Le processus d'évaluation d'impact sur la santé comme lieu d'interrogation des données probantes

National audienc

The challenge of assessing social cohesion in health impact assessment

International audienceHealth impact assessment (HIA) is a method by which a policy, programme or project falling outside traditional health fields, may be judged as to its potential effects on the health of a population to mitigate negative impacts and strengthen the positive ones. Proposals are analysed from the perspective of all the determinants of health. In France, HIAs are mainly applied to urban development projects where social cohesion (SCo) is a major issue. Although the HIA method is well structured as a step-by-step process, there are no guidelines for assessing SCo. This article opens with literature review to clarify the concept of SCo and to understand how the built environment influences SCo and how social environment influence health. Drawing on this work, this paper presents an analytical framework to assess SCo, integrating both the spatial and physical dimensions of urban design and the perceptions of the neighbourhood characteristics. Following a brief overview of the key findings from applying this framework to HIA of an urban development project, the paper discusses its related strengths and weaknesses. The framework could be a useful tool for HIA as it embraces knowledge from both urban planning and social sciences. It also allows for an overall analysis of all the indicators without relying on a checklist. Nevertheless, it should be tested further to improve its validit

Assessing the impact of urban development projects on social cohesion: testing an analytical framework for health impact assessment

International audienc

Évaluation d'impact sur la santé en Pays-de-la-Loire : quels enseignements pour les acteurs de la promotion de la santé ?

International audienceEn Pays-de-la-Loire, deux programmes de renouvellement urbain à Nantes - Saint-Herblain et à Angers et le programme de prévention des inondations de l'île de Noirmoutier ont fait l'objet d'une évaluation d'impact sur la santé (EIS). Une équipe de chercheurs a analysé le processus de déploiement de la démarche EIS et ses effets. Si le recul n'est pas suffisant pour en apprécier tous les résultats à long terme, les EIS ont d'ores et déjà permis à la santé de s'inviter dans quelques-unes des politiques qui déterminent l'état de santé de la population : urbanisme, habitat, transports, services publics. Des premiers résultats encourageants

A New Framework for Monitoring and Evaluating Health Impact Assessment: Capitalising on a French Case Study with the Literature in Evaluation

International audienceHealth impact assessment (HIA) is a prospective approach that aims to identify the potential consequences of policies or projects on health in order to propose measures to make them healthier. Initiated in the late nineties, the approach emerged over ten years ago in France. However, the evaluation of HIA effectiveness remains seldomly practised and its theoretical background should be deepened. The aim of this article is to generate a discussion on how to evaluate HIA effectiveness and contribute to its methodological tooling, drawing on an evaluative experience of multiple French HIAs. Our work is based on an iterative approach between an analysis of the evaluation literature and a critical look at an HIA evaluation. We first carried out the evaluation of three HIAs in 2017-2018, combining a normative approach and qualitative research in order to explore each HIA as a phenomenon in its own context. Two years later, we conducted a self-assessing expertise on this evaluation, supported by an analysis of the literature in the field of public policy evaluation, in order to refine the theoretical framework for evaluating HIA effectiveness and ultimately to enhance professional practice by evaluators. This work led to the production of a logic model that identifies, through three dimensions (context, implementation and governance), the multiple pathways that HIA may take to bring about change. It also seeks to show the interdependence of these pathways towards change and helps identify the key drivers and mechanisms of HIA success. In this respect, it complements existing HIA evaluation models as it can serve both as a generic framework for evaluating HIA effectiveness and as an instrument for monitoring HIA implementation

Evaluation of the Health impact assessment (HIA) deployment process in a French region

International audienceBackground Health impact assessment is a method aimed at identifying the potential health impacts of policies and projects before their implementation and suggesting proposals in order to mitigate negative impacts and enhance positive ones. HIA is growing in France mainly at the local level. The Pays de la Loire Regional Health Agency (PDL-HRA) took an early interest in HIA and supported three experiments proposed by the town councils. An assessment was performed to judge its added value, identify success factors and draw lessons for the development of the practice. Methods An evaluation framework was built based on standards and literature. Using a qualitative multiple case study design, a cross-sectional analysis of the HIAs was carried out in order to compare the implementation process in their respective contexts, the governance arrangements and the changes introduced as a result of the HIA. Evaluation draws upon HIA reports, workshops, field observation and 40 interviews that were analysed with NVivo. Results While the conduct of HIAs is generally in line with standards of practice, the analysis of the relevance of HIA and impact characterization remain insufficiently documented. Implementation and success factors depend on the political context, the culture of institutions, actors and the purpose of HIA. Recommendations have been taken into account and changes are emerging. The stakeholders indicate their interest in HIA insofar as it is a meeting point between the concerns of institutions regarding health equity and democracy and it provides tools for action. Conclusions Although the approach is unanimously valued, it faces time, resource and competition with other activities. The continuation of the approach depends on the HRA policy specifying the aims, resources, fields of application and positioning with regard to the partners.These findings are consistent with other French work and literature data. French experience coulfd benefit from that of other countries

Towards a better integration of health in urban development project: from theory to action

International audienceBackgroundDespite a well knowledge about links between urban planning and health, practices’ analyze highlights the difficulty to upgrade health into urban planning decisions. To overcome this issue, the EHESP has initiated a specific research dedicated to the development of tools for a better integration of health & wellbeing at different decision-making-level (urban planning & urban development project). The objective of this presentation is to focus on one dedicated research, Isadora project, and to share how the project was carried out to enable the production of an operational tool dedicated to urban planners to better integrate health issues into their practices.MethodsThe scientific management team mixed various skills from public health, environment and urban planning sectors which makes easier the implementation of two key-principles of research: (i) to adopt a systemic approach to health determinants, (ii) to address urban settings through an integrated approach to public health, environment and sustainable development issues. The implementation of this interdisciplinary and intersectorial project is based on a close collaboration with a national working group composed of various professionals and academics (urban planning, environment, and health). The Isadora project deliverables results from an iterative process between all the stakeholders involved in the project.Results and conclusionsFirst, we will present how we facilitated the working group throughout the deliverables development process and how we overcame the challenges of implementing intersectorality. Then, we will present the operational tool structured around of 15 key sheets with health focus to help professionals to integrate health at each step of an urban development project

L’évaluation d’impact sur la santé peut-elle être appliquée aux programmes de candidats à l’élection présidentielle ?

National audienceHealth impact assessment (HIA) is defined as a method by which a policy, program or project may be judged as to its potential effects on the health of a population in order to mitigate negative impacts and strengthen the positive ones. During the 2017 French presidential elections, health promotion actors decided to conduct an HIA on the political platforms of the five main candidates. The assessment of each political platform was conducted by 7 evaluators and reviewed by 35 health promotion experts. Then, a comparative analysis of the platforms was led on 3 specific topics. This HIA was conducted in accordance with the international standards of practice. Within all of the 5 political platforms, the proposals related to Environmental and energy policy, and to Agricultural policy were the ones with widely positive impacts on the determinants of health. Concerning all of the other policy proposals, their respective impacts and affected populations broadly change from one platform to another. Due to its political object, this HIA had to deal with methodological challenges such as platform instability, uncertainty over the genuine implementation of measures as well as the importance of the underlying platform values. Nonetheless, such an implementation of the HIA process on the political platforms of candidates running for an important position is interesting because it represents an opportunity to look at the platforms with fresh eyes and enriches the advocacy to take public health into account in the policy making processes and tries to operationalize the concept of health in all policies