The Delayed Growth of China’s Health Impact Assessment: Disentangling Causes from Different Disciplines

Background: Health Impact Assessment (HIA) is a practical tool used to judge the potential health effects of a policy, program, or project on a population. In 2016, China started implementing HIA to promote its nationwide “Health First” political campaign. The central government developed a succession of laws and plans to shape HIA’s political-administrative framework, yet they are too broad to advise how to undertake an HIA at a local level. Since 2017, China has tested HIA pilots in several jurisdictions to institutionalize HIA. However, all HIA pilots are far from completion as of September 2023, moving at a much slower rate than other policy pilots. This raises the question of why HIA has been so slow to grow in the Chinese context. What can China do to further its HIA development? By seeking answers to these questions, this article aims to inform Chinese policymakers and planning researchers whose scholarly interests vary from health impact assessment to governance and institution building in a volatile global economy that now places a high value on planning for public health. Methods In this qualitative study, we conducted 17, one-off, semi-structured, online interviews with Chinese scholars and officials from various disciplines who had direct or indirect experience with HIA. The disciplines include urban planning, public policy, public health, etc. We identified four major themes through a codebook thematic analysis using ATLAS.ti 22. Results Four themes have emerged concerning the delayed growth of HIA in China. They are conceptual differences between EIA and HIA; technical issues associated with environmental hazards and individual health; legislative issues; and cross-sector collaboration issues. Conclusions The delayed growth of China’s HIA prevents the country from widely refining its policies, programs, and projects to achieve public health goals. To address this, the paper offers several recommendations, including emphasizing policies that enact changes and de-emphasizing scientific uncertainty; developing the HIA implementation law, supporting policies, and a practical guideline; and promoting multidisciplinary professional development. We believe that these recommendations will eventually speed up the HIA development in China. We also hope that the recommendations can offer policy guidance to other developing countries as they navigate their public health policies.