2nd Day Plenary Session 4 - The Future of HIA as an intersectoral governance structure in Health in All Policies

Josef Figueras, Belgium

How can HIA be embedded into policymaking structures?

John Kemm, England

(Setting the scene for the discussion)

HIA or something similar is essential in HiAP to be a relaity
HIA has the potential support policy consistency in government
Very few governments make much use of HIA

Why HIA not used - demand side and supply side barriers

Overcoming demand side barriers:
Public commitment
Recognise health is only one of many issues
Leadership from governance centre - not Ministries/Departments of Health
Briefing ministers and civil servants on health
Briefing ministers and civil servants on HIA

Overcoming supply side barriers:
Civil servants in the Government Departments
External consultant

Reducing IA overload:
Integrated impact assessment
Parallel assessment alongside policy development
HIA support unit plus accessible guidance

Quality assurance of HIA:
Public scrutiny
Peer Review
Procedural checklist
Ministerial sign-off

Matthias Wismar, Belgium

Need to better understand how health feeds into the policy-making structures.
How does HIA fit with the other assessment/supervisory processes?
Role of public health ministers, health ministers and parliaments on health and policy.

Isabel de la Mata, Belgium (European Commission)

Impact assessment undertaken in European Commission (EC), to do when necessary.
Quantification, cost-effectiveness and cost-benefit are an important part of the process.

Taru Koivisto, Finland

Need awareness among political actors and health expertise and advocacy.
Even when HIAs are used e.g. alcohol policy they can be ignored by decision-makers.

Stanislaw Tarkowski, Poland

European Public Health Association (EUPHA) wanted to grasp the opportunity given fears about the use/lack of use of HIA. EUPHA has therefore engaged with Poland which is to be the next Presidency EU. And EUPHA have been invited to deliver a presentation/session to Ministers on the application of HIA within the HiAP strategy.

This will involve other key stakeholders, European Health Observatory and WHO Europe.

HIA is losing out to other assessments because it is seen as voluntary while others are becoming mandatory.

EUPHA will advocate a development process which will require a lot of actions to be taken in many areas.

Also focus on the need for capacity development and like to develop a way forward from Ministers.

EUPHA will look to have a long term approach with a HIA section.


Windows of opportunity are important to grasp and health champions are important.
Focus on 3-4 policy areas and do really good HIAs on them.
How can we learn from failures in the lack of influence of HIAs - one way is engaging civil society.
Want to say to policymakers that health should be the highest priority.
Cost benefit does have use but should not confuse cost with value.

Take home messages

Health champions especially senior ones are important.
HIA is only one approach there are other important approaches e.g. deliberative consultation.
Need to better understanding the real policymaking cycle.
Need to develop integrated assessment and support that process.
Need to create windows of opportunities - understanding, commitment and accountability for health issues
Need tools and policy solutions to support HiAP implementation.
Need political support.
Need to move from research to action, lack of data should not be an obstacle.
Need to engage with cost benefit analysis
Need to do HIAs even if they are not used they have a chance of influencing future action.
Need to work with the media better.
Can encourage Polish presidency to look at doing 2-3 HIAs as demonstration projects.
EUPHA can help member association in each country to pick up the issue of HIA to their parliaments and to non-health sectors.


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