A wake-up call: Public health at risk unless HIA guidance is strengthened

Background: Health impact assessment (HIA) is a key tool for operationalizing Health in All Policies within municipal planning and decision-making. While international research has identified many challenges related to HIA practice, knowledge about the implementation and potential challenges of HIA in Norwegian municipalities remains limited. To support the Norwegian Directorate of Health in making HIA a more user-friendly tool, this study pursued two objectives. First, we explored municipal HIA practices and associated challenges. Second, we reviewed international HIA methods to assess their relevance for Norwegian planning practice.

Methods: This study combined focus group interviews with a literature review. Municipal HIA practices and challenges were examined through four group interviews with key stakeholders: (1) public health coordinators and environmental health advisors, (2) planners and private consultants, (3) municipal chief medical officers, and (4) representatives from the County Governor and County Council. Existing HIA methods and tools were identified through systematic searches in scientific databases and strategic searches of international grey literature from relevant authorities, public bodies, and institutions. For each method, key characteristics, such as scope of application, target users and consideration of social inequality, were documented to assess their relevance.

Results: Stakeholders expressed a need for clearer guidance on HIA in planning and decision-making. The findings revealed substantial variation in stakeholders’ knowledge of HIA and inconsistent use of existing methods and tools. Current guidelines were perceived as overly comprehensive yet insufficiently operational, prompting municipalities and consultants to develop their own approaches. Moreover, HIAs are rarely conducted for regional and municipal master plans. The literature review uncovered a wide range of HIA methods and tools, ranging from brief checklists to comprehensive guidelines. Several tools explicitly focus on health impact analysis, social inequality and citizen participation. Notably, resources supporting the integration of health considerations into other types of impact assessments, such as environmental impact assessment, have increased in recent years. Many of the identified methods and tool were considered relevant and adaptable to Norwegian municipal planning practice.

Conclusion: There is an urgent need for clear guidance, knowledge-based methods and practical tools to ensure systematic integration of HIA into municipal planning and decision-making at all levels. The methods and tools identified in this study provide a solid foundation for developing context-specific resources that can strengthen HIA practice in Norway.