A tailored approach for health impact assessment in a context of uncertainty and resource constraints: a case study in Québec

Health impact assessment (HIA) can magnify the positive impacts of health promotion in practice, but practitioners face many challenges in implementing it, from the difficulties of intersectoral work to a lack of resources. These challenges require flexibility and sometimes involve adapting best practices in health promotion and the typical HIA process. This article presents an agile approach to conducting HIA when the window of opportunity is short, resources are scarce, and the expected value of appraisal is uncertain. Accordingly, this approach prioritizes the recommendations step over the appraisal step, while proposing an iterative and co-constructive process involving a limited number of stakeholders. The approach is exemplified through a case study of an HIA conducted in Québec on a guide promoting green, active and safe transportation networks. We argue that the adapted method can, in certain circumstances, lead to better results than a typical HIA. The article also suggests contextual criteria that allow HIA practitioners to assess whether this approach is suitable for their needs.