HIA: Principles and Practice – Preface

I wrote this textbook because there wasn’t one and I wanted to record my knowledge and experience, what I knew and didn’t know. I did not intend that it would cover all, or even most, of the vast field of HIA. I do not expect it to satisfy all my peers. If I had set my own expectations so high, then I would not have written it.

I have watched HIA grow from an off-the-wall, cranky kind of idea to a mainstream pursuit. I am reminded of Schopenhauer’s dictum that all truth passes through three stages: first it is ridiculed; then it is violently opposed; finally it is accepted as being self-evident. In the early days I was told that Iwas wasting my time, and later I was told it was an inappropriate academic pursuit. Now I am told it is self-evident.


The material for the book grew from teaching and training material that have been used and tested in many introductory lectures or courses on the subject. The audience for those courses have been drawn from many cultures and have included both postgraduate students and professionals. About half have had some form of health background such as medicine, nursing, occupational safety or community health. I have observed the bewilderment of experts without health backgrounds when presented with the question “what is health?”, as well as the bewilderment of those with health backgrounds when presented with the proposition that health is largely determined by decisions made outside the health sector. Many of the training courses have had an inter-sectoral focus. Experts from widely different disciplines do not always have skills in framing questions or explanations to colleagues in other disciples. I hope I have included enough explanation and examples to make my meaning clear to readers from many different disciplines.

HIA is now conducted in such widely different settings and contexts that they seem to be speaking a different language and have very different aims and objectives. Finding the common thread is getting harder. For example, there are civil servants in the UK who seek to maximise the health gain of local public sector policies. On the other hand, there are managers of transnational corporations who seek to safeguard the reputation of their company while implementing a project in a rural area of a least developed country. There are policy makers in the European Commission who seek to ensure that new social policy conforms to treaty agreements.

There are still vast and unexplored territories in the area of expertise covered by HIA. These await discovery by the next generation of practitioners. I try to map out some of the issues that have yet to be resolved and to put them in the context of examples based on my own, and others, experience.








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