Health Impact Assessment (HIA)

How to make HIA work with policy making and decision making

Decision-making does not take place at one moment, as is generally believed outside the decision arena, but it is a sequence of sub decisions made by different actors and stakeholders in different rounds during the whole policy or project process.

It is useful to distinguish between different policy stages (policy preparation; decision; implementation and evaluation). But remember that the separations between the stages are not black-and-white and that decision-making continues in the implementation and evaluation stages.

Also, decision-making is (or should be) about weighing several interests, of which the health interest is not always the most important one, before suggesting one or more options for decision makers. This distinguishes policy-making from research. Research does not always provide the answer for decision-making, and decision-makers or researchers do not always recognise this. A real life example of decision-making is described here [link to Betuwelijn railway example], to show its complexities.

Some key steps are:

  • During the scoping stage of HIA, explore the policy’s context by answering the questions:
    • ‘What is at stake (proposals, potential health impacts, other interests)‘.
    • ‘How does the policy come about (is there a consultation of stakeholders and citizens or is decision-making undertaken by one central actor) and how can HIA connect with this process’.
    • ‘Who are involved in the policy making process (decision-maker(s), stakeholders, researchers and other experts, citizens)’.
    • ‘What does the institutional context look like (formal decision-making procedures, communication rules, and informal relations between the several actors involved)’.

      This exploration can identify opportunities for the HIA to link up with decision-makers and stakeholders who have similar interests. Also, the HIA has a better chance of anticipating difficulties in the process, and being able to develop strategies to address these difficulties.
  • Produce an HIA that has a plan for active dissemination of HIA messages at key stages. Announcing the HIA (when it begins, and at other key steps, etc), disseminating preliminary findings, and using discussion groups will help to put health interests on the agenda of agencies. These steps are equally as important as producing a sound report. HIA practitioners realise that the process does not stop when the report has been produced and the ‘decision’ made.
  • HIA practitioners should try to establish long-term relationships with decision-makers. Gaining the commitment of the ‘health authority/department’ will help achieve this during intersectoral policy development.
  • Where appropriate, include a wide variety of stakeholders in the process, and draw on the best available qualitative and quantitative evidence. Policy makers appreciate these HIA values as they also underpin their own work. The inclusion of local communities provides policy makers with data and information that is typically hard to get, which is grounded in the realities of the local environment and is rich in experience.
  • Ensure that a longer-term follow-up of the HIA can be made to determine the actual impacts from the policy or project on the health awareness among others, on the health determinants and finally on health itself. The appropriateness of these different levels of evaluation is discussed in ‘Evaluating your HIA’