Francis Jambon
email: francis.jambon@ensma.fr

Lisi / Ensma

Taxonomy for Human Error and System Fault Recovery from the Engineering Perspective

Keywords: Human error recovery, system fault recovery, taxonomy, human-computer interaction, man-machine interface engineering

This paper deals with human error resistance. In the first part of it, a short state-of-the-art of human error resistance, i.e. error prevention and error handling is presented. Then, error handling, which is usually divided into four sequential tasks -error detection and explanation, recovery planning and execution -is described.

The second part of this paper put emphasis on error recovery, which is our main object of study. First and foremost, through an example, we can see what makes the distinction between forward and backward error recovery in current taxonomy. Then the limits of this distinction are going to be highlighted.

In the third part of this paper we propose and illustrate, from the engineering perspective, our own taxonomy of error recovery suitable for real-world and dynamic systems.

INTRODUCTION

Although human errors are often observed in humancomputer interaction, they are usually overlooked or ignored by most interface designers. Poor support for human error management in interactive system development may be an explanation of the designers' attitude. In this paper, taking into account designer's point of view, our aim is to support design for error recovery practices in interactive system development thanks to models. We all know that "to err is human". So, designers must support human error resistance functions into the user interface life cycle. In this article, we propose a new taxonomy of human error and system fault recovery in order to help practitioners to choose among recovery alternatives.

RELATED WORK Human Error

Human Error has been widely studied from the cognitive science perspective [START_REF] Amalberti | La conduite des systèmes critiques[END_REF][START_REF] Leplat | Erreur humaine, fiabilité humaine dans le travail[END_REF][START_REF] Rasmussen | Information processing and Human-Machine Interaction : An approach to cognitive engineering[END_REF][START_REF] Reason | Human error[END_REF] as well as from the applied science perspective [START_REF] Nicolet | Catastrophes ? Non merci ! La prévention des risques technologiques et humains[END_REF][START_REF] Swain | Handbook of human reliability analysis with emphasis on nuclear power plant applications[END_REF]. The definition of "human error" is an important topic, but cannot be reviewed here. For an overview on this topic, we suggest reading Reason [START_REF] Reason | Human error[END_REF].

One of the most significant result of human error studies -from the designer's point of view -is the Human Reliability Analysis [START_REF] Hollnagel | Human reliability analysis: context and control[END_REF]. As an example, the rather old THERP method [START_REF] Swain | Handbook of human reliability analysis with emphasis on nuclear power plant applications[END_REF] focuses on the evaluation of the Human Error Probability of nuclear power plant control rooms. Other contributions suggest that -extendedinterface specification notations can be used to detect a breakdown during human-computer interaction [START_REF] Gray | Supporting errordriven design[END_REF]. With these results, designers can evaluate human error rates and their consequences on the system state, at the very first step of the design process. So, at this stage, human error resistance strategies can be defined in order to prevent or limit the consequences of human errors.

Error Resistance Strategies

Error resistance can be achieved by means of two strategies: error prevention and error handling [START_REF] Lewis | Designing for Error in User Centered System Design / New Perspectives on Human-Computer Interaction[END_REF][START_REF] Van Der Schaaf | Prevention and Recovery of Errors in System Software[END_REF]. Error prevention can result from forcing functions [START_REF] Norman | The design of every day things[END_REF], operator's selection, or training. But error prevention will never get rid of all human error occurrences. That's why error handling -sometimes called error correction or error management -has to be actually supported in interactive systems.

Human error resistance is mostly supported -when that is the case -by user interface designers through prevention. Designers ought to follow the prevention strategy, for self-evident reasons. Unfortunately, they usually deal with human error only with the prevention strategy. And yet, scientific work [START_REF] Lenman | A framework for error recovery[END_REF], as well as aircraft accident report [START_REF]Ministère de l'équipement des transports et du tourisme. Commission d'enquête sur l'accident survenu le 20 janvier 1992 à l'Airbus A320 F-GGED près du mont Sainte-Odile (Bas-Rhin)[END_REF] stress the need for handling. In the former report, the authors criticize the fact that the human-system interface has given the crew too little chance to correct their disastrous error. Now, let's explore error handling.

Error Handling

As an operator, handling an error or a system fault, can be achieved by following four sequential tasks as shown figure 1: Error detection, i.e. the user needs to know that an error occurred ; Error explanation, i.e. the user must understand the nature of the error -do note that for the undo function, the user does not always need to know that ; Error recovery planning and execution, i.e. the user has to counteract the effects of the error [START_REF] Zapf | Introduction: Human Errors and Error Handling[END_REF]. Some systems have embedded auto-correction features [START_REF] Lewis | Designing for Error in User Centered System Design / New Perspectives on Human-Computer Interaction[END_REF]: in such systems, the error handling is achieved by the system which is in charge of the handling tasksdiagnosis and recovery.

Error detection and explanation are the first stepsdiagnosis -of error handling. They are primarily related to the interface presentation. In this paper, we focus on error recovery execution which involves the definition of the recovery procedures. Although error detection and explanation, and recovery planning are not our topic, we assume that they are compulsory in a perspective of design for error. For self-evident reasons, error recovery is void if the user cannot neither detect nor understand the error. Figure 1 summarizes the handling process of human error and highlights our topic of study.

Error Error detection

Error explanation

Error diagnosis

Error recovery

Planning Execution

Our topic of study Figure 1: The error handling process. Adapted from [START_REF] Zapf | Introduction: Human Errors and Error Handling[END_REF] FORWARD VERSUS BACKWARD ERROR RECOVERY Dix, Finlay, Abowd, & Beale [START_REF] Dix | Human-Computer Interaction[END_REF] make a distinction between backward and forward error recovery. This distinction is now commonly used in interactive system development. However, we suggest that this distinction is not as useful as it could be from the designer's point of view. So we propose our own taxonomy.

Backward Error Recovery

Backward error recovery is an attempt to restore the system state after an error has occurred. Backward recovery can be considered as the only real "recovery" function, since the unexpected effects of error are totally removed. Backward error recovery can be seen as a function to go back in time. As a result, novice users usually use it as a fail-safe learning method. According to Yang -in [START_REF] Lenman | A framework for error recovery[END_REF] -there are three kinds of backward error recovery commands: undo, cancel, and stop.

• The Undo function is the most famous one [START_REF] Dix | The cubeextending systems for undo[END_REF][START_REF] Thimbleby | User Interface Design[END_REF], and most editors -for texts or graphics -implements an undo function. Unfortunately, the undo function is also the most complex one. Designers have to do with the presentation, the granularity, the scope, and the range of the undo function. Moreover, current implementations of the undo function seem to fall short of user expectations [START_REF] Lenman | Investigating the granularity of the Undo function in human-computer interfaces[END_REF]. • The Cancel function is used to abandon commands under specification. For example, a user can cancel the typing of an e-mail message if the addressee has just entered the user's office. However, as for the undo function, the cancel function has to deal with its scope: the user must know which command(s) are concerned by the recovery. • The Stop function is used to terminate the process under execution. For example, a user can make the choice to stop a long printing command when he realizes that many users are waiting for the printer. However, the stop function is not always implemented as a pure backward recovery: in the former example, the user can stop the printing command while the printer is working, so, some pages may have been printed uselessly.

