Abstract
BackgroundHealth impact assessments (HIA) of policies and projects are conducted differently in different contexts although there has been less HIA research to date in non-western countries. Global HIA research has however suggested that the technical conduct of HIAs is tied to broader conditions and influences to do with decision making and policy development.This study was conducted to develop a conceptual framework for progressing HIA in Iran including all factors influencing HIA planning and practice.MethodsA comprehensive review of the international HIA literature identified core characteristics and principles. Then key informant interviews (n = 14) identified Iranian perspectives about factors influencing HIAs practice. These two stages resulted in a conceptual framework for HIA planning and practice including influencing factors and HIA content that was confirmed by our participants using e-Delphi technique.Results91 HIA characteristics were organized into 20 categories. The interviews showed that four core concepts i.e. context, actors, HIA principles and policies and HIA capacities influence HIA practice in Iran. Comprehensive content of HIA considering all health dimensions and health determinants, assessing health inequalities, appropriate HIA type, quantification and participation is formed under influence of the above mentioned four factors. The study also demonstrated need to redefine the HIA principles and make decision about integration of HIA in Environmental Impact Assessment and also about the level of HIA before implementing HIA. The e-Delphi resulted in expert consensus on the variables, concepts, and their relations in proposed framework.ConclusionsProgressing HIA practice in Iran is perceived locally as subject to similar contextual conditions to those identified in the international literature. Further we have demonstrated the utility of mixed methods to progress HIA implementation in differing country contexts.
Highlights
Health impact assessments (HIA) of policies and projects are conducted differently in different contexts there has been less HIA research to date in non-western countries
In future more detailed quantitative work can confirm and refine our proposed framework both in Iran and in other contexts and countries response to call to develop an international HIA consensus that moves the field forward [34]. This is a study which has developed categories to navigate the practice of HIA as a decision making tool
Our framework suggests HIA could be modified to become a healthy public policy approach that considers all social determinants of health at multiple levels: project, programs, plans and policies
Summary
Health impact assessments (HIA) of policies and projects are conducted differently in different contexts there has been less HIA research to date in non-western countries. Global HIA research has suggested that the technical conduct of HIAs is tied to broader conditions and influences to do with decision making and policy development. This study was conducted to develop a conceptual framework for progressing HIA in Iran including all factors influencing HIA planning and practice. One established way of doing this is the use of Health Impact Assessment (HIA) to aid decision makers by predicting positive and negative health impacts of proposed policies, programs and projects. This placing of HIA within the array of influences on decision-making suggests that HIAs are conducted differently in different contexts. Each country requires its own policy frameworks and procedures
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