Health promotion is informed by epidemiology, requires engagement with socially situated subjects and can involve diverging emphases. For some practitioners, health promotion is a specialised set of activities and technical knowledge for disseminating health information. For others, it advances broad-based and interlinked goals of socio-economic and health equality through processes of community engagement and participation. These diverging approaches are explored in qualitative data gathered from health promotion workers and residents involved in an area-based initiative that included aims to reduce health inequalities. The findings describe two distinctive approaches to health promotion that are characterised as 'procedural' and 'cooperative'. Procedural styles, in the manner of 'top down' approaches, tend to differentiate between lay communities and professionals, involve predefined channels for community input, rely on 'off the shelf' health promotion packages and minimise the significance of local contexts. In contrast, cooperative styles are grounded in empathetic understanding of the impact of socio-economic and other disadvantages on everyday life, enact inclusive community engagement practices and develop 'bottom up', locally relevant health promotion initiatives. Noting the limitations of relying only on 'top down' or 'bottom up' approaches we argue that health promotion in community settings occupies a paradoxical space that is continuously negotiated by both health promotion workers and community residents. Further, health promotion workers need to be able to move between cooperative and procedural approaches in order to navigate the frequently conflicting demands of community, agency and professional expectations in order to achieve the best outcomes for communities.