Cross-country analysis of the institutionalization of Health Impact Assessment.
Social Determinants of Health
Jennifer h. lee, Nathalie Röbbel and Carlos Dora
Discussion Paper Series 8 (Policy & Practice). Geneva, World Health Organization, 2013
“…..There has been increasing international attention on the potential for using Health Impact Assessment as a way to mainstream health into sector policies, as evidenced during the World Conference on Social Determinants of Health (Rio de Janeiro, October 2011) and the United Nations Conference on Sustainable Development (Rio de Janeiro, June 2012). The institutionalization of HIA is a clear indicator of a country's implementation of a Health in All Policies agenda.
A number of countries have adopted legislative frameworks and governance mechanisms to consider the impact of policies, programmes or projects on health.
However, differences in the political, socioeconomic and institutional settings may lead to substantial variations in the use and institutionalization of HIA.
This report presents the findings of a cross-country study that describes and compares the institutionalization of HIA in nine (mainly middle- and high-income) countries and the European Union. It aims to provide greater insight to the enabling and limiting factors of HIA implementation and institutionalization and concludes with recommendations to increase and improve HIA practice.
The key factors enabling institutionalization of HIA were legislation; political willingness; involvement of research communities; awareness of the inadequacy of Environmental Impact Assessment or other assessments in considering health; capacity and resources; availability of international committal documents and tools; and public participation.
Challenges to institutionalization and systematic implementation included lack of clarity around methodology and procedures; narrow definitions of health; lack of awareness of relevance to other sectors; and insufficient funding and tools.
Based on their experiences, key informants proposed these core recommendations: embed HIA in national normative systems; clarify definition and operationalization of HIA and develop guidelines and methodological criteria; strengthen and build capacity for HIA practice; and improve cooperation between sectors….”
….Dissemination of the report findings to relevant audiences, mainly policy-makers and public health practitioners, is essential for them to benefit from the implementation and institutionalization experiences of other countries….”
3.1 Degree of and mechanisms for institutionalization
3.1.1 Degree of institutionalization
3.1.2 Mechanisms for institutionalization
3.1.3 Factors that led to institutionalization
3.2 Political setting and context
3.2.1 Political support and commitment
3.2.3 Triggers for HIA
3.2.4 Where in the policy cycle does HIA fit?
3.3 Framing: forms and types of HIA used
3.3.1 Stand-alone Health Impact Assessment (HIA)
3.3.2 Environmental Impact Assessment (EIA)
3.3.3 Strategic Environmental Assessment (SEA)
3.3.4 Integrated Impact Assessment (IIA)
3.3.5 Health Lens Analysis (HLA)
3.3.6 Scope of the health impacts assessed
3.3.7 What HIA covered
3.3.8 Comprehensiveness of HIA
3.4 Implementation, resource requirements and structures
3.4.2 Actors and stakeholders
3.4.3 Capacity and pool of experts
3.4.5 Data availability and monitoring
3.4.6 Knowledge transfer
3.4.7 Public participation
3.5 Outcomes and conclusions
3.5.1 Factors that led to institutionalization
3.5.2 Integration of HIA through other assessments
3.5.3 Limiting factors
4.1 Embed HIA in national normative systems
4.2 Clarify definition and operationalization of HIA and develop guidelines and methodological criteria
4.3 Strengthen and build capacity for HIA practice
4.4 Improve cooperation between sectors
Annex A. Analytical framework: key dimensions and questions addressed
Annex B. S ummary of country findings by dimensions of the analytical framework
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