Forward Error Recovery

In forward error recovery, the user has to execute unexpected tasks to recover the fault. Usually the final result -the system state -is non-optimal. For example, if you break a dish plate, you have to use glue to recover your error. Of course, the final dish plate is not as nice as the unbroken one. In civil aviation, a lot of emergency procedures [1] are forward recovery procedures. In these procedures the "error" is a system fault. The result is generally a non-optimal state of the aircraft: after an engine fire, the latter can remain inoperative for the flight.

Forward recovery is commonly the only way to recover from technical failure or human error in critical systems like nuclear power plants, chemical plants, aircraft, vessels, etc. In these systems, side-effects of many actions cannot be easily removed. As Lenman & Robert [START_REF] Lenman | A framework for error recovery[END_REF] say "Forward error recovery is an important topic, and more research is needed concerning these questions". We do so.

Limits of this classification

Dix et al. [START_REF] Dix | Human-Computer Interaction[END_REF] use the example of an house of cards to show the difference between backward and forward error recovery: "for example, in building a house of cards, you might sneeze whilst placing a card on the seventh level, but cannot undo the effect of your misfortune except by rebuilding".

Erroneous task granularity

Dix et al. suppose that you cannot undo the fall of your house of card after placing a wrong card. Obviously Dix et al. consider that the erroneous task is placing one card on the house. But that's not so obvious, if we consider that the real task is building an eight level house of cards.

You may place a card in a wrong way, and then, the house falls down. Now collect all the fallen cards: that's a backward error recovery because you have undone the effect of your error. The system is exactly in the state before the beginning of your task "building the house of cards". Rebuilding the house of cards is now considered as a new task occurring after the recovery. So, the difference between backward and forward recovery is relative to the granularity of the erroneous task.

Additional cost of error

It is assumed that backward error recovery -undo, cancel, & stop -is the best way for a user to recover from an unexpected error. Clearly, pressing the "undo" button after a typing error is easy. Yet to achieve this goal, the user must retype the right letter, word, paragraph, or why not, the document. The cost of an error is clearly the cost of the correction task, as well as the cost of the correctly executed task. So, many users may prefer to use forward error recovery in order to move the system to a nonoptimal state but at a lower cost. This is a critical topic from the designer's point of view in dynamic systems, in which the cost of the recovery is, at first, Time.

Time

In dynamic systems, the recovery functions are not always available. In these systems, Time is also an interesting dimension. In order to illustrate the importance of time, let us study the example of a crew who has forgotten to extend the landing gear of the aircraft. The crew can easily correct this mistake for a few minutes by activating the extension of the gear. A few minutes later, the aircraft is at a too low altitude, so, the crew must follow a go-around procedure. Finally, the aircraft lands on the runway -without it's gear being extended -and no recovery is possible.

PROPOSED TAXONOMY

Based on these limitations, we proposed, in a recent publication [START_REF] Jambon | Error Recovery Representations in Interactive System Development[END_REF], three dimensions of analysis -Error Additional Cost, System State Degradation, and Timein order to help designers to understand the critical issue of error recovery from the operator's point of view. Our approach is now to define a novel taxonomy of error recovery, suitable for both static and dynamic systems.

System State Modification

We first propose a new distinction between forward and backward error recovery based on the expected state of the system.

Initial, Final, and Erroneous states

Three states from the operator's point of view are here below defined:

• The Initial State is the system's state before the error.

• The Final Expected State is the system's state that the operator wants to achieve thanks to his action. • The Erroneous State is the system's state resulting from the operator's error or system fault.

We assume that backward error recovery must be viewed as an attempt to restore the system state after an error or a failure occurrence. In other words, backward error recovery can be seen as a way to go back in time. As a consequence, all actions that restore the system's state after an error occurrence -not only undo and cancel functions but also complex or planned actions -are backward error recovery actions. Our definition of backward error recovery differs from the previous one [START_REF] Dix | Human-Computer Interaction[END_REF][START_REF] Lenman | A framework for error recovery[END_REF] on that point. As an example, the stop function cannot always be considered as a backward error recovery in our taxonomy, because the achieved state is sometimes closer to the final expected state than to the initial one as shown in the former printer example -nearly all of the pages may have been printed.

On the contrary, all actions which are an attempt to reach the final expected state must be considered as forward error recovery actions. So, complex planned action as well as simple atomic actions can be forward recovery actions. As an example, the correct performance of a previously forgotten action -an error can be due to a lack of action -is a forward error recovery in our taxonomy. Do note that to get the final expected state, the operator may execute a backward recovery action -undo for example -and then performs the correct action. However, these two sequential tasks cannot be considered as a forward error recovery because the effects of the error are first counteracted by a backward error recovery.

So, the transitions between the three states -initial, final expected, and erroneous -define the notion of error recovery as shown on figure 2. In real-world systems, the recovery -backward or forward -may not be perfect. In other words, neither the initial state nor the final expected state may not be reached from the erroneous state. As an example, the fire in an aircraft engine may be extinguished by the crew, but the engine often remains, then, inoperative for the flight. So, let us introduce a new distinction between perfect and imperfect recovery as shown on figure 3.

Initial
The imperfect recoveries introduce the notion of approach state for both initial and final expected states. These states are the result of an unsuccessful attempt to restore the initial state or to get the final expected state.

In the former example of the dish plate, the use of glue to recover the error -the action of breaking the dish plateis an imperfect attempt to restore its initial state -unbroken. Sometimes it is difficult to find which is the closest state of the reached state further to the imperfect recovery action. In this case, we suggest defining an intermediate state and not distinguishing backward and forward recovery.

First, let us study the failure of a aircraft landing gear system -as shown on figure 4 -to illustrate the concept of system state degradation. In our example, a failure in the extension of the landing gear occurs while the crew is attempting to extend the gear. Do note that this failure occurs during the operator's action, but must be considered as a system fault -in action -because the operator's goal cannot be achieved due to the system.

I' F'

Landing On the one hand, in order to recover the system's fault, the crew can extend the gear by gravity. This is an imperfect forward error recovery since the gear is extended, but also jammed in this position. The gear cannot be retracted -in our example -but this approached final state is although a safe state to land the aircraft.

On the other hand, the crew can retract the gear. This is an imperfect backward error recovery because the landing gear is retracted, but jammed in this position. We assume that this action is still possible. Then, the crew cannot get a normal extension of the landing gear: this is an approached initial state.

Sudden system fault recovery

In case of a sudden system fault, or unwanted action, any final expected state cannot be defined. As a consequence, if we follow our taxonomy, only perfect and imperfect backward error recovery are possible as shown on figure 5. Do note that the system fault which occurs during an action -for example the landing gear faultmust be distinguished from a sudden system fault -as an other example, an engine fire. A final expected state can be defined in the latter example and not in the former.

Static versus Dynamic Systems

A static system, is defined as a system which state cannot be modified by time. In such systems, the erroneous state can only be modified by an operator's action. As an example, word processor softwares are static systems: the user can correct his error whenever he wants -if no action is performed in the meantime.

