A Critical Realist Approach to Integrating Human Rights into Health Impact Assessment

Abstract

Objective To conceptualise a practically adequate theory and methodology of Human Rights Health Impact Assessment (HRHIA) using critical realist (CR) ontological perspectives and research approaches. Research design A CR framework for theory development and verification was applied. It involved four interrelated and iterative steps: description and analytic resolution of events and their effects; explication of structure using abductive and retroductive reasoning; assessment of explanatory power and contextualisation; and verification and concretisation of emergent theory. Application of the framework involved analysis and theorising of data from 23 international human rights (HR) and health impact assessment (HIA) experts; existing case studies of HIAs (11 case studies, 33 interviews) and a HR-based initiative (1 case study, 12 interviews); my own recollections and introspections on HIA projects; and relevant literature. Findings A methodology is conceptualised as an entity with specific properties that give it the power to guide an overall process intended to achieve a defined outcome or purpose. Methodologies can exist in four states: conceptualised, intended, enacted, and experienced. The properties that empower the guidance mechanisms of a methodology include interrelated points of view concerning: the (health rights) environment that the methodology is intended to respond to and influence; relevant knowledge properties of people involved in use of the methodology; the intended purpose and goals of the methodology; the methodology rationale; conceptual frameworks about HRHIA and HR environments that inform decision-making; processes for enacting the methodology that subsume methods, tools and conditions associated with their use; and criteria and standards for evaluating the methodology, and the outcomes when the methodology is enacted. This definition and framework were used to develop an HRHIA-specific methodology framework (state 1) and some aspects of an intended methodology (state 2). The latter included development of a procedural model and identification of potential mechanisms associated with its implementation. Conclusion This research demonstrates that a theory and methodology for HRHIA can be conceptualised using a critical realist theorising framework. The research makes a significant contribution to scholarship associated with the application of a CR paradigm in the contexts of HRHIA and methodology development.