Public health lessons from the French 2012 soda tax and insights on the modifications enacted in 2018.

In 2016, the World Health Organization officially recommended sugar-sweetened beverage (SSB) taxation as a strategy to reduce purchases, stimulate product reformulation and generate revenues for health-related programmes. Four years before, France had been one of the first countries to tax SSBs. However, the design of this tax was not considered optimal: its rate was flat, low, identical for SSBs and artificially-sweetened drinks containing no added sugars, and its initial public health justification was set aside in favour of budgetary concerns. In 2018, a new taxation scheme was enacted. Integrated in the Social Security Finance Bill, the tax on SSBs is now linearly indexed to the quantity of added sugars in the drink. In this article, we summarize the lessons learnt from the 2012 soda tax and offer insights on the potential public health benefits of the new tax enacted in 2018. A multidimensional framework aimed at gathering evidence about SSB taxation for public health drove our rational so that we address: (1) the soda tax policy-change process; (2) its impact on price and purchases; (3) the consumer receptiveness to the tax and; (4) its legal framework. We also discuss the potential application of the tax to other foods/nutrients.

Can Air Quality Citizen-Sensors Turn into Clean Air Ambassadors? Insights from a Qualitative Study.

While the figure of ambassador is being increasingly called upon in the field of environmental health, its scope remains fuzzy and its success factors have been little studied. This article presents the results of a qualitative study performed over three years on a French citizen-sensor scheme for air quality. The scheme draws on volunteer citizens to measure fine particles by means of micro-sensors. Volunteers are also tasked with raising awareness in their entourage about environmental issues with the aim of changing people's behaviour. We investigated this strategy and sought to identify the conditions that enable citizens to become effective clean air ambassadors. The scheme's intervention logic was first reconstructed and a literature review of similar projects was conducted. Then, three surveys were carried out with the scheme's volunteers. Each survey consisted of an observation of the volunteers' practices and individual interviews (70 in all) in order to understand these citizen-sensors motivations and experiences, and characterize how they fulfilled their role. We concluded that, for citizen sensing, the scope and role of ambassador should be reconsidered insofar as these citizens serve as peer leaders and mediators. In this respect, we try to define the success factors for citizen-sensing-based ambassadors programmes.

La participation citoyenne dans les évaluations d'impact sur la santé en France.

OBJECTIVE: Citizen participation is one of the core values of Health Impact Assessment (HIA). Nevertheless, there is a gap between the ideal described in HIA foundational texts and its current practice as reported in the international literature. In the light of HIA recent development in France, this article provides some insights to better understand this concept and the challenges associated to its actual implementation in France. METHODS: This exploratory study is based on semi-structured interviews, on-site observations and document analysis of a panel of 11 HIAs carried out in 8 French regions between 2011-2018. Citizen participation is analyzed according to 5 dimensions: stakeholders’ perceptions and expectations, scope of participation, scale, methods of engagement, constraints. RESULTS: As reported in other studies published abroad, the concept of citizen participation remains unclear in France. Despite some progress observed in more recent HIAs, its actual implementation remains incomplete due to political, financial and human constraints and to competition with other existing mechanisms for public participation at a local level. CONCLUSION: While accumulated experience may contribute to effectively integrate citizen participation in HIA, this study shows that in order to better bond this practice to health promotion values, it is important to clearly define the objectives of such participation, to sensitize city counselors in advance, to strengthen HIA practitioners’ capacities, and to rely on participation specialists.

Similitudes et différences entre l'évaluation d'impact sur la santé et l'évaluation de politiques publiques.

INTRODUCTION: Health impact assessment (HIA) is rapidly growing in France. It shows similarities with other approaches, such as the evaluation of public policies (EPP), with which it can sometimes be mistaken for.Purpose of research: The aims of this article are to identify the similarities and differences between HIA and EPP and to assess the extent to which HPA skills are transferable to HIA. RESULTS: The two approaches share common features: they are both based on principles and values that structure practice; they produce a judgement at the end of an argumentation process; they follow the same thinking process and use similar tools. However, HIA has specific features that justify the strengthening of skills, particularly in relation to its participatory dimension. CONCLUSIONS: The two approaches have more similarities than differences due to their evaluative nature. The competences acquired in PPE are transferable to HIA and the evaluator at the crossroads of the two exercises can revisit and enrich his practice in PPE.

L'évaluation d'impact sur la santé pour scruter et sculpter les politiques.