Whereas the state of a dynamic system may be altered by time. In such systems, as aircraft, vessels, etc., the error state can be worsened by time. Consequently, the recovery functions may not be always available. As an example, a fire in an aircraft engine may be recovered by a correct use of the fire extinguisher. If the procedure is not correctly followed, the aircraft may suffer from an engine separation… Do note that in dynamic systems, the error can be triggered by time. Indeed, a forgotten action -for example extending the landing gear -becomes an error after a few minutes -when the aircraft reaches low altitude.

Recovery tasks

The operator's point of view makes out two types of recovery tasks:

• The Generic recovery tasks are undo, cancel, and stop functions. These tasks are well-known by the operator and are usually not difficult to perform. No planning is required and their cost, in terms of time, cognitive or conative [START_REF] Dorwell | Towards a conception for an engineering discipline of human factors[END_REF] load, etc. is usually low. We would like to add to this category the forgotten actions performed by the operator after noticing the missing.

• Needless to say that Planned recovery tasks require planning for the operator. The cost of these tasks result usually high for the operator. However, the cost is not always higher than backward error recovery because the total cost of a backward error recovery is the cost of the recovery in addition to the cost of the correctly executed task [START_REF] Jambon | Error Recovery Representations in Interactive System Development[END_REF].

This distinction between generic and planned recovery tasks is a engineering-driven distinction, i.e., it is related to the availability or not of atomic recovery functionsundo, cancel, and stop -in the man-machine interface. A more cognitive point of view can be taken here, considering that the recovery tasks are related to the three levels of control of human actions of Rasmussen's simplified human operator model Doing so makes out three types of recovery tasks: skill-based, rule-based, or knowledge-based recovery.

DISCUSSION

The novel distinction between recovery alternatives can be put side-by-side to the former distinction between forward and backward recovery. This is the topic of the first part of this discussion section. Then, in a second part, some limits of our approach are going to be highlighted.

Taxonomy mismatch

In our approach, we define a new taxonomy for error recovery. The two main dimensions -forward/backward & generic/planned -of our taxonomy are independent. So, from the operator's point of view, four types of recovery can be listed. Let us study the two recovery functions which are here below defined:

• Generic Backward Recovery in which we can find the well-known undo and cancel functions. • Planned Forward Recovery generally used to recover from system failure or to correct some tiny errors.

As an example, let us study a typical task in a graphical editor like MacDraw®. The user's task is to create a perfect circle. In our example, the user forgets to press the shift key before drawing, so the circle is in fact an oval. On a one hand, the user can choose to manage the error by the undo function of MacDraw®, and re-draw the circle. This is a generic backward error recovery. On the other hand, the user can choose to turn his oval into an approximate circle by direct manipulation. This is a imperfect -planned forward error recovery. The system state is not optimal -the circle is not perfect -but enough satisfactory for the user's need.

We assume that these two error recovery functions are the more often recovery functions met in real world. They are shown on figure 7 on a gray tint background. We suppose that the former taxonomy of human error recovery [START_REF] Dix | Human-Computer Interaction[END_REF][START_REF] Lenman | A framework for error recovery[END_REF] merge the main dimensions of our novel taxonomy: forward/backward & generic/planned, i.e., it regards planned forward recovery as forward recovery and generic backward recovery as backward recovery. So, this former taxonomy is a subset of the proposed one. And yet, the latter is backward-compatible with the former.

However, the two other recovery functions listed below are critical issues in the design of real-world humancomputer interfaces:

• Generic Forward Recovery gathering, for example, the performance of forgotten actions. • Planned Backward Recovery often used to recover from sudden system failure.

In order to illustrate our position, the figure 7 reveals some typical examples of human error and system failure recovery in accordance with the main dimensions of our taxonomy.

Planned

Generic

Backward Forward

Undo, Cancel

Sudden system fault recovery

Performance of forgotten actions

System fault (in action) recovery, Low-cost error recovery

Figure 7 : Example of the two main dimensions of our error recovery taxonomy

Limits

First and foremost, our approach is only an engineering view on human error and system fault recovery. We admit that this is an important limitation of the taxonomy. However, our approach is a bottom-up view of human error, i.e., error is only studied from the engineering perspective of the availability of recovery functions. No assumptions are done about cognitive aspects of detection, explanation of error, nor recovery planning. Our contribution deals with the execution of recovery. This view is directly related to the engineering process of man-machine systems: it should help designer to explore recovery alternative through available recovery functions.

Another point limits our contribution. We consider that the operator goal is always to recover from the error. Sometime, due to lack of time in dynamic systems, the operator may want not to recover from an error in order to save time, i.e., to live with error.

CONCLUSION & FUTURE WORK

As a conclusion, we hope we have provided designers a new way to understand the operators' point of view in error recovery. We assume that these dimensions can be used to evaluate system failure as well as human error recovery alternatives of safety-critical systems. By doing so, we hope that this taxonomy can ensure more safety in the conception of the Human Computer Interface of these systems. Obviously, these dimensions can also be used in the design process of non-critical desktop computer interfaces in order to evaluate the real benefits of recovery.

This article deals with a taxonomy of human error and system fault recovery from the engineering perspective. This taxonomy is a first attempt to enrich the classical human reliability analysis step of the critical manmachine interface engineering process. The next step of our approach, which is in progress, is to identify the basic patterns -in the dialogue controller of man-machine interfaces -that implements recovery functions. Then, we will make links between the taxonomy and these patterns.

Figure 4 :

 4 Figure 4 : Landing gear failure example

Figure 5 :

 5 Figure 5 :System Failure Recovery

ACKNOWLEDGMENTS

The author would like to acknowledge the participants of the "User Interfaces for All" ERCIM workshop whose questions inspired this article. Many thanks to Sylvie Ferrés for the English review of the article and Jean-Marc Robert for his encouragement leading me to write it.


EHESP Françoise Jabot

Ana Rivadeneyra-Sicilia

Keywords: health impact assessment, institutionalisation, health promotion, intersectoral collaboration, capacity building

art, challenges and perspectives

HIA implementation has rapidly grown in France. The question arises as to whether such growth is paving the way towards institutionalisation. An analytical framework was built based on the literature and capturing key dimensions characterising HIA practice and institutionalisation. Collected data draw upon documented HIAs, evaluation reports, direct observations and workshops. HIA practice in France follows a stand-alone procedure and is based on a holistic model of health. Its largely concerns intermediate HIAs commissioned by municipalities with the support of regional health authorities. Mainly applied to urban planning, HIAs are usually conducted by private firms, and local health observatories. Levers for institutionalisation include: an enduring tradition of intersectoral collaborations for health; a growing culture of health promotion; supportive environmental regulatory requirements; and policy frameworks and mandates addressing health inequalities at a regional and municipal level. For HIA to be more institutionalised, there is a need to clarify its purpose, continue building capacity, promoting impact evaluations for evidence on HIA' potential to advance HiAP and obtain greater commitment from national authorities.

