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Health Promot Int. 2014 Dec;29(4):621-33. doi: 10.1093/heapro/dat012. Epub 2013 Feb 28.

Health equity impact assessment.

Author information

  • 1Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
  • 2Centre for Health Equity Training, Research and Evaluation, Part of the Centre for Primary Health Care and Equity, University of New South Wales, A Unit of Population Health, Sydney and Sydney South West Local Health Districts, NSW Health, Sydney, New South Wales, Australia


The World Health Organization's Commission on Social Determinants of Health has called for 'health equity impact assessments' of all economic agreements, market regulation and public policies. We carried out an international study to clarify if existing health impact assessment (HIA) methods are adequate for the task of global health equity assessments. We triangulated data from a scoping review of the international literature, in-depth interviews with health equity and HIA experts and an international stakeholder workshop. We found that equity is not addressed adequately in HIAs for a variety of reasons, including inadequate guidance, absence of definitions, poor data and evidence, perceived lack of methods and tools and practitioner unwillingness or inability to address values like fairness and social justice. Current methods can address immediate, 'downstream' factors, but not the root causes of inequity. Extending HIAs to cover macro policy and global equity issues will require new tools to address macroeconomic policies, historical roots of inequities and upstream causes like power imbalances. More sensitive, participatory methods are also required. There is, however, no need for the development of a completely new methodology.

© The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email:


health impact assessment; inequalities; international health; methodology

[PubMed - indexed for MEDLINE]
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