Health impact assessment institutionalisation in France: state of the art, challenges and perspectives

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Abstract
HIA implementation has rapidly grown in France. The question arises as to whether such growth is paving the way towards institutionalisation. An analytical framework was built based on the literature, capturing key dimensions characterising HIA practice and institutionalisation. Collected data draw upon documented HIAs, evaluation reports, direct observations and workshops. HIA practice in France follows a stand-alone procedure and is based on a holistic model of health. Its largely concerns intermediate HIAs commissioned by municipalities with the support of regional health authorities. Mainly applied to urban planning, HIAs are usually conducted by private firms, and local health observatories. Levers of institutionalisation include: an enduring tradition of intersectoral collaborations for health; a growing culture of health promotion; supportive environmental regulatory requirements; and policy frameworks and mandates addressing health inequalities at a regional and municipal level. For HIA to be more institutionalised, there is a need to clarify its purpose, continue building capacity, promote impact evaluations for evidence on HIA’ potential to advance HiAP and obtain greater commitment from national authorities.
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