title: Political and institutional influences on the use of evidence in public health policy. A systematic review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Marco
authors.initials: M
authors.lastname: Liverani
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hawkins
authors.forename: Justin O
authors.initials: JO
authors.lastname: Parkhurst
mesh_terms: D000349:Africa; D003657:Decision Making / Q000941:ethics*; D005060:Europe; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D011050:Policy Making; D011057:Politics; D011634:Public Health / Q000331:legislation & jurisprudence*; D014481:United States