Introduction

Health impact assessment (HIA) has been defined as "a process which systematically judges the potential, and sometimes unintended, effects of a project, program, plan, policy, or strategy on the health of a population and the distribution of those effects within the population" in order to identify measures to adapt the design and the delivery of the initiative to both protect and to promote health [START_REF] Winkler | Health Impact Assessment International Best Practice Principles[END_REF]. HIA developed from two streams of influence: environmental health and health promotion [START_REF] Harris-Roxas | Health impact assessment: the state of the art[END_REF]) and it includes elements from both traditions. HIA is particularly influenced by health promotion to the extent that it applies a holistic model of health which emphasises the importance of the social determinants of health and adheres to ethical principles such as equity and social justice, democracy and citizen participation, principles that distinguish HIA from other forms of impact assessment [START_REF] Cave | Lessons from an International Initiative to Set and Share Good Practice on Human Health in Environmental Impact Assessment[END_REF]. It follows a structured stepwise process that uses an array of data sources and analytical methods, and it addresses the unequal distribution of impacts within a given population. It relies on inputs of a wide range of stakeholders [START_REF] Lock | Health impact assessment[END_REF][START_REF] Wise | The role of Health Impact Assessment in promoting population health and health equity[END_REF]). As a result, it can fulfil a regulatory requirement, support a decision-making process, develop advocacy for better well-being and social justice, and empower populations [START_REF] Harris-Roxas | Differing forms, differing purposes: A typology of health impact assessment[END_REF].

HIA practice has rapidly developed in France over the last ten years [START_REF] Jabot | A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France)[END_REF]). The first HIA was undertaken in 2008 in Rennes and focused on a day-care centre [START_REF] Moulin | d'une méthodologie et application à un projet pilote : La crèche Colette de la ZAC de Beauregard[END_REF]. Although focused on environmental determinants, it helped to raise HIA awareness among municipal officials and led to a second HIA in 2011 on a railway station renewal project [START_REF] Tollec | L'Évaluation d'Impacts sur la Santé (EIS) : une démarche d'intégration des champs santé-environnement dans la voie du développement durable Application à un projet d'aménagement urbain : la halte ferroviaire de Pontchaillou à Rennes[END_REF]. Integrating a wider range of determinants, this second HIA served as a model for other municipalities that would later embark on the process. In 2010, the Ministry of Health organised a seminar to raise interest in HIA among national-level stakeholders. Subsequently, the National Institute for Prevention and Health Education (NIPHE) funded a comprehensive HIA on a transportation project in Greater Paris. This was followed by a call for funding several HIAs in different regions and the organization of a package of training sessions for elected officials, staff from public institutions and future practitioners. Following these early years, HIA practice gathered momentum in 2016 thanks to the political will and interest of some Regional health agencies (RHAs) to put health on the political agenda and enhance proactive collaboration to this end. Since then, HIA has continued to grow, particularly at the local level. The EHESP has been engaged in the process from the very beginning, conducting HIAs and providing training and tools. Around sixty HIAs have been launched in France since 2011, even though this number should be interpreted with caution for two reasons: there is no national HIA repository and some experiences qualified as HIAs do not necessarily meet practice standards.

HIA institutionalisation, that is, "the systematic integration of HIA into the decision-making process" (Wismar and European Observatory on Health Systems and Policies 2007), has progressed internationally with variations from one country to another. Different strategies have been proposed to advance towards this end institutionalisation, including promoting non-health sectors awareness and concern on health issues and the interest of using HIA, developing supportive policy or administrative frameworks to conduct HIA and implementing legal frameworks as permanent rules and procedures for mandated HIA [START_REF] Banken | Strategies for Institutionalising HIA[END_REF][START_REF] Lee | Cross-country analysis of the institutionalization of Health Impact Assessment[END_REF]. While legal frameworks constitute the most effective means to advance HIA institutionalisation, it has been noted that they may be insufficient as ongoing input, support and quality control by the health sector will be required [START_REF] Cave | Lessons from an International Initiative to Set and Share Good Practice on Human Health in Environmental Impact Assessment[END_REF]. This finding has led some authors to propose the effective inclusion of health and health equity in environmental impact assessment (EIA), as an opportunity to advance health issues in decision making processes subjected to environmental regulatory requirements [START_REF] Bhatia | Integrating human health into environmental impact assessment: an unrealized opportunity for environmental health and justice[END_REF][START_REF] Cave | Lessons from an International Initiative to Set and Share Good Practice on Human Health in Environmental Impact Assessment[END_REF].

Literature published in different countries over the last fifteen years provides some insight on contextual and process factors that have helped or hindered HIA integration into the decision-making process. There appears to be a broad consensus regarding the need for a strong political commitment and public support for HIA institutionalisation [START_REF] Finer | Implementation of a Health Impact Assessment (HIA) tool in a regional health organization in Sweden-a feasibility study[END_REF][START_REF] Davenport | Use of health impact assessment in incorporating health considerations in decision making[END_REF][START_REF] Wismar | The effectiveness of health impact assessment: scope and limitations of supporting decision-making in Europe[END_REF]Wismar and European Observatory on Health Systems and Policies 2007;[START_REF] Mannheimer | Introducing Health Impact Assessment: an analysis of political and administrative intersectoral working methods[END_REF][START_REF] Ahmad | Enabling factors and barriers for the use of health impact assessment in decision-making processes[END_REF][START_REF] Morgan | Health and impact assessment: Are we seeing closer integration?[END_REF][START_REF] O'mullane | Health Impact Assessment (HIA) in Ireland and the role of local government[END_REF][START_REF] Negev | Integration of health and environment through health impact assessment: Cases from three continents[END_REF][START_REF] Harris | Including health in environmental impact assessments: is an institutional approach useful for practice? Impact Assess Proj Apprais[END_REF][START_REF] Morteruel | Health Impact Assessments in Spain: Have They Been Effective[END_REF]. A mandatory legal framework is also identified as an enabling factor as it provides legitimacy within the policy process, facilitates working relations and supportive infrastructures, and clarifies under which circumstances HIA is required [START_REF] Knutsson | Review Article: Health impact assessment developments in Sweden[END_REF][START_REF] Fakhri | Proposing a framework for Health Impact Assessment in Iran[END_REF][START_REF] Winkler | Current Global Health Impact Assessment Practice[END_REF][START_REF] Iglesias-Merchan | Challenges to integrate health impact assessment into environmental assessment procedures: the pending debate[END_REF][START_REF] Diallo | Health impact assessment-insights from the experience of Québec[END_REF], notably in countries lacking a tradition of HIA [START_REF] Negev | Integration of health and environment through health impact assessment: Cases from three continents[END_REF]). In addition, authors point to wellestablished policy and administrative frameworks allowing HIA integration into existing Accepted Manuscript / Final version formal procedures and putting health authorities to work with other agencies [START_REF] Finer | Implementation of a Health Impact Assessment (HIA) tool in a regional health organization in Sweden-a feasibility study[END_REF][START_REF] Davenport | Use of health impact assessment in incorporating health considerations in decision making[END_REF][START_REF] Ahmad | Enabling factors and barriers for the use of health impact assessment in decision-making processes[END_REF][START_REF] Morgan | Health and impact assessment: Are we seeing closer integration?[END_REF][START_REF] Dannenberg | Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports[END_REF]. The existence of a regulatory foundation in other impact assessment procedures such as Strategic Environmental Assessment (SEA) and EIA may also contribute to HIA institutionalisation [START_REF] Fehr | Health in Impact Assessments: Opportunities not to be missed[END_REF][START_REF] Mccallum | An adaptable Health Impact Assessment (HIA) framework for assessing health within Environmental Assessment (EA): Canadian context, international application[END_REF]. In Europe, progress in use of integrated assessments could contribute to further HIA recognition and development [START_REF] Wright | Institutionalizing policy-level health impact assessment in Europe: is coupling health impact assessment with strategic environmental assessment the next step forward?[END_REF]. The application of Directive 2014/52/EU encourages a greater consideration for health in SEA and EIA and, in some countries, it has led to specific actions (creation of working groups, production of guides…) that have provided the actors in charge of conducting these assessments with an holistic view of health and new tools to integrate such views into their practice [START_REF] Baumgart | Improving the consideration of human health in environmental planning and decision-makingperspectives from Germany[END_REF][START_REF] Roué | Lessons learned from co-constructing a guide on healthy urban planning and on integrating health issues into environmental impact assessments conducted on French urban development projects[END_REF][START_REF] Cave | Lessons from an International Initiative to Set and Share Good Practice on Human Health in Environmental Impact Assessment[END_REF]. Strategic mandates such as the Healthy Cities Network have also proven to be highly supportive to HIA development at a local level in decentralized countries [START_REF] Kraemer | Implementation of Health Impact Assessment in Danish Municipal Context[END_REF][START_REF] Mattig | HIA in Switzerland: strategies for achieving Health in All Policies[END_REF].

