In today's world "health" means far more than merely the absence of illness. Indeed the impact that social, cultural and economic pressures have on health is well documented. The main task for health promoters is therefore to create conditions which promote rather than damage health by bringing about changes in policy on a local, national and international level. In "Rethinking Health Promotion: A Global Approach, " Theodore H. MacDonald sweeps away the confusion surrounding the function and position of health promotion. He retraces the history to show that, far from being a modern innovation, it has existed as a distinct and separate enterprise for as long as biomedicine. He argues that this difference should be reflected in the organization of health care services and cautions against health promotion becoming merely an off shoot of medical care.