Health Impact Assessments (HIAs) can influence policies that reduce health inequalities

Historically their use is sporadic, rather than routine in political decision making

Embedment in national policy can achieve sustained cross-government action on health inequalities

This will require political commitment, sustainable funding and a dedicated support structure

Mandatory screening and assessment for significant policies is a key for efficacy

Consistent and systematic integration of health considerations in upstream political decision making is needed to improve population health and enhance health equity. Previous research supports the effectiveness of Health Impact Assessments (HIA), as a key component of a Health in All Policies (HiAP) approach, demonstrating its ability to influence cross-government policies that affect health and health equity. HiAP is an approach to embedding health and health equity in multi-sector decision making. Despite proven potential, HIA has historically been used sporadically and opportunistically rather than as a part of routine policy making. Here we argue that mandatory HIA in national policy, as part of an overall HiAP approach, is needed to achieve effective and sustained cross-government action on health and equity. Implementing mandatory HIAs would ensure that health considerations are routinely evaluated in policy decisions, enabling governments to proactively address health disparities and improve public well-being. Harnessing the benefits of HIA requires political commitment to an evidence-informed approach to population health, with dedicated civil service support, and a mandatory screening and assessment process for significant policies. A systematic and obligatory approach would foster accountability, enhance policy coherence and ultimately promote health and equity. It would also send a clear message that consideration of health is a non-negotiable in every policy decision.

Health impact assessment

Health in all policies

Health inequalities

Health politics

Health equity

© 2025 The Author(s). Published by Elsevier B.V.