Health impact assessment (HIA) is a prospective approach that consists of identifying the potential consequences, both negative and positive, of an intervention on the health of populations with the aim of improving it. Identified as a specific practice in 1999, it rapidly gained in popularity and was progressively deployed on all continents with variations in terms of implementation strategies, area of application, scales of implementation, modes of governance, institutions and actors involved. It is currently booming in France and Quebec, where it is generating real expectations with regard to the issues of health inequalities, democracy and the coordination of sectoral policies. This article, based on our research, provides a brief portrait of HIA in France and introduces questions on the strengths, limitations and added-value of the approach. This special issue sheds light on the practice through applications in different fields and contexts, emphasizes the methodological, political and social issues related to the process as well as the challenges to be met in order to strengthen the potential of HIA to improve decision-making and develop policies and projects that promote health.

The challenge of assessing social cohesion in health impact assessment.

Health impact assessment (HIA) is a method by which a policy, programme or project falling outside traditional health fields, may be judged as to its potential effects on the health of a population to mitigate negative impacts and strengthen the positive ones. Proposals are analysed from the perspective of all the determinants of health. In France, HIAs are mainly applied to urban development projects where social cohesion (SCo) is a major issue. Although the HIA method is well structured as a step-by-step process, there are no guidelines for assessing SCo. This article opens with literature review to clarify the concept of SCo and to understand how the built environment influences SCo and how social environment influence health. Drawing on this work, this paper presents an analytical framework to assess SCo, integrating both the spatial and physical dimensions of urban design and the perceptions of the neighbourhood characteristics. Following a brief overview of the key findings from applying this framework to HIA of an urban development project, the paper discusses its related strengths and weaknesses. The framework could be a useful tool for HIA as it embraces knowledge from both urban planning and social sciences. It also allows for an overall analysis of all the indicators without relying on a checklist. Nevertheless, it should be tested further to improve its validity.

A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France).

Many countries have introduced health impact assessment (HIA) at the national, regional, or local levels. In France and in Québec, there is increasing interest in using HIA to inform decision-makers and influence policies, programs, and projects. This paper aims to compare HIA implementation models in two regions: Nouvelle-Aquitaine (France) and Montérégie (Québec, Canada) using a case study methodology. The objective is to gain a better understanding of the similarities and differences in the approaches used to achieve the operationalization of HIA. The methodological approach involves four steps: (1) design of an analytical framework based on the literature; (2) exchanges within the research team and review of documents concerning the two implementation strategies under study; (3) development of the case studies based on the proposed framework; and (4) cross-comparison analysis of the case studies. The findings show that the two regions share certain similarities, including the strong commitment and political will of the public health organizations involved and a well-established culture of engaging in intersectoral action with municipal partners. Differences mainly concern their different approaches to implementing HIAs in accordance with the regional policies and the organizational and administrative contexts in place. This study identifies potential avenues for supporting the practice of HIA at the municipal level.

[Can health impact assessment be conducted on the political platforms of presidential election candidates?] / L'évaluation d'impact sur la santé peut-elle être appliquée aux programmes de candidats à l'élection présidentielle ?

Health impact assessment (HIA) is defined as a method by which a policy, program or project may be judged as to its potential effects on the health of a population in order to mitigate negative impacts and strengthen the positive ones. During the 2017 French presidential elections, health promotion actors decided to conduct an HIA on the political platforms of the five main candidates. The assessment of each political platform was conducted by 7 evaluators and reviewed by 35 health promotion experts. Then, a comparative analysis of the platforms was led on 3 specific topics. This HIA was conducted in accordance with the international standards of practice. Within all of the 5 political platforms, the proposals related to Environmental and energy policy, and to Agricultural policy were the ones with widely positive impacts on the determinants of health. Concerning all of the other policy proposals, their respective impacts and affected populations broadly change from one platform to another. Due to its political object, this HIA had to deal with methodological challenges such as platform instability, uncertainty over the genuine implementation of measures as well as the importance of the underlying platform values. Nonetheless, such an implementation of the HIA process on the political platforms of candidates running for an important position is interesting because it represents an opportunity to look at the platforms with fresh eyes and enriches the advocacy to take public health into account in the policy making processes and tries to operationalize the concept of health in all policies.

[Can health impact assessment influence policies relating to green spaces in urban areas?] / L'évaluation d'impact sur la santé peut-elle influencer les politiques d'espaces verts dans l'espace urbain ?

