L’évaluation d’impact sur la santé (EIS) s’intéresse aux effets potentiels de politiques, programmes ou projets sur la santé des populations, avant leur mise en œuvre, dans le but de proposer des réajustements destinés à en atténuer les impacts négatifs et en renforcer les impacts positifs. Lors de la campagne présidentielle de 2017, un collectif d’acteurs du champ de la promotion de la santé a appliqué cette démarche aux programmes des cinq principaux candidats afin d’attirer l’attention des électeurs sur les conséquences possibles de ces programmes sur la santé des populations. L’analyse de chaque programme a été menée conformément aux standards de la démarche EIS par sept évaluateurs, anonymisée et soumise à la relecture de 35 experts. Une analyse comparative des programmes a ensuite été conduite sur trois thèmes spécifiques. Quel que soit le programme considéré, les mesures relatives aux thèmes environnement-énergie-transports et agriculture-ruralité sont celles qui auraient un impact très majoritairement positif sur les déterminants de santé. Pour toutes les autres catégories de mesures, l’impact sur la santé ainsi que les publics affectés par ces impacts varient considérablement d’un programme à l’autre. L’EIS a été confrontée à des défis méthodologiques en raison du caractère politique de l’objet et du contexte de campagne électorale. L’instabilité des programmes, l’incertitude sur l’effectivité de la mise en œuvre des mesures ainsi que le poids des valeurs sous-jacentes à chaque programme en sont les principaux. Cependant, le regard différencié porté sur les programmes et le plaidoyer pour la prise en compte de la santé dans toutes les politiques construit du fait de l’EIS sont deux arguments qui militent en faveur de la reconduction d’une telle expérience sur d’autres programmes politiques.

Health Impact Assessment (HIA), an inherently trans-disciplinary approach, is used to help evaluate and improve projects or programmes in sectors such as transportation, where new infrastructure is likely to have effects on health. This article describes the screening, scoping, appraisal, and recommendation steps of an HIA on a new 24 km highway around the conurbation of Strasbourg, France. Methods included a literature review and quantitative estimates of the health effects of air pollution and noise. Although planned, interviews and focus groups proved impossible due to political and administrative difficulties. In replacement, answers to a related public inquiry were submitted to a secondary, thematic analysis. The new infrastructure is likely to create or help maintain some jobs in the short term and might accelerate certain journeys, but it does not seem able to improve local mobility and air quality issues. It crystallises the dissatisfaction of a part of the local population and raises the question of the transparency of the design and validation processes of major infrastructure projects. Despite an unfavourable political context, the HIA approach described in this article was able to overcome methodological difficulties and obstacles thanks to creative research methods and trans-disciplinarity to finally yield relevant information and suggestions for urban health promotion.

Background Health impact assessment (HIA) is a method aimed at anticipating the potential effects of proposals on health prior to their implementation in order to include health issues in decisions made outside the health sector. It is structured in several steps. The first one (screening), aimed to decide if a full assessment is required or not, is poorly documented. In France, the interest shown for HIA has led to a growing number of experiments, which questions the quality of practices linked to this step and its capacity to fulfil its purpose. This study describes how screening is implemented, explores the main issues at this stage, the decision-making process and to what extent it conditions the HIA's success. Methods All HIAs undertaken between 2011 and 2019 were listed in order to provide a picture of the process. Then, we focused on the 3 most involved regions to describe the screening process (reports, interviews, observation). Drawing on quality standards and literature review, we built an analytical framework to analyze practices, the interface with other approaches, the influence of the local context and the HIA's success factors. Results 59 HIAs were identified. Among them, 54 have gone beyond screening. HIAs are applied to land use planning (72%,) policies (19%), equipments (9%) and are carried out by public organisations (37%), private firms (35%), universities (15%), municipalities (13%). 11 regions (out of 18) conducted at least one HIA and practice varies significantly across regions. Case studies in 3 regions (36 HIAs) show that screening length and depth vary greatly. Its features depend on political commitment to HIA, advocacy for HIA, guidance, relationship with local authorities, technical skills. Overall, screening is more dedicated to promote HIA and select a pilot project than to study the HIA's relevance and feasibility. Conclusions Since screening is methodologically poorly underpinned, it weakens HIA's quality and efficiency whatever its duration. Key messages Screening step is key to raise decision-makers’ awareness of the consequences of their engagement in HIA. Screening allows to ensure that HIA is the relevant method for the project and the conditions are met to gain its utility.

