Health impact assessment research and practice: A place for paradigm positioning?

In this article, we provide a critical review of the place of paradigm in health impact assessment (HIA) research and practice. We contend that most HIA practitioners have given insufficient attention to paradigm positioning when developing and applying HIA methodologies and that some concerns about current HIA practice can be attributed to this. We review HIA literature to assess the extent and nature of attention given to paradigm positioning and these related concerns. We then respond to our critique by exploring the implications, opportunities and challenges of adopting a critical realist paradigm, which we believe has the potential to help HIA practitioners to develop HIA methodology in a way that addresses these issues.

► We provide a critical review of the place of paradigm in HIA.
► We demonstrate that HIA practitioners give insufficient attention to paradigm.
► The implications, opportunities and challenges of adopting a critical realist paradigm are explored.
► This is the first paper, to our knowledge, that discusses a critical realist approach to HIA.