Other enabling factors contributing to HIA mainstreaming in decision making include the existence of organisational schemes and structures facilitating intersectoral work and collaboration across stakeholders' structures and institutional cultures [START_REF] Davenport | Use of health impact assessment in incorporating health considerations in decision making[END_REF][START_REF] Mannheimer | Introducing Health Impact Assessment: an analysis of political and administrative intersectoral working methods[END_REF][START_REF] Ahmad | Enabling factors and barriers for the use of health impact assessment in decision-making processes[END_REF][START_REF] Negev | Integration of health and environment through health impact assessment: Cases from three continents[END_REF][START_REF] Kraemer | Implementation of Health Impact Assessment in Danish Municipal Context[END_REF][START_REF] Diallo | Health impact assessment-insights from the experience of Québec[END_REF][START_REF] Morteruel | Health Impact Assessments in Spain: Have They Been Effective[END_REF]). These organisational schemes facilitate high-quality relationships across sectors and promote the establishment of shared goals and values that have proved essential to consolidate HIA practice [START_REF] Haigh | The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005-2009[END_REF][START_REF] Mattig | HIA in Switzerland: strategies for achieving Health in All Policies[END_REF][START_REF] Winkler | Current Global Health Impact Assessment Practice[END_REF]. Authors also agree on the importance of assuring sustainable funding and capacity building efforts [START_REF] Fakhri | Proposing a framework for Health Impact Assessment in Iran[END_REF][START_REF] Winkler | Current Global Health Impact Assessment Practice[END_REF][START_REF] Morteruel | Health Impact Assessments in Spain: Have They Been Effective[END_REF]). More precisely, other authors recognise the appointment of a HIA unit or team at an strategic level to steer and guide HIA capacity building and development [START_REF] Davenport | Use of health impact assessment in incorporating health considerations in decision making[END_REF][START_REF] Wismar | The effectiveness of health impact assessment: scope and limitations of supporting decision-making in Europe[END_REF][START_REF] Ahmad | Enabling factors and barriers for the use of health impact assessment in decision-making processes[END_REF][START_REF] Morgan | Health and impact assessment: Are we seeing closer integration?[END_REF], the provision of an evidence base, practical tools and guidelines (Johnsdatter [START_REF] Kraemer | Implementation of Health Impact Assessment in Danish Municipal Context[END_REF][START_REF] Dannenberg | Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports[END_REF]) and the delivery of other capacity building and training initiatives to effectively conduct HIAs [START_REF] Finer | Implementation of a Health Impact Assessment (HIA) tool in a regional health organization in Sweden-a feasibility study[END_REF][START_REF] Mannheimer | Introducing Health Impact Assessment: an analysis of political and administrative intersectoral working methods[END_REF][START_REF] Huang | Health impact assessment in China: Emergence, progress and challenges[END_REF][START_REF] Fischer | Health impact assessment in spatial planning in England -types of application and quality of documentation[END_REF].

Given that HIA is rapidly growing in France, the question arises as to whether such growth might be paving the way towards institutionalisation. This article aims to describe how HIA practice is developing in France and to assess how institutionalised it has become in accordance with key enabling factors described in the literature.

Accepted Manuscript / Final version

Methods

A literature review was conducted to clarify concepts and to identify key context and process factors facilitating HIA institutionalisation. We searched articles in English, French and Spanish published in the Pubmed and Scopus databases using the free text terms "health impact assessment", "implementation", "institutionalisation" and ''effectiveness" in the title, abstract and keywords. Obtained results were subsequently refined using the database filters in accordance with the objectives of the review and non-relevant articles were removed. By using the term "effectiveness" we sought to capture articles that discuss enabling factors for effective HIA practice following [START_REF] Davenport | Use of health impact assessment in incorporating health considerations in decision making[END_REF] definition of a successful HIA as "one where its findings are considered by decision makers to inform the development and implementation of a policy, program or project". Thirty-five articles were finally selected for full reading according to the review objectives of identifying key contextual and process factors leading to HIA institutionalization.

On this basis, an analytical framework to characterize HIA implementation and institutionalization in France was developed based on two analytical frameworks that have capitalized on the experiences of several countries. We first studied the conceptual framework by [START_REF] Wismar | The effectiveness of health impact assessment: scope and limitations of supporting decision-making in Europe[END_REF] aimed at mapping and assessing enabling factors for effective implementation and institutionalization of HIA in Europe. Drawing on concepts developed in health system research, the authors propose four main dimensions, subdivided in detailed tasks, to assess the degree of HIA institutionalization in a given country. These include: stewardship, financing, capacity building and delivery. Secondly, we reviewed the framework developed some years later by [START_REF] Lee | Cross-country analysis of the institutionalization of Health Impact Assessment[END_REF] based on a study conducted in nine countries and the European Union. The aim was to gain a better understanding of the enabling factors contributing to effective HIA implementation and institutionalization. The framework covers five main areas: degree of and mechanisms for institutionalization; political setting and context; framing and type of HIA; implementation, resource requirements and structures; and outcomes and conclusions. While these two frameworks share some features they also present some differences insofar as they have been carried out some years apart, which allowed its authors to develop an analytical framework in line with newly cumulated experience Accepted Manuscript / Final version in a wider sample of countries. In recent years, some other authors have published new studies to identify enabling factors that could contribute to wider and more effective implementation of HIA in specific countries and contexts [START_REF] Haigh | What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand[END_REF][START_REF] Linzalone | Institutionalizing Health Impact Assessment: A consultation with experts on the barriers and facilitators to implementing HIA in Italy[END_REF][START_REF] Fakhri | Proposing a framework for Health Impact Assessment in Iran[END_REF]. Drawing on these works, we built up an analytical framework distinguishing implementation, i.e. HIA practice, from institutionalisation, i.e. its systematic integration by various means into routine decision making. In addition and, based on our previous work [START_REF] Jabot | A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France)[END_REF], we further explored the dimensions of governance and capacity building to cover certain aspects not fully described in the frameworks reviewed. The proposed framework integrates two main parts (Table 1).

