Health impact assessment as a tool for assuring social justice regarding interventions implemented on populations

Development is interventions on populations with winners – people who benefit, and losers – people who benefit less. Therefore there are always opposing interests – who will benefit more. What should we strive for when allocating resources: increasing average health status, or decreasing health inequalities?

Health impact assessment tries to identify changes in health of populations which are affected by development. However, if nobody is worse-off HIA would stop at its first step – Screening. Even if HIA proceeds with recommendations to enhance potential positive effects, assuming no negative effects to be minimized, there are possibilities for creating and widening health inequalities.

For any intervention implemented on populations the distribution of the benefit is the most important factor influencing the outcomes, no matter whether the primary objective is improving health of whole populations, i.e. in public health, or the primary objective is different than health, i.e. in other sectors (transport, education, agriculture, etc.), however with impact on health of populations. Since this distribution can be different in any different case, the evidence about effectiveness becomes even more equivocal.

I've established that evidence for interventions on populations is relative and depends on the distribution of the benefit among population. Any appraisal of interventions should start with analyzing this distribution at local level. I have identified eight combinations of this distribution, leading to different results. Based on this decision-makers should tailor the interventions in order to maximize the outcome for whole populations in any specific case, which is premise for social justice.