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Through a structured approach that allows urban projects to be observed with a holistic view of health, health impact assessment (HIA) encourages partnerships and anticipates health issues as early as possible in the decision-making process of urban programs. The appropriation of the approach by communities, the integration of recommendations and their follow-up are apprehended through the feedback from three HIA carried out in Auvergne-Rhône-Alpes. It appears that the structuring of proposals according to political criteria and technical feasibility is a very effective decision-making tool for elected officials and technicians. The emergence of new risk factors and the sharing of this knowledge between elected representatives, technicians and inhabitants facilitate the establishment of a common scientific culture and the conditions for a balanced debate between actors on complex subjects. HIA also makes it possible to involve other actors who were absent from the previous phases of consultation. The continuity of the monitoring group is an important element. HIA makes it possible not only to act on health determinants but also to create dynamics favorable to health in the long term. But this interdisciplinary work can be felt to be a hindrance, as some actors find it difficult to grasp work opportunities, to have a new approach that can lead to different outcomes and that requires personal investment. Through its cross-cutting nature, HIA helps to have a different approach to projects and a willingness to move forward to speed things up. There is a strong challenge to go all the way through all the stages of the process.