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.

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.

Summary Health impact assessment (HIA) is a method by which a policy, programme or project falling outside traditional health fields, may be judged as to its potential effects on the health of a population to mitigate negative impacts and strengthen the positive ones. Proposals are analysed from the perspective of all the determinants of health. In France, HIAs are mainly applied to urban development projects where social cohesion (SCo) is a major issue. Although the HIA method is well structured as a step-by-step process, there are no guidelines for assessing SCo. This article opens with literature review to clarify the concept of SCo and to understand how the built environment influences SCo and how social environment influence health. Drawing on this work, this paper presents an analytical framework to assess SCo, integrating both the spatial and physical dimensions of urban design and the perceptions of the neighbourhood characteristics. Following a brief overview of the key findings from applying this framework to HIA of an urban development project, the paper discusses its related strengths and weaknesses. The framework could be a useful tool for HIA as it embraces knowledge from both urban planning and social sciences. It also allows for an overall analysis of all the indicators without relying on a checklist. Nevertheless, it should be tested further to improve its validity.

Background Despite a well knowledge about links between urban planning and health, practices’ analyze highlights the difficulty to upgrade health into urban planning decisions. To overcome this issue, the EHESP has initiated a specific research dedicated to the development of tools for a better integration of health & wellbeing at different decision-making-level (urban planning & urban development project). The objective of this presentation is to focus on one dedicated research, Isadora project, and to share how the project was carried out to enable the production of an operational tool dedicated to urban planners to better integrate health issues into their practices. Methods The scientific management team mixed various skills from public health, environment and urban planning sectors which makes easier the implementation of two key-principles of research: (i) to adopt a systemic approach to health determinants, (ii) to address urban settings through an integrated approach to public health, environment and sustainable development issues. The implementation of this interdisciplinary and intersectorial project is based on a close collaboration with a national working group composed of various professionals and academics (urban planning, environment, and health). The Isadora project deliverables results from an iterative process between all the stakeholders involved in the project. Results and conclusions First, we will present how we facilitated the working group throughout the deliverables development process and how we overcame the challenges of implementing intersectorality. Then, we will present the operational tool structured around of 15 key sheets with health focus to help professionals to integrate health at each step of an urban development project. Key messages ISadOrA project aspires to promote an evolution of urban planner’s practices in order to achieve a healthy urban development project. This ambition requires the translation of concepts into actions.