The first includes the key elements characterizing HIA practice: nature of the submitted proposal, type of HIA, stakeholders involved, governance mechanisms, and HIA teams' profiles. The second focuses on the mechanisms and levers facilitating HIA institutionalisation. It covers four main dimensions: stewardship, means of endorsement, provision of funding and capacity building. Published reports on HIAs conducted in France were subsequently analysed following this analytical framework.

The selection of HIA reports for analysis was made on the basis of identified HIA experiences that qualified as such in relation to practice standards (Bhatia R, Farhang L, Heller J, Lee M, Orenstein M, Richardson M and Wernham A. 2014; [START_REF] Green | Development of a quality assurance review framework for health impact assessments[END_REF][START_REF] Winkler | Health Impact Assessment International Best Practice Principles[END_REF]. Reports were retrieved from the EHESP HIA platform or from institutional websites of regional health authorities and other institutions conducting HIAs in France. Of the 65 HIAs launched between 2011 and 2020, 49 had been completed but only 43 had been documented. We discarded two experiences that did not follow the minimum practice standards. The 41 remaining HIAs were submitted for analysis, 17 of them (shades lines) in greater detail based on the direct knowledge of the authors of this article as a result of their involvement in their implementation or evaluation (Table 2). Data extraction and content analysis were conducted in accordance with the proposed conceptual framework. If data were missing, supplementary information was requested directly from HIA corresponding authors by email or direct exchanges during seminars organized in different locations in France and in which the authors of this article participated.

Finally, results were related to the international literature and more precisely, to the findings of the review conducted by Linzalone et al [START_REF] Linzalone | Institutionalizing Health Impact Assessment: A consultation with experts on the barriers and facilitators to implementing HIA in Italy[END_REF] shedding some light on the main contextual elements contributing to HIA institutionalisation and Accepted Manuscript / Final version their relative weight. Our final discussion captures the enabling factors and obstacles that, according to these authors, help to anchor HIA in institutions and routine decisionmaking practices.

Results

HIA implementation in France

More than two thirds of documented HIAs are applied to urban development projects and, to a lesser extent, to social or transportation policies and public infrastructurerelated projects. Most HIAs are commissioned by the local government authorities and usually undertaken in partnership with RHAs and with their financial support. However, it is noteworthy to mention one HIA that was conducted in 2019 on the initiative of a group of public health practitioners following an advocacy purpose [START_REF] Jabot | L'évaluation d'impact sur la santé peut-elle être appliquée aux programmes de candidats à l'élection présidentielle ?[END_REF].

Most HIAs are conducted by private firms, independent consultants and local health observatories. Universities are more rarely involved. Eleven regions out of 16 have carried out at least one HIA, although a great disparity is found across regions, ranging from a single experience in some regions to more than 20 documented HIAs in the four most committed regions (graph 1). Three of them have also commissioned process and impact evaluations of completed HIAs.

As in other countries, HIA is essentially implemented as a stand-alone procedure [START_REF] Lee | Cross-country analysis of the institutionalization of Health Impact Assessment[END_REF][START_REF] Gall | Health impact assessment on urban development projects in France: finding pathways to fit practice to context[END_REF] Quantitative modelling, risk assessment and cost-effectiveness analyses are less frequently applied, reflecting a preponderance of a health promotion approach in France.

Following the "decision-support model" as described by Harris-Roxas & Harris [START_REF] Harris-Roxas | Differing forms, differing purposes: A typology of health impact assessment[END_REF], HIAs are not mandatory and they are often commissioned by public authorities interested in putting health and healthy urban planning (HUP) on the agenda. They are carried out in collaboration with the proponents of the project and with a degree of flexibility in terms of the procedures and methods applied and in terms of what is considered as a reliable source of evidence.

HIA governance is often shared between three entities: a RHA that very often provides funding, a municipal authority responsible for the pending decision, and a HIA team. RHAs are generally represented by the health promotion and/or the environmental health departments while the municipality can be represented by different service sectors. Other stakeholders may include representatives of health promotion associations or other bodies specialising in population health surveillance and monitoring, environment or urban planning, and researchers and professionals from different sectors, as well as citizen representatives. Relationships between all these stakeholders vary across regions and they are regulated through two governing bodies: a steering committee (comprising the RHA, some local elected representatives and occasionally other stakeholders), and a technical committee which assists the HIA team throughout the process.

HIA institutionalisation

The degree of HIA institutionalisation was examined through four main dimensions following the analytical framework developed for this study.

Political commitment and stewardship

HIA development in France should be placed with regard to the regional and municipal authorities' growing interest on Health in all policies (HiaP) and HUP approaches, respectively. Within this context, HIA is increasingly perceived as an effective procedure for advancing healthy public policies and thereby, translating HiAP and HUP into action. The enactment of the Grenelle II Law in 2010 prompted interest in integrating health considerations into environmental impact assessment [START_REF] Gall | Health impact assessment on urban development projects in France: finding pathways to fit practice to context[END_REF]. In 2015, the Ministry of Health commissioned an expert report aimed at disseminating existing methods and tools to assess the health impacts of urban development projects (Haut Conseil de la Santé Publique (HCSP) 2017). Public authorities' interest in HIA also arises from the recognition of its potential to make health promotion more tangible, to promote intersectoral collaboration for health and to enhance citizen participation. Contrarily to other countries, no dedicated HIA team has been appointed at a national level to provide HIA advocacy, expertise and support for commissioning, supervising and conducting HIAs. The initial involvement of the NIPHE was stopped when it was restructured in 2016 and no other central government entity has taken over.

Means of endorsement

As stated before, there is no statutory requirement to undertake HIA in France.

Nevertheless, there are some supportive policies and administrative frameworks at a regional level (health and environmental health programmes) and at a municipal level (intersectoral local health plans). Recent legislative and policy documents endorsing public commitment to reducing health inequalities also legitimize HIA as an effective procedure for putting health equity on the political agenda. This is the case of the Health System Modernization Act (2016) and the National Health Strategy 2018-2022, neither of which refer explicitly to HIA provisions but they do recognise the need to reduce health inequalities by taking action on the social determinants of health.

Funding

In addition to political will and supportive frameworks, the sustained and systematic use of HIA is dependent on the availability of resources. There is no dedicated budget at a national level although in recent years some funding has been provided ad-hoc by the NIHPE and other public agencies to promote HUP initiatives. In addition, some RHAs are currently financing HIA implementation schemes in close collaboration with municipalities and other local stakeholders. At sub-regional and municipal levels, HIA practice is also being financed through funds transferred by the National Agency for Urban Renewal.

Capacity building

Capacity building initiatives in other countries include the establishment of dedicated support units, the training of HIA practitioners and the provision of relevant documentation, guidelines and tools (Wismar and European Observatory on Health Systems and Policies 2007; [START_REF] Lee | Cross-country analysis of the institutionalization of Health Impact Assessment[END_REF]. There is no dedicated HIA unit in France with the exception of a team of university professors at the EHESP. Several universities have included a HIA training module within their master programmes.