Low-cost sensors are considered as a promising tool to contribute to urban air quality policies. In some initiatives, based on citizen sensing, they are used to gather data and gain a better understanding of the problem, thus fitting in a technology-oriented smart city model. In others, closer to citizen science, they are used to engage citizens in finding solutions, therefore fueling a more citizen-oriented smart city model, the smart enough city. Although important, the political effects of such initiatives have not been widely analyzed so far. To address this issue, we have studied Ambassad'Air, a citizen sensing initiative led in Rennes since 2016: What are the political consequences of this project? And which smart city model does it fuel? Based on a littterature review, we built an analytical framework for the two smart city models. Then, we realized 81 interviews with Ambassad'air's volunteers and managers to analyze the initiative's strategy, its implementation (participatory mechanisms; use of data) and its political effects (change in political agenda or projects; citizen mobilization). Initially, micro-sensors were lent to volunteers with the aim of turning them into peer-educators able to raise awareness around them and into empowered citizens able to influence local air quality policies. However, the initiative faced implementation barriers (persistent blurring between citizen science and citizen sensing; limitations to produce problem-oriented, scientifically validated, mass data) that limited its short-term political effects. It has sparked a local interest, though, for micro-sensors, and it is questionning the management of citizen-produced data. With no political mechanisms that transform citizen sensing from a practice to an input for risk regulation, Ambassad'Air is not quite yet a tool of a smart enough city. But as a way to produce sensitive environments that any citizen can interact with in real-time, it is a step towards a more senseable city. Key messages Citizen sensing can fix the participatory breakdowns of the smart city while feeding its big data but it needs political mechanisms that recognize the role of citizen expertise in decision making. Micro-sensors can serve a wide range of strategies, from community-based environmental surveillance that seeks knowledge to gain power, to top-down citizen sensing that seeks data to gain control.

Background Health impact assessment is a method aimed at identifying the potential health impacts of policies and projects before their implementation and suggesting proposals in order to mitigate negative impacts and enhance positive ones. HIA is growing in France mainly at the local level. The Pays de la Loire Regional Health Agency (PDL-HRA) took an early interest in HIA and supported three experiments proposed by the town councils. An assessment was performed to judge its added value, identify success factors and draw lessons for the development of the practice. Methods An evaluation framework was built based on standards and literature. Using a qualitative multiple case study design, a cross-sectional analysis of the HIAs was carried out in order to compare the implementation process in their respective contexts, the governance arrangements and the changes introduced as a result of the HIA. Evaluation draws upon HIA reports, workshops, field observation and 40 interviews that were analysed with NVivo. Results While the conduct of HIAs is generally in line with standards of practice, the analysis of the relevance of HIA and impact characterization remain insufficiently documented. Implementation and success factors depend on the political context, the culture of institutions, actors and the purpose of HIA. Recommendations have been taken into account and changes are emerging. The stakeholders indicate their interest in HIA insofar as it is a meeting point between the concerns of institutions regarding health equity and democracy and it provides tools for action. Conclusions Although the approach is unanimously valued, it faces time, resource and competition with other activities. The continuation of the approach depends on the HRA policy specifying the aims, resources, fields of application and positioning with regard to the partners.These findings are consistent with other French work and literature data. French experience coulfd benefit from that of other countries. Key messages Skills of professionals have to be reinforced in order to make appropriate and quality HIAs. Evaluation is useful for understanding the development of an emerging practice and for supporting a decision-making in terms of scaling up, integration, role assigned to the health sector.