The Politics of Healthy Policies: Redesigning health impact assessment to integrate health in public policy

Abstract

Public health issues, such as obesity, lung disease \nfrom air pollution or mental health complaints from living in an \nunsafe neighbourhood, are complex, intractable policy problems. The \ncauses are dispersed at the individual and the collective level among \ndifferent societal sectors. One strategy to integrate health in other \nsectors\xc3\xa2\xe2\x82\xac\xe2\x84\xa2 policies for developing effective and cooperative policy \nsolutions is to provide evidence in a Health Impact Assessment (HIA) \nfrom proposed policies and project plans. In 15 years of practising \nHIA, policymakers and academics nevertheless express concern about \nits effectiveness.\nIn The Politics of Healthy Policies a conceptual and empirical \nanalysis is presented of the role of HIA in policy development. From \na governance perspective the author identifies different purposes of \nHIA for indicating societal problems and democratic deficits. These \nsuggest that a technical design of HIA to assess causes and effects \ninsufficiently addresses the political and normative issues of \ncollaborative policymaking without institutional requirements or \nincentives. Four case studies are analysed of Dutch HIA practices at \nthe national and local policy level, including a game simulation of \nhealth advocacy without HIA. The outcomes suggest that a re- \norientation on HIA is necessary in order to mobilise other sectors to \nprevent or mitigate public health problems.\nThe author proposes an interaction-oriented, reflective design and a \nnew definition of HIA. The book is especially relevant to HIA \npractitioners and health policymakers at different governmental \nlevels. Many of the implications are highly relevant to other forms \nof impact assessment as well