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Health impact assessment (HIA) is a multidisciplinary aid to decision-making that assesses the impact of policy on public health and on health inequalities. Its purpose is to assist decision-makers to maximize health gains and to reduce inequalities. The 1999 Gothenburg Consensus Paper (GCP) provides researchers with a rationale for establishing community participation as a core value of HIA. According to the GCP, participation in HIA empowers people within the decision-making process and redresses the democratic deficit between government and society. Participation in HIA generates a sense that health and decision-making is community-owned, and the personal experiences of citizens become integral to the formulation of policy. However, the participatory and empowering dimensions of HIA may prove difficult to operationalize. In this review of the participation strategies adopted in key applications of HIA in the United Kingdom, we found that HIA's aim of influencing decision-making creates tension between its participatory and knowledge-gathering dimensions. Accordingly, researchers have decreased the participatory dimension of HIA by reducing the importance attached to the community's experience of empowerment, ownership and democracy, while enlarging its knowledge-gathering dimension by giving pre-eminence to "expert" and "research-generated" evidence. Recent applications of HIA offer a serviceable rationale for participation as a means of information gathering and it is no longer tenable to uphold HIA as a means of empowering communities and advancing the aims of participatory democracy.

European Union (EU) Member States are interested in using health impact assessment (HIA) as a means of safeguarding their obligations to protect human health under the 1997 Treaty of Amsterdam. However, several have encountered difficulties institutionalizing HIA with the policy-making process. As a consequence, the World Health Organization (WHO) Regional Office for Europe has suggested coupling HIA with strategic environmental assessment (SEA). Traditionally, the incorporation of HIA into other forms of impact assessment has been resisted, for fear of losing its focus on health issues to environmental concerns, and compromising its social model of health with the introduction of biophysical indicators. But can these fears be substantiated? In this paper, we investigate the grounds for such concerns by reviewing the relevant policy documents and departmental guidelines of four non-European countries that have considered the use of integrated assessment. We found that the case for associating HIA with SEA in Europe is strong, and offers potential solutions to problems of screening, theoretical framework, causal pathways and ready entry to the policy process. Coupling HIA with SEA may thus be the next step forward in a Ionger journey towards institutionalizing HIA as an independent policy-linked device. Keywords Outcome assessment (Health care); Risk assessment; Environmental health; Public policy; Decision making, Organizational; Strategic planning; European Union; Australia; Canada; New Zealand; United States (source: MeSH, NLM). Mots cles Evaluation resultats (Sante); Evaluation risque; Hygiene environnement; Politique gouvernementale; Prise decision institutionnelle; Planification strategique; Communaute economique europeenne; Australie; Canada; Nouvelle-Zelande; Etats-Unis (source: MeSH, INSERM). Palabras clave Evaluacion de resultado (Atencion de salud); Medicion de riesgo; Salud ambiental; Politica social; Toma de decisiones (Administracion); Planificacion estrategica; Union Europea; Australia; Canada; Nueva Zelandia; Estados Unidos (fuente: DeCS, BIREME)., Introduction The aim ofhealth impact assessment (HIA) is to assist policymakers and other decision-makers to formulate "healthier" decisions and thus maximize population health gain and, whcre possible, reduce health inequalities. [...]