Step 4: Decision making

The HIA aims to inform decision makers and one of the main products of the HIA is therefore a set of recommendations that point towards decisions to reduce hazards and/or improve health. These recommendations should be clear and concise. They should be evidence-based wherever possible but also practical, realistic and achievable. Although some interventions or policies may have a very large potential health gain, if they are not feasible in real life, they are unlikely to substantiate this gain. It may therefore be better to recommend interventions or policies with smaller potential health gains which are more realistic or acceptable within the community. To be sustainable, the recommendations should therefore be developed and agreed upon between all relevant stakeholders.

Potential equity-focused core topic areas (Gunther, 2011) that need to be covered in the recommendation are “the impact of the policy or intervention on existing health equity issues” or “the evidence-based measures that would reduce the negative and enhance the positive health equity impacts of the policy” (Download here).

The results of the HIA, including the recommendations should be reported to the decision makers and all stakeholders concerned, including the affected community. Ideally, all of these stakeholders would be asked for feedback which could then lead to an improved report. This report is important for ensuring an effective adoption and implementation of the recommendations and it can also assist in securing (additional) funding.

Next: Step 5: Monitoring & evaluation