Developing methods for systems-informed Health Impact Assessment (System-HIA)

Abstract

Background: Health Impact Assessment (HIA) is a process for systematically assessing the potential health and wellbeing impacts of a policy, plan, or project, including recommendations on how those impacts may be managed. Increasingly policy is seen as interventions in complex systems. Methodologically guidance for undertaking HIA do not explicitly draw on complex systems approaches. This study explores the potential contribution of systems approaches to HIA, with a view to informing practical guidance on conducting HIA. The study was registered with Research Registry (reference: researchregistry9504). Methods: Scoping review, Stakeholder Workshops. Results: 25 eligible sources were identified applying systems approaches in IA, mostly quantitative modelling approaches, such as system dynamics, though several advocated for the application of systems thinking more broadly. HIA is inherently seen as systems oriented, given the involvement of multiple stakeholders and the focus on the wider determinants of health. Workshop participants showed a range of reactions towards applying the systems tools. Major concerns were HIA already being under resourced and systems methods potentially adding pressure and reducing stakeholder buy-in for HIA. Whilst broadening perspectives was seen as enriching, the difficulty to apply system tools directly would require adaptation to the HIA process. Participants valued the tools for their capacity to structure discussion or stakeholder engagement, and their capacity to communicate findings. There was concern about adding to the structured HIA process. Conclusions: This is the first study systematically assessing potential value and practical implications of applying systems informed tools as part of HIA. Although there is some conceptual overlap between HIA and systems approaches, there are practical challenges in incorporating new systems tools into HIA practice. Systems tools have a potential role in the initial setting of boundaries for a HIA, and as a lens to find opportunities to embed HIA in institutional decision-making processes.