Health promotion in the market place: constraints and opportunities

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Abstract
An emerging trend internationally is for health promo tion services to be privatised and organised through a division of ‘purchaser’ and ‘provider’ functions. This paper examines the constraints and opportunities for health promotion in the market place through a discus sion often ‘vital signs’ drawing on British experience where appropriate. If the market is not closely managed there are considerable concerns that health inequalities could increase, that ethical issues could be ignored, and that health promotion practice could be seriously com promised. Nevertheless, there are also potential benefits from a market economy, but these will only be realised if there is a shared understanding of the purchaser/provider roles, adequate skills and resources for the purchaser function, earmarked funding for health promotion investment, effective monitoring and refereeing by government as ‘regulator’, and training for the new tasks and responsibilities. To improve pe, formance a distinction should be made between health promotion Design, Development, and Delivery-the three ‘Ds’ of health promotion practice. Tasks for the three stages are described, together with the potential roles of govern ment, public sector agencies, professional bodies, voluntary organisations and private sector companies. Long-and medium-term time scales are essential for effective implementation.

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