A. Skills building seminar: Health Impact Assessment – integrating equity and inequality

Abstract Health Impact Assessment (HIA) is an evidence-based tool which evaluates how policies, programs, and projects affect population health, including the distribution of these impacts across groups. This makes the use of HIA key to ensure sustainable policies that recognise the diversity of the population. HIA is also a powerful tool to promote ‘Health in All Policies’ and the economy of well-being, as it helps analyse the health impact of policies from different sectors. Equity is a core value of HIA. It was defined in the 1999 Gothenburg Consensus as one of the founding values guiding HIA practices. This commitment to equity aligns with most health system goals. Despite this, significant challenges persist in putting equity and inequalities into practice. Although HIAs aim to minimise negative health impacts and maximise benefits, they frequently fail to consider how marginalised groups are affected or to incorporate equity considerations. Recent research reveals a disconnect between theoretical equity commitments and their practical implementation. Many HIAs still fail to adequately analyse structural drivers of health disparities, such as poverty. In response, equity-focused HIA frameworks and guides have emerged to help researchers incorporate equity concepts into their work. While equity and inequalities are closely linked, integrating them into HIAs might require distinct methodologies, such as including marginalised populations in the conceptualisation process, as well as looking at redistributive policies or systemic reforms. On the other hand, to meaningfully address inequalities, analyses might require more disaggregated data as well as the implementation of targeted interventions. The integration of equity and inequalities in HIAs, although requiring different strategies, is not mutually exclusive and could be done simultaneously. This skills-building seminar will draw on insights from an international Joint Action program, the experience of the Welsh Health Impact Assessment Support Unit, and the work of EuroHealthNet. The workshop will feature a mix of interactive activities and presentations, encouraging attendees to actively engage with strategies for integrating equity and inequality concepts into HIAs. Through three lenses, the session will explore: • Examples of work conducted at both local and international levels; • Practical tools for incorporating inequality and equity into HIAs; • The role of HIA in ensuring that public policy reflects health equity concerns. To support learning and encourage reflection, each presentation will end with a brief discussion for sharing experiences and questions. Additionally, attendees will have the opportunity to work on a scenario exercise applying equity and inequality concepts. By combining cutting-edge research, practical case studies, and hands-on participation, this workshop will equip attendees with the knowledge and skills needed to advance HIA practices with a focus on equity and inequalities. Key messages • The integration of equity and inequality concepts into HIA is crucial to help meet the equity goal of health systems and health organisations. • Aligning the values in the HIAs with policymakers’ key priorities, such as equity and decreasing inequalities, can help improve the implementation of HIA's recommendations.