The founding documents of HIA identify citizen participation as one of its cornerstones. However, participatory practices in HIA are still limited in scope and in number. In addition, at times even the idea of citizen participation in HIA seems poorly articulated and is sometimes called into question.
Basing our discussion on a review of the literature on HIA, we explore, in this fact sheet, five categories of factors that can explain the significant gap between the participatory rhetoric attached to HIA, and actual practices. This short document might be of interest to public health actors who want to learn more about issues relating to health impact assessment.