The politics of evidence in health system crises: the case of Colombia.

Health systems worldwide are in crisis, facing financial sustainability challenges, workforce shortages and shifting demands due to demographic change. Limited or decreasing public resources, aid cuts, population ageing and health workforce shortages affect countries in different but serious ways, l...

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Bibliographic Details
Published in:International Affairs Vol. 102; no. 2; pp. 639 - 659
Main Author: Hanrieder, Tine
Format: Article
Published: Oxford University Press / USA Mar2026
Subjects:
Online Access:View this record in EBSCOhost
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      dt: Mar2026
      vid: 102
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      pub: Oxford University Press / USA
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        10.1093/ia/iiaf266
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        atl: The politics of evidence in health system crises: the case of Colombia.
      aug:
        au: Hanrieder, Tine
        affil: Department of International Development, London School of Economics and Political Science, London WC2A 2AE, UK
      su:
        Colombia
        Health policy
        Financing of public health
        Rhetoric & politics
        Socioeconomic disparities in health
        Health care reform
      sug:
        subj:
          Health policy
          Financing of public health
          Colombia
          Administration of Public Health Programs
          Health and Welfare Funds
          Rhetoric & politics
          Socioeconomic disparities in health
          Health care reform
      keyword:
        constructivism
        copyrightHolder:The Royal Institute of International Affairs
        copyrightYear:2026
        global health
        inLanguage:en
        international development
        narratives
        publisher:Oxford University Press
        sameAs:https://dx.doi.org/10.1093/ia/iiaf266
        social justice
        constructivism
        copyrightHolder:The Royal Institute of International Affairs
        copyrightYear:2026
        global health
        inLanguage:en
        international development
        narratives
        publisher:Oxford University Press
        sameAs:https://dx.doi.org/10.1093/ia/iiaf266
        social justice
      ab: Health systems worldwide are in crisis, facing financial sustainability challenges, workforce shortages and shifting demands due to demographic change. Limited or decreasing public resources, aid cuts, population ageing and health workforce shortages affect countries in different but serious ways, leading to a sense of ongoing crisis. This article investigates the politics of health system crisis and its contentious interpretation in Colombia, where this issue is highly politicized. I analyse how proponents and opponents of a major health system reform proposal have mobilized evidence in favour and against the reform bill put forward by the leftist government elected in 2022. This analysis yields that the politics of slow, gradual health system crises is also one of sense-making, in which evidence is assembled within larger and changing narratives about development. Colombia's international status as a recent OECD member, the idea of progress and modernity amid social inequality, and the political legitimacy of state and private actors are all renegotiated through evidence about health system performance and crisis. I draw on in-depth qualitative research conducted in 2024 and 2025. The article invites cross-fertilization between analyses of gradual, 'slow-burning' crises and of changing notions of international development.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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