Institutionalizing policy-level health impact assessment in Europe: is coupling health impact assessment with strategic environmental assessment the next step forward?

European Union (EU) Member States are interested in using health impact assessment (HIA) as a means of safeguarding their obligations to protect human health under the 1997 Treaty of Amsterdam. However, several have encountered difficulties institutionalizing HIA with the policy-making process. As a consequence, the World Health Organization (WHO) Regional Office for Europe has suggested coupling HIA with strategic environmental assessment (SEA). Traditionally, the incorporation of HIA into other forms of impact assessment has been resisted, for fear of losing its focus on health issues to environmental concerns, and compromising its social model of health with the introduction of biophysical indicators. But can these fears be substantiated? In this paper, we investigate the grounds for such concerns by reviewing the relevant policy documents and departmental guidelines of four non-European countries that have considered the use of integrated assessment. We found that the case for associating HIA with SEA in Europe is strong, and offers potential solutions to problems of screening, theoretical framework, causal pathways and ready entry to the policy process. Coupling HIA with SEA may thus be the next step forward in a Ionger journey towards institutionalizing HIA as an independent policy-linked device. Keywords Outcome assessment (Health care); Risk assessment; Environmental health; Public policy; Decision making, Organizational; Strategic planning; European Union; Australia; Canada; New Zealand; United States (source: MeSH, NLM). Mots cles Evaluation resultats (Sante); Evaluation risque; Hygiene environnement; Politique gouvernementale; Prise decision institutionnelle; Planification strategique; Communaute economique europeenne; Australie; Canada; Nouvelle-Zelande; Etats-Unis (source: MeSH, INSERM). Palabras clave Evaluacion de resultado (Atencion de salud); Medicion de riesgo; Salud ambiental; Politica social; Toma de decisiones (Administracion); Planificacion estrategica; Union Europea; Australia; Canada; Nueva Zelandia; Estados Unidos (fuente: DeCS, BIREME).
Introduction The aim ofhealth impact assessment (HIA) is to assist policymakers and other decision-makers to formulate "healthier" decisions and thus maximize population health gain and, whcre possible, reduce health inequalities. [...]