Moreover, as part of HIA implementation schemes in place, some regions offer practical training sessions integrating 1-2 day workshops to put theory into practice. Dedicated seminars are also held in different locations and a number of public institutions provide relevant documentation and guidance on their websites. The EHESP offers a mentorship programme offering technical assistance and advice throughout the HIA procedure for a given project. In addition, since 2018 it has administered a website platform for providing HIA documents and tools, sharing experiences and promoting a community of practice.

Discussion

This study has shown important advances in HIA deployment in France in the last decade, although progress is still needed in order to advance towards institutionalisation. According Linzalone [START_REF] Linzalone | Institutionalizing Health Impact Assessment: A consultation with experts on the barriers and facilitators to implementing HIA in Italy[END_REF]), a strong political will is the very first condition to meet this end insofar as it triggers, through a "cascade mechanism", other key factors including supportive regulatory frameworks, the facilitation of intersectoral action for health, the provision of resources, and the investment in capacity building. Following these elements, this study has also provided some relevant insights on the growing political interest that HIA raises in France and on some contextual factors that might enable its steady institutionalisation in formal decision-making settings in the coming years.

A strong political will at the local and regional levels

There is significant and shared interest in HIA among decisions makers in France.

However, it is at the local and the regional levels that such interest is most noteworthy and effective. Within this context and, as in other European countries, the health sector is playing a driving role by ensuring HIA advocacy, providing dedicated funding and building partnerships through proactive policies and strategies [START_REF] Finer | Implementation of a Health Impact Assessment (HIA) tool in a regional health organization in Sweden-a feasibility study[END_REF] Accepted Manuscript / Final version O'Mullane 2013; [START_REF] Berensson | Health impact assessment (HIA) of political proposals at the local level: successful introduction, but what has happened 15 years later?[END_REF][START_REF] Jabot | A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France)[END_REF]. This is favoured by a long-standing and close collaboration between the regional and the local authorities on social and health issues. Such collaboration was strengthened in 2009 as a result of a territorial reform that created joint local policy schemes aimed at improving health and reducing health inequalities at the local level. In addition, in some regions, the health sector is forging partnerships with other public institutions to provide new sources of funding. It is worth mentioning the alliance established in the Ile de France region between the RHA and an environmental regional agency. If political will is key for HIA development [START_REF] Pursell | Impacts of an HIA on inter-agency and inter-sectoral partnerships and community participation: lessons from a local level HIA in the Republic of Ireland[END_REF], this enduring tradition of intersectoral partnerships is actually the foundation on which HIA is progressing in France.

A growing culture in health promotion

Even though the classical biomedical approach to health prevails in France, the progressive introduction of health promotion values on the political agenda has cleared the way for a proactive action on the social determinants of health [START_REF] Porcherie | Promotion de la santé en France[END_REF]). In accordance with health promotion approaches, HIA is at the crossroads of multiple concepts and values, including equity, participation, holistic approach, interdisciplinarity, and sustainable development. These underlying principles and HIA methodology awake a growing interest and its practice brings together a wide range of actors evolving in distinct spheres [START_REF] Jabot | Quelle plus-value de la démarche d'évaluation d'impact sur la santé pour les politiques urbaines ?[END_REF]. These conditions contribute to a general consensus on the relevance of adopting HIA in France. It is also worth noting that HIA and HiAP are not explicitly mentioned in national policy documents or strategies. However, intersectoral action for health, a common principle for HIA and HiAP, has been promoted in France for a while, and more recently it has been widely acclaimed in the context of the RHAs reform. It can be concluded that, while HIA is not currently portrayed as an effective tool to advance HiAP, one might expect that such a link won't take long to be made, as it happened in Ireland [START_REF] Kearns | Time for a paradigm change? Tracing the institutionalisation of health impact assessment in the Republic of Ireland across health and environmental sectors[END_REF].

Bridging the gap between EIA and HIA

HIA is the result of the dual heritage of environmental health and health promotion traditions and its evolution is largely influenced by the administrative and legal frameworks in place in different contexts [START_REF] Lee | Cross-country analysis of the institutionalization of Health Impact Assessment[END_REF]. In some countries, HIA practice evolves as an stand-alone procedure (O'Mullane and Quinlivan 2012; [START_REF] Berensson | Health impact assessment (HIA) of political proposals at the local level: successful introduction, but what has happened 15 years later?[END_REF][START_REF] Diallo | Health impact assessment-insights from the experience of Québec[END_REF][START_REF] Morteruel | Health Impact Assessments in Spain: Have They Been Effective[END_REF], while in others, it is integrated into existing IA frameworks [START_REF] Kang | Health impact assessment in Korea[END_REF][START_REF] Chang | Health impact assessment in environmental impact assessment in China: Status, practice and problems[END_REF][START_REF] Fischer | Health impact assessment in spatial planning in England -types of application and quality of documentation[END_REF]. In France, HIA has mainly developed in the field of urban design in parallel with healthy urban planning (HUP) approaches. Within this context, new regulatory frameworks have increased awareness of health issues in urban planning and have contributed to changes in routine practice of the institutions responsible [START_REF] Gall | Health impact assessment on urban development projects in France: finding pathways to fit practice to context[END_REF]. In addition, the recommendations of the High Council for Public Health to conduct HIAs on urban development, housing and urban mobilityrelated projects have also promoted HIA practice in France (High Council for Public Health 2017). HUP and HIA approaches are gradually converging, bringing together actors in the fields of the environment and the health sectors. The regional environmental health programmes implemented across all French regions offer frameworks that can provide clarity, legitimacy and funding opportunities for HIA applied to land use planning. HIA development in France is the result of active advocacy by health promotion actors at the Regional Health Agencies, while delivery and managing functions are shared with environmental players. Within this configuration, methods and tools applied by environmental players are rooted in a professional culture marked by the notion of risk and far removed from principles and values linked to health promotion [START_REF] Jabot | A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France)[END_REF]. In contrast, health promotion actors in line with HIA principles develop qualitative and participatory approaches but they don't always address the determinants of the physical environment, as was also noted in England [START_REF] Fischer | Health impact assessment in spatial planning in England -types of application and quality of documentation[END_REF]. Even though health concerns have been associated with environmental issues for several years, and in particular in the context of the European Union EIA Directive (2011/92/EU) amended by 2014/52/EU, the representations of health do not fully overlap for those working in EIA and HIA. In addition, consideration for human health in EIA remains a challenge due to the regulatory context, the weakness of health expertise and the lack of guidance (Cave et al. 2021). In the field of health promotion, over the past decade there has been a growing awareness of the highly complex nature of health. It has been portrayed as "an emerging product of systemic interplay of many continuously co-changing biocognitive-social techno-environmental factors" and a call for a paradigm shift embracing a complexity science perspective that requires revised theories, frameworks and tools has been made (Keshavarz Mohammadi 2020)(Keshavarz Mohammadi 2020).

