Exploring the relation between evidence and decision-making: A political-administrative approach to health impact assessment

Like any policy-relevant research, HIA faces the risk of not being used by decisions-makers. This article addresses the questions: “How do policy decisions come about?” and “How does this affect HIA?” Current literature in political-administrative sciences identifies three ways for decision-making: rational, incremental and mixed model. These models define the relationship between the policy process at stake and the HIA. In incremental or mixed model decision-making, use of HIA evidence by policy-makers is heavily dependent on their values in the context, which may result in conceptual utilization or may extend to strategic utilization. In rational decision-making, HIA provides information independent from the context, which results in instrumental utilization. HIA practitioners need to optimise utilization and produce an appropriate HIA by mapping the policy process. They can do this by asking the questions ‘What? How? Who? and What context? and by maintaining continuous communication with the decision-makers. An appropriate HIA is policy-, time- and place-specific: reflecting the decision-making of the policy at stake. Furthermore, HIA concerns two policy fields with two different contexts and, in some cases, two different decision-making models. The administrative requirements for an appropriate HIA need further exploration.