Prospective health impact assessment: pitfalls, problems, and possible ways forward

“The general objective of such assessments is to improve knowledge about the potential impact of a policy or programme, inform decision-makers and affected people, and facilitate adjustment of the proposed policy in order to mitigate the negative and maximize the positive impacts.”

European Centre for Health Policy1

The long tradition of never considering the impact on health of public investment has ended. The white paper Saving Lives: Our Healthier Nation exhorted local decision makers to “think about the effects which their policies have on health, and in particular, how they can reduce health inequality,”2 a recommendation that echoes statements made in the Acheson report, by the European Union, and by the World Health Organization.3-5

In the United Kingdom, government support for assessment of the health impact of policies has continued with the recent call for proposals for health impact assessment projects under the inequalities in health research programme, the establishment of a cross departmental health impact assessment group in central government, and the organisation and publication of methodological seminars and reports.6-8 The European Centre for Health Policy of the World Health Organization has produced a series of publications that includes the “Gothenberg paper,” regarded by many as the key document in stating the aims, objectives, and methods for health impact assessment.1

Increasing recognition of the effects of the socioeconomic and physical environment on health may, on the face of it, make it difficult to question the philosophy of health impact assessment—indeed the hype currently surrounding health impact assessment would imply that it is the indispensable condition of policy investment. But what is health impact assessment, and can it in its present format reliably inform better decision making?