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Cross-country analysis of the institutionalization of health impact

This paper is the eighth in a series of papers produced by the World Health Organization’s (WHO) Commission on the Social Determinants of Health (CSDH). Paper #2 is also in our Resource Library. All of these papers are peer reviewed and intended to provide a forum for sharing knowledge on how to approach the inequitable distribution of health determinants in countries around the world.

The institutionalization of health impact assessment (HIA) is considered to be a clear indicator of a country’s implementation of a “health in all policies” agenda.  However, differences in political and socioeconomic conditions, and institutional settings, lead to substantial variations in the use and institutionalization of this process.  The authors of this review of the literature and analysis across countries set out to identify factors that enable or inhibit the development of effective strategies to institutionalization HIA more broadly.

Key factors that enable the institutionalization of HIA are identified as

  • strong political will and support; 
  • legislative mandate;
  • international commitment to Health in All Policies and health promotion;
  • awareness and importance of intersectoral cooperation;
  • using the experience of other countries as a positive example; and
  • involvement of research communities.

Challenges to institutionalization include

  • lack of clarity around methodology and procedures;
  • narrow definitions of health;
  • lack of awareness of the relevance of health impacts in non-health sectors; and
  • insufficient funding and tools.

Based on their experiences, the key informants propose the following core recommendations

  1. Embed HIA in national normative systems (e.g. in legislation and Public Health Acts)
  2. Clarify definitions and develop guidelines and methodological criteria to operationalize HIA
  3. Strengthen and build capacity for HIA practice
  4. Improve cooperation between sectors

Use this resource to

  • learn about the approaches and resources used in other countries to support HIA; 
  • develop a plan (which includes the development of academic and community partnerships) for your jurisdiction to increase the likelihood that HIA will be used; and
  • introduce the benefits of HIA with your intersectoral partner to encourage a “health in all policies” approach.


Lee, JH, Robbel, N, & Dora, C. (2013).  Cross-country analysis of institutionalization of Health Impact Assessment.  Social Determinants of Health Discussion Paper Series 8 (Policy & Practice). Geneva, World Health Organization.

Tags: Community engagement, Environmental health, Healthy public policy, Intersectoral action, Methods & tools, Report / Document

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