Health promotion as practiced by public health inspectors: the BC experience.

To explore the experiences of British Columbia's (BC's) Public Health Inspectors in practicing health promotion.We administered a mixed qualitative-quantitative survey to 15 BC Public Health Inspectors (in BC, titled Environmental Health Officers--EHOs), selected to represent different levels of authority, areas of work and geographic regions. We queried whether and how they practice health promotion, strategies utilized, how health promotion relates to their enforcement mandates, perceived effectiveness of health promotion, and barriers and enabling factors affecting its adoption.Fourteen respondents (93%) practiced health promotion. Common practices included building healthy public policy, developing personal skills, and creating environments that support health. Health promotion was most often applied as " part of enforcement"; EHOs first attempted to educate and create environments that support regulatory standards and best practices, utilizing enforcement measures should the former prove ineffective. Enforcement was recognized as an important tool. Most respondents did not feel that their enforcement mandate limited their use of health promotion; however barriers exist where the EHO is perceived unfavourably as an "enforcer". The majority felt that an increased use of health promotion would make their protection work more effective. Strategies to facilitate its application include practical training in implementation, clear expectations and accountability at all levels of planning, resources, and relationships with stakeholders.EHOs engage in a broad and varied health promotion practice. Practical training with a focus on health promotion implementation in the BC context, and clear and consistent direction regarding expectations and accountability, would facilitate greater involvement.