Political and Institutional Influences on the Use of Evidence in Public Health Policy. A Systematic Review

Abstract

BackgroundThere is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making.MethodsWe conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review.Findings56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies.ConclusionsThis review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.

The Health of People: How the social sciences can improve population health

“…382 Empirical literature suggests that the greatest impact is often achieved through 'enlightenment' -changing thinking around a specific problem in an unanticipated way. 383,384 Other research outputs valued by policymakers include those that indicate outcomes in real-world scenarios (such as effectiveness or pragmatic trials) and rigorous and unbiased synthesis of existing information, preferably from multiple disciplines. 385 Producing relevant evidence, however, does not always mean that it meets the immediate needs of users: it may instead aid decision-making by future Governments and policymakers.…”

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“…Second, increasingly attention of researchers in global health has focused on the rise of evidence-based policy-making in health, and the extent to which the use of 'evidence-based policy-making' itself has been political. 7 For example, the initial abstinence only focus of the US President's Plan for AIDS Relief (PEPFAR) was critiqued for presenting an approach informed by religious values and beliefs as empirical evidence. 8 This type of research, analysing the policy process and 'how' evidence is used, go to the core of understanding how the normative issues in global health shape action and inaction as well as success and failure.…”

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“…The existing political system is another contextual issue that needs to be considered when implementing the framework. A recent systematic review identified the level of state centralization and democratization as one of the "relevant political and institutional aspects affecting the use of health evidence" (23). The included studies suggested that centralized political systems were likely to be less open to the uptake of research evidence than decentralized systems and democratic governments (23).…”

“…A recent systematic review identified the level of state centralization and democratization as one of the "relevant political and institutional aspects affecting the use of health evidence" (23). The included studies suggested that centralized political systems were likely to be less open to the uptake of research evidence than decentralized systems and democratic governments (23). Regardless of the type of government, the presence of a receptive environment for the use of evidence is essential for the operation of the framework.…”