Political and institutional influences on the use of evidence in public health policy. A systematic review.
Political and institutional influences on the use of evidence in public health policy. A systematic review.
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DOI：
10.1371/journal.pone.0077404
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Parkhurst JO
中科院分区：
文献类型：
--
作者：
Liverani M;Hawkins B;Parkhurst JO
越来越多的人认识到，制定循证保健政策不仅是知识交流或翻译的技术问题，而且是一项政治挑战。然而，尽管政治学家长期以来一直认为政治制度的性质、制度结构的作用以及政策问题的政治辩论是理解政策决策的核心，但研究循证政策制定的学者们在很大程度上仍然没有探索这些问题。我们对实证研究进行了系统的回顾，这些研究考察了政治制度和体制机制的关键特征对证据使用的影响，以及可能有助于健康证据政治化的背景因素。通过搜索七个健康和社会科学数据库、相关组织的网站、大英图书馆数据库和手动搜索学术期刊，确定了符合条件的研究。使用统一的数据提取工具提取相关结果，并通过叙述性审查进行综合。56项研究被选入研究。影响健康证据使用的相关政治和体制方面包括国家集中化和民主化程度、外部捐助者和组织的影响、官僚机构的组织和职能以及与社会规范和价值观相关的证据框架。然而，考虑到关于这一主题的实证分析的数量有限，比较著作的稀少，以及这些研究中对政治和制度理论的有限考虑，我们对这些影响的理解仍然零碎。这项审查强调需要更明确地接触影响在决策中使用健康证据的政治和体制因素。要更细致入微地理解卫生政策制定中的证据使用，既需要对证据使用进行额外的实证研究，也需要参与公共卫生或知识利用研究当前范围之外的理论和方法。
There 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. We 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. 56 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. This 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.
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