The effectiveness of health impact assessment: lessons learnt from an experience in metropolitan Bordeaux

Introduction: This work presents the results of an impact evaluation applied to an HIA of an urban development project. The purpose of the evaluation was to assess the direct effects of the HIA procedure on the decision making by the implementation of the recommendations as well as its indirect effects in terms of stakeholders' appropriation and use of the information produced throughout the process. Methods: 12 semi-structured interviews were conducted with HIA stakeholders including regional public health directors and professionals, local elected officials, and technical stafffrom the engaged local authorities. Results: Data collected confirmed HIA indirect impacts in terms of interviewees' enhanced values and beliefs according to a holistic model of health, changes in professional practices through appropriation of the knowledge generated throughout the process and strengthening of intersectoral collaborations for health. More modest results were identified regarding HIA direct effects on decision making through the consideration of the proposed recommendations because of their redundancy with technical teams' routine practices and their late timing. Nevertheless, interest in capitalizing on these recommendations for future municipal and metropolitan projects suggests deferred effects on decision making that should not be neglected. Conclusions: This study provides new data on the effectiveness, to varying degrees, of one of the first HIAs conducted in the region of Nouvelle Aquitaine. Other evaluations should be promoted in France to demonstrate HIA value and to draw useful lessons to inform its further development and consolidation in the coming years.