Growing urbanisation in the last decades and the increase in population density have significantly contributed to lessening contacts between people and nature. In response to this phenomenon, the consideration given to the role played by nature in urban environments has increased uninterruptedly, supported by the social demand for a greener urban environment. Health impact assessment is an approach aimed at anticipating the consequences of policies, projects or laws on health, prior to their implementation, and offering suggestions for readjustments that limit negative impacts and reinforce positive ones. It has been developing in France since 2010 mostly in connection with urban planning projects in which green space development is an important feature. This article examines HIA's capacity to influence urban planning choices and policies to make them greener, fairer and more beneficial to health.

Health impact assessment on urban development projects in France: finding pathways to fit practice to context.

In France, there is increasing interest in health impact assessments (HIAs) and most are performed on urban projects. The field of expertise is still under development and mostly established within the public health sector. To date, in France, all HIAs conducted in urban planning are stand-alone HIAs disconnected from the required environmental impact assessment (EIA). The paper opens with an introduction of the close and complex relationship between health and urban planning, HIA and a description of key elements needed for understanding the French context. Then, the paper analyses the context and the implementation process for four HIAs in progress in order to understand the specific characteristics of urban development, identify the key stages for introducing a health perspective into urban projects, and extract avenues to be explored when adapting HIAs applied to urban planning in France. Using a qualitative multiple case study design, an analysis framework was built to compare several aspects of the four HIAs and made it possible to highlight three pathways for adapting HIA to the urban planning sector: the schedule, links between the EIA and HIA, and the complementarity of the initiatives to involve residents. Legal measures enable a point of contact that brings health institutions and cities closer together. HIA is yet another tool that public authorities now have at their fingertips to work together in strengthening democracy and in reducing social, geographical and environmental health inequalities. More research must be undertaken to develop an understanding of the practice-related context; to judge HIA's capacity to draw on existing approaches in different fields; and to explore the different avenues leading to increased health, wellbeing and equity.

[Evaluation: an avenue to improvement of health promotion in Africa?]. / L'évaluation, une voie pour faire progresser la promotion de la santé en Afrique ?

Are the methods used to evaluate health promotion interventions in Africa adapted to the specificities of this field ? The authors try to answer this question based on reflective analysis of four evaluations that they conducted in Benin, Burkina Faso and Mali. The experiences reported illustrate the desire to conduct the evaluation approach in line with the principles of health promotion but also the difficulties involved to overcome the obstacles to practical application of evaluation. Considerable progress has yet to be made to ensure that evaluation fully meets the expectations of stakeholders and the values of health promotion : all of the dynamics generated by health promotion interventions must be taken into account, equity must be integrated at the heart of the reflection, innovative practices must be supported in view of their durability. Because it facilitates the emergence and sharing of multiple visions of this still poorly defined concept, evaluation constitutes an avenue to improvement of health promotion in Africa.

[Evaluation of public health plans: a driver of change for regional health policy in France?]. / L'evaluation des plans de sante publique: un levier de changement pour les politiques regionales de sante en France?

Between 2007­2010, each French region carried out an evaluation of their public health plan, at the very moment when regional health system governance reform was taking place. The objective of this article is to analyze the influence of this dynamic of evaluation on health policy at the regional and national levels. An in-depth analysis in nine regions showed short-term consequences that were inconsistent among regions, depending on the implementation schedule and the evaluation process that was put into place. On the other hand, the lessons that emerged reinforced local expertise that was useful for the new planning exercise. This regional work has not yet been taken up nationally, but we cannot exclude the possibility that it fueled discussions in the working groups preparing the reform.

[The relationship between a health education program and its assessment: the example of Couleurs Santé]. / Interactions entre un programme de promotion de la santé et son processus d'evaluation: l'exemple de Couleurs Santé.

Couleurs Santé was a community mobilization program implemented in six areas of Brittany, France. The aim of the program was to develop health education projects in schools and among children and adolescents with a view to promoting the development of psychosocial skills and creating healthy environments. Assessment was an integral part of the program, the main aim being to evaluate the effectiveness of the program and its transferability to other settings. The assessment process was examined in order to determine the impact of the assessment on the program and to assess the influence of stakeholders on the assessment method. This paper provides an overview of the development of the program and the associated assessment process and shows how the assessment process has helped to improve the program. The findings highlight the diversity of local approaches and strategies, underlining the importance of the varying interpretations of the initial framework, the contributions of actors and environmental opportunities and constraints. The study also highlights the importance of considering the context and the expectations of actors for developing a method adapted to the program model and for meeting the needs of users.