Public health issues, such as obesity, lung disease from air pollution or mental health complaints from living in an unsafe neighbourhood, are complex, intractable policy problems. The causes are dispersed at the individual and the collective level among different societal sectors. One strategy to integrate health in other sectors’ policies for developing effective and cooperative policy solutions is to provide evidence in a Health Impact Assessment (HIA) from proposed policies and project plans. In 15 years of practising HIA, policymakers and academics nevertheless express concern about its effectiveness.
In The Politics of Healthy Policies a conceptual and empirical analysis is presented of the role of HIA in policy development. From a governance perspective the author identifies different purposes of HIA for indicating societal problems and democratic deficits. These suggest that a technical design of HIA to assess causes and effects insufficiently addresses the political and normative issues of cooperation without institutional requirements or incentives. Four case studies are analysed of Dutch HIA practices at the national and local policy level, including a game simulation of health advocacy without HIA. The outcomes suggest that a re-orientation on HIA is necessary in order to mobilise other sectors to prevent or mitigate public health problems.
Marleen Bekker proposes an interaction-oriented, reflective design and a new definition of HIA. The book is especially relevant to HIA practitioners and health policymakers at different governmental levels. Many of the implications are highly relevant to other forms of impact assessment as well.
Marleen Bekker is a Research Fellow at the Institute of Health Policy and Management at Eramus MC, Rotterdam, the Netherlands.