Use of Policy Risk Assessment Results in Political Decision Making

Health Impact Assessment claims to be applicable to policies, programmes and projects but relatively little work on policy has been reported. The appearance of a book on assessing the health consequences of national policies in several countries is to be warmly welcomed. The contrasting of a top down approach (assessing the health consequences of a proposed or existing policy) and a bottom up approach (starting with a health problem and working back to policy solutions for that problem) is a useful addition to our thinking on this subject. The bottom up approach chimes with the suggestions made elsewhere that impact analysis should not be a final step, which is only undertaken when a policy has been finalised, but should be an integral part of the whole policy making process. Throughout the book emphasises how causal diagrams and full chain thinking help to unpick the consequences of policy. The approach in RAPID relies very heavily on epidemiological thinking and pays little attention to the stakeholder participation, which is emphasised in other approaches.