HIA, the next step: Defining models and roles

If HIA is to be an effective instrument for optimising health interests in the policy making process it has to recognise the different contests in which policy is made and the relevance of both technical rationality and political rationality. Policy making may adopt a rational perspective in which there is a systematic and orderly progression from problem formulation to solution or a network perspective in which there are multiple interdependencies, extensive negotiation and compromise, and the steps from problem to formulation are not followed sequentially or in any particular order. Policy problems may be simple with clear causal pathways and responsibilities or complex with unclear causal pathways and disputed responsibilities. Network analysis is required to show which stakeholders are involved, their support for health issues and the degree of consensus.From this analysis three models of HIA emerge. The first is the phases model which is fitted to simple problems and a rational perspective of policymaking. This model involves following structured steps. The second model is the rounds (Echternach) model that is fitted to complex problems and a network perspective of policymaking. This model is dynamic and concentrates on network solutions taking these steps in no particular order. The final model is the “garbage can” model fitted to contexts which combine simple and complex problems. In this model HIA functions as a problem solver and signpost keeping all possible solutions and stakeholders in play and allowing solutions to emerge over time. HIA models should be the beginning rather than the conclusion of discussion the worlds of HIA and policymaking.