[Health impact assessment: the state of the art]

Health impact assessment (HIA) is being increasingly used due to governments' growing interest in putting health high on their agendas. HIA provides a structured framework to estimate the potential consequences of non-health sector policies in community health. The ultimate goal of this framework is to maximize health gains and, as far as possible, to reduce health inequalities. HIA is believed to have significant potential to address health determinants and to promote intersectorial action in health. Challenges for the future include the need to strengthen its methodological bases, particularly those concerning the process of impact prediction, and the need to promote its progressive incorporation into decision-making processes, either independently or integrated within other impact assessment tools. The strategic affinity of HIA with the European "Health in All Policies" strategy strengthens current opportunities for the implementation of this tool in Spain, especially in the context of the ongoing debate on the future of public health and the need to give public health higher priority in political-institutional agendas. To move forwards, we should promote debate on HIA, as well as research and the practice of this tool in Spain, where only some pioneer experiences exist. The public health sector should lead the development of HIA pilot studies in order to assess its current contribution to the formulation of healthy public policies. In addition, HIA should be promoted among policy makers and other stakeholders in order to facilitate its adoption and integration into strategic planning and relevant agencies and decision-making structures. The ultimate goal is to find new formats for intersectorial collaboration and new tools for putting the principles of Health in all Policies into practice, thus successfully achieving health and public health goals.