The IUHPE (http://www.iuhpe.org) is half a century old, and is the only global organisation entirely devoted to advancing health promotion and health education. It is a leading global network working to promote health worldwide and contribute to the achievement of equity in health between and within countries. It has an established track record in advancing the knowledge base and improving the quality and effectiveness of health promotion and health education practice, with members ranging from government bodies, to universities and institutes, to nongovernmental organisations (NGOs) and individuals across all continents.

The IUHPE decentralises its activity through regional offices and works in close cooperation with the major intergovernmental and NGOs such as WHO, UNESCO, UNICEF, to influence and facilitate the development of health promotion strategies and projects.

The IUHPE has four goals:

The EPHA (http://www.epha.org) is a network of NGOs (NGOs are organisations that are independent of government control) and other agencies actively involved in protecting and promoting public health. EPHA’s mission is to promote and protect the health of all people living in Europe and to advocate for greater participation of citizens in health-related policy making at the European level.

The WFPHA (http://www.wfpha.org) is an international, nongovernmental, multiprofessional and civil society organisation bringing together public health professionals interested and active in safeguarding and promoting the public’s health through professional exchange, collaboration and action. It is the only worldwide professional society representing and serving the broad area of public health, as distinct from single disciplines or occupations (such as the IUHPE). The Federation’s members are national and regional public health associations, as well as regional associations of schools of public health.

There are a number of NGOs concerned specifically with public health in the UK, such as The Royal Society for Public Health, the UK Public Health Association and The Institute of Health Education and Health Promotion.

There are many voluntary organisations concerned with health promotion, some of which have regional and/or local branches. Examples of these are The Advisory Council on Alcohol and Drug Education (TACADE) (http://www.tacade.com) and the National Association for Mental Health (MIND) (http://www.mind.org.uk). Most of these organisations produce educational material, and some run training courses for professionals and/or the public. Some organisations act mainly as pressure groups, such as Friends of the Earth (http://www.foe.co.uk).

Professional associations, such as the British Medical Association (BMA) (http://www.bma.org.uk), the Royal College of Nursing (RCN) (http://www.rcn.org.uk), the Chartered Institute for Environmental Health (CIEH) (http://www.cieh.org) and the Faculty of Public Health (FPH) (http://www.fphm.org.uk) have been highly influential in policy and legislative changes and in the practice and training of their members in health promotion.

Trade unions are active in promoting health and safety at work, both through negotiating workplace conditions and through their health and safety representatives (Barbeau et al 2005). In the UK, The Health and Safety Executive (HSE) (http://www.hse.gov.uk) also oversees the implementation of health and safety at work legislation.

These have a role in safeguarding public health. Examples include companies providing water and refuse removal companies. In recent years in the UK, some facilities with a public health protection function have been privatised, which has raised public health dilemmas. For example, should water companies have the right to cut off supplies to consumers who do not pay their bills, when a possible consequence of this is the occurrence and spread of infectious diseases such as dysentery?

Manufacturers have increasingly taken the health and safety aspects of their products into account. These include manufacturers of children’s toys, food manufacturers and producers of green eco household products. Large supermarket chains have made a wide range of healthy options available to the public, such as fat-reduced and low-sugar foods. These trends are often as a result of increased consumer demands, reflecting heightened awareness of health issues (House of Commons 2002).

Health promotion is undertaken by national and local mass media organisations, including television, radio, newspapers and magazines (Hubley & Copeman 2008), and through the Internet many people have easy access to a huge range of health information (Korp 2006).

See Chapter 11 for more about mass media in health promotion.

Churches and religious organisations play an important part in developing values, attitudes and beliefs that affect health. Kramish Campbell et al (2007) show how church-based health promotion can influence members’ lifestyle at multiple levels of change and produce significant impacts on a variety of behaviours.

The NHS, established in 1948, has been reorganised on a regular basis, usually as a new government is voted into power. The most significant and fundamental reorganisation happened in the 1990s, starting with the National Health Service and Community Care Act reforms (DoH 1990). During the 1990s, a key feature of the NHS was the internal market and the division into purchasers and providers. Local health authorities were the purchasers, who decided what health care was required and purchased it, setting and monitoring contracts with provider local hospitals and community services. These providers became NHS trusts, in competition with one another to win contracts from the purchasers. The election of a new government in 1997 brought an approach which emphasised integrated care, and working in a spirit of cooperation. The New NHS: Modern, Dependable (DoH 1997) set out the plan for the health service, with partnership, quality and performance at the heart of the NHS, a focus on improving health and wellbeing, and tackling the root causes of ill health and inequalities. A separate White Paper was published for Scotland (DoH/Scottish Office 1997). In a shift towards a primary care-led NHS, primary care groups (PCGs) were set up in the late 1990s. These were basically groups of GP practices that worked closely with local authorities, especially social services, to assess local health needs and develop local health services. The NHS Plan (DoH 2000) set out a further programme for reform, investment and expansion of the NHS, including a central role for the wider public health function, including health promotion.

See below for information on primary care trusts.

Shifting the Balance of Power Within the NHS – Securing Delivery (DoH 2001) set out further change with a power shift to frontline staff. Primary care groups were given additional responsibilities to run services; they developed into primary care trusts (PCTs) with a responsibility to work closely with social services.

Larger strategic health authorities replaced the existing smaller health authorities in England in 2002. Strategic health authorities support the PCTs and NHS trusts in delivering The NHS Plan, to build capacity and support performance improvement, ensuring that all NHS organisations work together to meet government targets. (See http://www.nhs.uk for an interactive timeline which details milestones in the history of the NHS from its very beginning in 1948 to the present day.)

In 2002, the Department of Health was refocused. Figs 4.2 and 4.3 show the overall structure of the NHS in England. At the top in Fig. 4.2 is the Secretary of State for Health, the government minister in charge of the Department of Health, responsible for the NHS in England and answerable to Parliament. The Department of Health and the NHS Executive are responsible for the strategic planning of the health service as a whole. Under the Department of Health are strategic health authorities which plan health care for the population of the region they cover.

Health services are divided between primary and secondary. Primary care services include general medical practitioners (GPs), dentists, pharmacists, opticians, district nursing and numerous other services. Secondary care includes not only hospitals but also ambulances and specialised health services for the mentally ill and the learning disabled, as shown in Fig. 4.2.

Services are provided by NHS organisations called trusts. NHS trusts supply secondary care. PCTs provide primary care services and are responsible for buying almost all of the health care, both primary and secondary, required by the local populations they serve (see more on PCTs and NHS trusts under Agents of Health Promotion, below).

The structures in Scotland, Wales and Northern Ireland differ. In the interests of keeping the text in this book short, the terms used are applicable to England but readers in all countries will need to familiarise themselves with the structure in the country where they work by undertaking Exercise 4.1.