The study of the social determinants of health has greatly expanded, including the Accepted Manuscript / Final version commercial determinants of health [START_REF] Kickbusch | The commercial determinants of health[END_REF], racial, gender and sexual discrimination [START_REF] Krieger | Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm-An Ecosocial Analysis[END_REF], health literacy [START_REF] Kendir | Health Literacy: From a Property of Individuals to One of Communities[END_REF], and other issues, as well as explanatory models that generate health inequalities (World Health Organization 2010). For example, health promotion professionals apply some tools, such as the Swiss Model for Outcome Classification in Health promotion and Prevention [START_REF] Spencer | Modelling the results of health promotion activities in Switzerland: development of the Swiss Model for Outcome Classification in Health Promotion and Prevention[END_REF] to address causality and to obtain an overall view of potential impacts. Within this context, the health sector and HIA practitioners are expected to contribute to EIA through their expertise and experience in qualitative and participatory approaches. This will facilitate an enhanced holistic and dynamic analysis of impacts through various determinants of health while improving health knowledge and new knowledge-for-action [START_REF] Cave | Lessons from an International Initiative to Set and Share Good Practice on Human Health in Environmental Impact Assessment[END_REF]. In a context of constrained resources, it is not desirable to require parallel procedures and EIA and HIA practitioners have an interest in joining forces and to progress towards mutual acculturation. This rapprochement could lead HIA practitioners to be more focused in the analysis of different options and not only in improving the proposal [START_REF] Fischer | Health impact assessment in spatial planning in England -types of application and quality of documentation[END_REF]. As pointed out by [START_REF] Kim | HIA and EIA Are Different, but Maybe Not in the Way We Thought They Were: A Bibliometric Analysis[END_REF], EIA and HIA are based on distinct paradigms and research traditions. Even though there is still progress to be made to build up an interdisciplinary view of health and integrated methods, as in other countries [START_REF] Chanchitpricha | Investigating the effectiveness of mandatory integration of health impact assessment within environmental impact assessment (EIA): a case study of Thailand[END_REF][START_REF] Fischer | Health impact assessment in spatial planning in England -types of application and quality of documentation[END_REF], an ongoing rapprochement between these two fields in France constitutes an opportunity for the future development of HIA [START_REF] Gall | Health impact assessment on urban development projects in France: finding pathways to fit practice to context[END_REF][START_REF] Cave | Lessons from an International Initiative to Set and Share Good Practice on Human Health in Environmental Impact Assessment[END_REF].

A "background noise" that should pay off

HIA practice is steadily growing in France; training activities are in place and HIAdedicated sessions are being included in national conferences to disseminate knowledge and to encourage the sharing of experiences. In addition, some national entities and institutions have put HIA on their agendas. Although national authorities are not taking the lead in promoting HIA, all these trends contribute to a background noise that keeps stakeholders alert and may ultimately open a window of opportunity. In addition, environmental regulatory requirements have increased awareness about the relevance of including health in urban planning procedures. Following all these developments and, as documented in other countries, it can be expected that HIA practice will grow and consolidate in France in the coming years through a bottom-up strategy engaging municipal and regional actors [START_REF] Mattig | HIA in Switzerland: strategies for achieving Health in All Policies[END_REF]. Bearing in mind that today HIA is conducted voluntarily and that a legal mandate would not attract much interest, along with the EHESP's efforts to build a community of practice, a greater political commitment from the national health authorities would certainly help to encourage HIA development.

The way forward

This study has shown important advances in HIA deployment in France in the last decade.

Nevertheless, to realise its full potential, HIA still needs further development and institutionalisation. Some challenges need to be met in France to advance towards this end in the coming years. First, there is a need to clarify HIA purpose, methods and processes in order to avoid confusion with other procedures applied in local decisionmaking contexts such as public consultations, community needs assessments, HUP and risk evaluations. These efforts will contribute to showing HIA distinctiveness and to undertaking HIA only where relevant. Second, HIA credibility should be enhanced through a systematic use of solid methods and procedures and an adequate adaptation of international standards to the French politico-administrative context. Likewise, a clear definition of good practice needs to be agreed by all institutions and practitioners. Third, impact evaluations providing evidence on HIA effectiveness and added value should be encouraged to prevent decision makers from thinking that the resulting recommendations could have been identified through routine planning processes, as pointed out by the literature (Harris-Roxas et al. 2014, p.) and confirmed in the few HIA evaluations recently conducted in France [START_REF] Jabot | L'évaluation d'impact sur la santé pour scruter et sculpter les politiques[END_REF][START_REF] Rivadeneyra-Sicilia | L'efficacité de l'évaluation d'impact sur la santé : leçons tirées d'une expérience dans l'agglomération bordelaise[END_REF]. Fourth, there is also a need to seize opportunities to demonstrate HIA contribution to HiAP and thereby, its potential for improving public decisions in terms of intersectoral action for health, enhanced transparency and accountability, citizen participation and health equity. Finally, it is also necessary to make clear HIA contribution to strengthening public mandates and strategic priorities in the political agenda in the fields of environmental health, sustainable development, prevention and health promotion.

Funding: This research received no external funding.

  , generally rooted in a holistic model of health and undertaken in compliance with the Gothenburg Consensus values of democracy, equity, sustainable development and ethical use of evidence. Nevertheless, and consistent with the literature (den Broeder et al. 2017), insufficient resources and time often constrain practitioners' ability to properly address citizen participation and equity issues[START_REF] Parry | Community participation in health impact assessments: intuitively appealing but practically difficult[END_REF][START_REF] Gauvin | Centre de collaboration nationale sur les politiques publiques et la santé[END_REF][START_REF] Chadderton | Health impact assessment in the UK planning system: the possibilities and limits of community engagement[END_REF][START_REF] Rococo | La participation citoyenne dans les évaluations d'impact sur la santé en France[END_REF]. Current practice largely concerns intermediate HIAs and involves the collection of available evidence and new quantitative and qualitative data. Some piloting experiences have required extended resources and timeframes.

Figure 1 .

 1 Figure 1. Regional distribution of HIAs carried out in France between 2011 and 2021

Figure

  Figure

Table 1 .

 1 Analytical framework (adapted from[START_REF] Lee | Cross-country analysis of the institutionalization of Health Impact Assessment[END_REF][START_REF] Wismar | The effectiveness of health impact assessment: scope and limitations of supporting decisionmaking in Europe[END_REF] Accepted Manuscript / Final version Table1. Analytical framework (adapted from[START_REF] Lee | Cross-country analysis of the institutionalization of Health Impact Assessment[END_REF][START_REF] Wismar | The effectiveness of health impact assessment: scope and limitations of supporting decisionmaking in Europe[END_REF]

		Intervention	Decision level (national, regional, local)
			Type of proposal (policy, plan, project, legislation …)
			Intervention sector
		Type	Mandated, decision-support, advocacy, community-led
			Stand-alone, integrated
	Implementation	Governance	Underlying model of health Rapid, intermediate, comprehensive Alignment with practice standards Commissioners' and other stakeholders' profile
			Governance bodies and functioning
			Citizen participation
		HIA teams	Profile (associations, consultancy firms, universities…)
			Outsource or in-house HIA
			Practitioners' background, experience, competencies
		Stewardship	Political commitment
			Central government leadership (HIA-dedicated unit, lead agency or
	Institutionalisation	Means of endorsement Funding Capacity building	team…) Legislation Policy or administrative frameworks Budget Human resources Training & mentorship
			Validated procedures, tools, guidelines, resources
			Health intelligence for HIA (technical leadership and expertise)

Table Accepted Manuscript / Final version

Level: N National; R Regional; L Local 4 HIA Team : RHA Regional health agency RHO Regional health observatory; RHPA Regional health promotion association; UPA Urba planning agency