title: Exploration of the functions of health impact assessment in real-world policymaking in the field of social health inequality: towards a conception of conceptual learning.
abstract: With the implementation of health impact assessment (HIA)'s conceptual model into real-world policymaking, a number of fundamental issues arise concerning its decision-support function. Rooted in a rational vision of the decision-making process, focus regarding both conceptualisation and evaluation has been mainly on the function of instrumental policy-learning. However, in the field of social health inequalities, this function is strongly limited by the intrinsic 'wickedness' of the policy issue. Focusing almost exclusively on this instrumental function, the real influence HIA can have on policymaking in the longer term is underestimated and remains largely unexploited. Drawing insights from theoretical models developed in the field of political science and sociology, we explore the different decision-support functions HIA can fulfill and identify conceptual learning as potentially the most important. Accordingly, dominant focus on the technical engineering function, where knowledge is provided in order to 'rationalise' the policy process and to tackle 'tame' problems, should be complemented with an analysis of the conditions for conceptual learning, where knowledge introduces new information and perspectives and, as such, contributes in the longer term to a paradigm change.
authors.affiliation: 1 Health Policy and Systems - International Health, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Belgium.|2 Brussels-Capital Health and Social Observatory, Research Centre of the Joint College Services of the Joint Community Commission, Brussels, Belgium.|3 Interface Demography, Department of Sociology, Faculty Economic and Social Sciences and Business Solvay School, Vrije Universiteit Brussel (VUB), Belgium.
authors.forename: Gille
authors.initials: G
authors.lastname: Feyaerts
authors.affiliation: 2 Brussels-Capital Health and Social Observatory, Research Centre of the Joint College Services of the Joint Community Commission, Brussels, Belgium.
authors.forename: Murielle
authors.initials: M
authors.lastname: Deguerry
authors.affiliation: 3 Interface Demography, Department of Sociology, Faculty Economic and Social Sciences and Business Solvay School, Vrije Universiteit Brussel (VUB), Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.affiliation: 1 Health Policy and Systems - International Health, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Belgium.
authors.forename: Myriam
authors.initials: M
authors.lastname: De Spiegelaere
mesh_terms: D018672:Community Health Planning; D062489:Health Impact Assessment / Q000379:methods*; D006291:Health Policy; D054624:Health Status Disparities; D006801:Humans; D011050:Policy Making; D015397:Program Evaluation
keywords: determinants of health; evaluation; health impact assessment; policy; politics