Public health at risk in planning practice: HIA guidance must be strengthened in Norway

Background

Health impact assessment (HIA) is a key instrument for operationalizing Health in All Policies in municipal planning and decision-making. While international research has identified many challenges related to HIA practice, knowledge regarding the implementation of HIA and associated challenges in Norwegian municipalities remain limited. To support the Norwegian Directorate of Health in making HIA a more user-friendly tool, this study aimed to explore current municipal HIA practices, and the challenges encountered within Norway.

Methods

A qualitative study was undertaken to gain in-depth insights into municipal HIA practices and associated challenges in Norway. Focus group interviews were conducted with stakeholders involved in HIA implementation and practice across administrative levels. The stakeholder groups included (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.

Results

Stakeholders expressed a need for guidance on HIA in planning and decision-making. The findings revealed substantial variation in stakeholders’ knowledge of HIA, along with inconsistent use of existing methods and tools. Current guidelines were perceived as overly comprehensive yet insufficiently operational, prompting municipalities and consultants to develop ad hoc approaches. Furthermore, HIAs are rarely conducted for overarching municipal master plans or detailed zoning plans, and health considerations are weakly integrated into political decision-making and statutory impact assessments. Despite the prominence of health equity on the political agenda, impact assessment on health inequalities is largely absent.

Conclusions

We recommend establishing a national digital platform with a guidance framework consolidating and presenting HIA methods and tools to strengthen public health in future planning and decision-making.

Key messages

• Lack of clear, practical HIA guidance leads to ad hoc practice. weak political integration, and missing assessment of health inequalities in Norwegian planning.

• 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.