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Re-design Social and Health Impact Assessment as a decision support tool in the field of social health inequality

par Feyaerts, Gille
Référence 22nd IUHPE World Conference on Health Promotion, International Union for Health Promotion and Education (22-26 may 2016: Curitiba, Brazil)
Publication Non publié, 2016-05-24

Communication à un colloque

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Résumé :

IntroductionIn terms of political action, the reduction of social health inequalities requires policy action across the broad range of social determinants of health, which exceeds the sole health sector authority and must involve the entire government. For this purpose, Health Impact Assessment (HIA) has been identified as a potentially powerful decision-support tool. However, despite the development of a multitude of conceptual models and the increasing application at different policy levels, the role of HIA within the policymaking process remains largely questioned and clearly doesn’t fulfill its high level ambitions.MethodsA literature review focused on the theoretical models of the policymaking process and the mechanisms of policy change on the one hand, and the way knowledge can contribute to these processes on the other.In an HIA case study in the Brussels Region, the theoretical assumptions are applied and tested on a new policy to tackle youth unemployment, the "Youth Guarantee".ResultsStuck in a rational vision on the policymaking process, focus within the field of HIA has mainly been on one particular function of decision-support, that is the function of instrumental or rational learning. When applied in the concrete context of real-world policymaking, this technical-rational model of HIA clashes with the inherent messiness of the policy process, characterized by the presence of a multitude of actors, pursuing a multitude of divergent goals, driven by conflicting interests, ideas and beliefs.Drawing insights from theoretical models developed in political sciences and sociology, we identify other, potentially more important functions of HIA to support policies addressing social health inequalities, more in particular the function of conceptual learning.This allows us to rethink and renew research and practice of HIA, both in terms of the evaluation approach, using a realist approach, as in terms of the design and management of the process.ConclusionsIf HIA is to be deployed as a tool to support the establishment of healthy and equitable public policies, this requires abandoning the rational vision of the function of HIA. Focus should be reoriented towards the analysis of the opportunities HIA offers for conceptual learning. The approach applied in the case study on the Brussels Youth Guarantee can serve as inspiration in this regard.