Recent years have seen a change in focus in UK public health policies towards an emphasis on individual lifestyle choices. As part of this shift, NHS health trainers were introduced in disadvantaged communities in England, to provide peer support to people 'at risk' of developing lifestyle-related health problems and to help them to self manage their behaviour.Concerns have been expressed, however, about the strength of the evidence supporting the initiative.This paper outlines a number of gaps between the theory and rhetoric underpinning the NHS health trainer initiative, and the reality in practice. The paper critiques the evaluation evidence, questions the assumption that engaging lay people in health promotion activities in place of health professionals is necessarily a preferable option, identifies inconsistencies in the evidence supporting individually-based health improvement initiatives, and suggests that interventions which target deprived areas but neglect the social determinants of health may be limited in their effectiveness. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Focused on providing 'advice from next door' to people within disadvantaged communities 'at risk' of developing health problems and supporting them to set behavioural goals and to self manage their behaviour, it was anticipated that one of the 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Much of this evidence relates to providing basic health care in situations where little or no formal health services exist or are unavailable to the majority of the population. In contrast, health trainers' role is to provide advice and motivation for their clients.In this paper, we outline and unpack the underlying theory of change or programme logic of NHS health trainer programme to explore the assumptions underpinning the programme. We then examine this theory and rhetoric in the light of the available evaluation evidence, and contextualise these findings within some of the wider critiques of individual behavioural approaches to health improvement. We conclude by asking to what extent the NHS health trainer initiative is able to improve health outcomes and reduce health inequalities in disadvantaged communities without the support of efforts to tackle more macro-level structural inequalities. proposed outcomes of the programme that will address the problem. In this section, we unpack the underlying programme logic of the health trainer initiative to examine how the programme defined the 'problem' it was designed to address and how it proposed (theoretically) to address this perceived 'problem'. In a following section, we describe the limitations of the evaluation evidence and ex...

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