The contextual prerequisites in a country are crucial to the implementation and effectiveness of health impact assessment (HIA). This article aims to show how the Swedish government has been working to create supportive contextual prerequisites for HIA. These prerequisites are described based on the following factors: stewardship, including public health policy, party politics and legal preconditions; organization, including resources and funding; and delivery, which is dependent on the public health culture. The aim has also been to draw conclusions about facilitators of and obstacles to HIA implementation.
The article is based on a review of relevant literature.
Since 2000, the Swedish government has taken a number of initiatives to increase the application of public health and HIA. National agencies and all of Sweden's county administrative boards have received government assignments with the National Institute of Public Health in a supportive role.
Some facilitators of HIA implementation are: utilizing existing impact assessment knowledge; connecting HIA with the concept of a sustainable social development; and awareness of the time needed to adopt complex information. Obstacles detected are: the lack of a mandatory law for HIA; a lack of funding; and an occasional lack of public health skills. The final conclusion is that the public health policy adopted by the Swedish Riksdag, with its overarching aim of equality in health and its 11 domains of objectives, has had a crucial effect as a framework for HIA in Sweden.