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In the French Community of Belgium (the Wallonia-Brussels Federation), the changing political landscape and the various laws relating to the roles of the federal state, communities and regions introduced since 1980 have had a significant impact on health policy. Since then, there have been significant developments in health education services and activities.In 1997, a government decree was issued to promote the concept of health promotion, to reform the existing system and to define policy priorities as part of a new five-year plan (1998-2003). Significant progress was made during this period as a result of the development of a global approach extending beyond the mere analysis of risk factors. The second five-year plan (2004-2008), aimed at combining preventive medicine and health promotion, resulted in the involvement of a wider range of actors and greater cross-sector collaboration. However, the sheer number of decision-making levels has been a major obstacle to popular participation and consultation. If the question of social and cultural accessibility is not seriously addressed, the focus on preventive medicine programs may prove to be detrimental to the development of an effective health promotion framework. The disconnect between the political vision and the reality of practice has had an adverse impact on health promotion. Health promotion professionals have repeatedly called for a third five-year plan involving all ministers and aimed at developing a cross-sector approach, at addressing the determinants of health, at promoting the active participation of local communities and at reducing social health inequalities.The concerns of health promotion practitioners were further exacerbated by the introduction of an external assessment process initiated by the Ministry of Health in 2010. The current concerns over the future of the Belgian state, the economic crisis and the impact of spending cuts have increased the sense of uncertainty. The upcoming elections provide further incentive for health promotion professionals to continue in their efforts to promote effective policy responses based on the skills and experience of associations and on practice quality.