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the majority of HIAs are done voluntarily&#44; outside legislative or regulatory requirements&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In Spain&#44; the National Public Health Act 2011 incorporated HIA to the Spanish legal system 8 years ago&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The incorporation of HIA to the Spanish legal system was deemed positive in technical and scientific environments&#46; However&#44; Spain is a decentralized state and most policies &#40;e&#46;g&#46; health governance&#41; are based in the gradual development of federal arrangements through its regional governments&#44; also known as Autonomous Communities&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Despite multijurisdictional countries are supposed to facilitate better matching of citizen preferences&#44; sometimes&#44; there is a lack of basic common rules at a national level&#46; On a regional level&#44; HIA has been institutionalized in only one out of 17 autonomous communities &#40;as is the case of Andalusia&#41;&#46; On the other hand&#44; HIA is also mentioned in regional Public Health Laws in the Autonomous Communities of Catalonia&#44; Valencia&#44; the Balearic Islands&#44; Aragon and Galicia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; However&#44; there has not been further regulatory development of HIA in these last Autonomous Communities&#44; where only some pilot HIAs have been conducted&#44; mostly in urban planning&#44; as well as within the Basque country&#46; In short&#44; Andalusia is leading the implementation of HIA in Spain&#44; and more than 700 HIAs have been conducted in different activity sectors between the years 2015 and 2018 in Andalusia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Despite the limited development of HIA in Spain&#44; it has already been documented that some stakeholders perceive it as a competitive limitation and a possible disadvantage in economic development between Autonomous Communities&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> This approach is a serious threat that may conduct HIA towards a bureaucratic drift and the trivialization of the process could generate more rejection than its expected positive results&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this context&#44; implementation of HIA faces many difficulties and barriers at different levels&#44; including poor governance and lack of political support&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> which can cause a lack of equity in health and its determinants&#46; Thus HIA practice should be based on a legal obligation within European Union&#44; in order to avoid inequities in health and its determinants between groups of people within regions and between regions&#46; In this sense&#44; a general consensus exists today that the European Union treaty provides grounds for upgrading the status of HIA&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">C&#46; Iglesias-Merchan and E&#46; Dom&#237;nguez-Ares conceived and designed the manuscript&#46; The first draft of the manuscript was written by C&#46; Iglesias-Merchan&#46; E&#46; Dom&#237;nguez-Ares authored and reviewed all versions of the manuscript&#46; Both authors have reviewed and approved the final draft&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aknowledgments</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors thank Rebeca L&#243;pez Gosling that kindly improved the English of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that there was no funding received for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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