessarily enhancing occupational status. This study revealed that, currently, health promotion managers experience a lack of role clarity in their work and are uncertain about future career pathways in public health. Health promotion managers (not working at assistant level) do not readily identify with public health as a profession, or with the UKVR's 'defined health promotion specialist' accreditation process. The career choices and motivations of health promotion managers shed some light on the future of the 'specialist health promotion' workforce and how this may be structured.