Health impact assessment (HIA) figures among the practices that encourage the adoption of healthy public policies. The HIA approach is a structured series of steps designed to determine the potential effects, both negative and positive, of a project or policy on a population’s health and well-being. HIAs are generally prospective in nature, meaning that they attempt to estimate the future impacts of a policy in order to inform decision makers before decisions are made and policies implemented. They generally address policies developed outside the health sector.

Several models exist for applying the HIA approach. Depending on the purpose of the assessment, the approach may place more emphasis on finding scientific data, encouraging public participation and strengthening local communities, or supporting intersectoral decision making. The HIA pilot project carried out in Montérégie falls more within this last model of practice, which is also the approach adopted at the provincial level.

This practice model has been used by the Québec provincial government for almost 10 years in its application of the Public Health Act. Under section 54 of the Act, all government departments must ensure that their legislative bills and regulations will not have significant negative health impacts on the population. To help different government sectors to meet this obligation, the Ministère de la Santé et des Services sociaux (the provincial department of health and social services, MSSS) has implemented a strategy based on interdepartmental collaboration and searching for situations that may be considered mutually beneficial. The long-term objective of this strategy is to support cultural change that will foster accountability for population health that is shared across all government sectors.

Given the significant influence of municipal policies on the determinants of health and knowing that, internationally, HIA is mostly used at the local level, interest has grown in adapting HIA practice to this decision-making level.

In 2007–2008, a pilot project was launched in one of Québec’s health and social services regions. Its objective was to assess the relevance and feasibility of applying a health impact assessment process on policies developed at the municipal level.

This document presents the approach taken by the public health sector in the Montérégie region to interest municipal authorities in HIA and encourage them to make prospective evaluations of policies proposed at the municipal level. It provides a brief description of the different stages in the pilot project, the collaboration mechanisms implemented, the identified objectives, the evaluation strategy and the main conclusions drawn from the experiment.

This document is intended to provide information on the process of introducing HIA practice at the municipal level and present the public health sector’s main findings on the process. It does not present the results of impact analyses for each of the analyses performed. Furthermore, the nature of the projects studied and, above all, the constraints inherent in a pilot project did not allow the project’s team to complete all the steps of the HIA approach with each policy project. However, the lessons learned on the potential influence of the municipal level, the strengthening of policy formulation processes, relations between the health and municipal sectors and knowledge development on both sides led the various partners to conclude that HIA should become a permanent practice, serving as a tool to support healthy public policies. This led to a health impact assessment mechanism being introduced in 2009–2010 as one of the services offered by Montérégie’s public health authorities.



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