Institutionalization of health impact assessment in China: status quo, challenges and perspectives

Health Impact Assessment (HIA) is a critical tool for integrating health into public policy. While China has advanced HIA institutionalization through national legislation, a comprehensive analysis of its implementation across different levels of governance is needed.

This study conducts a systematic policy analysis of national laws, subnational pilot programs, and technical guidelines to examine the development of HIA in China. The analysis focuses on institutional arrangements, drivers, and barriers identified in key regions, including Zhejiang, Sichuan, and Shanghai.

The analysis reveals that despite innovative subnational models such as Zhejiang's AI-powered decision-support system, national implementation remains fragmented. Key challenges include unclear institutional mandates, a critical tension between health-led and department-led assessment processes, and limited public participation.

We conclude that sustainable HIA institutionalization in China requires not only dedicated legislation but also deeper integration with the Health in All Policies (HiAP) framework, coupled with robust mechanisms for transparency and accountability. These findings offer a roadmap for China and a comparative case for HIA development in other complex governance systems.