What prevents health policy being ‘evidence-based’? New ways to think about evidence, policy and interventions in health

Abstract

Abstract Background Evidence-based policy decision-making is a dominant paradigm in health but realizing this ideal has proven challenging. Sources of data This paper conceptually maps health policy, policy studies and social science literature critically engaged with evidence and decision-making. No new data were generated or analysed in support of this review. Areas of agreement Barriers to evidence-based policy have been documented, with efforts made to increase the uptake of evidence. Areas of controversy Evident complexities have been regarded as a problem of translation. However, this assumes that policy-making is a process of authoritative choice, and that ‘evidence’ is inherently valuable policy knowledge, which has been critiqued. Growing points Alternative accounts urge consideration of how evidence comes to bear on decisions made within complex systems, and what counts as evidence. Areas timely for developing research An ‘evidence-making intervention’ approach offers a framework for conceptualizing how evidence and interventions are made relationally in practices, thus working with the politics and contingencies of implementation and policy-making.