The use of scientific evidence in health policy decisions: Notes on ontology

Abstract

The use of scientific evidence in the formulation and implementation of policies has become an internationally recognized guiding principle for decision-making in health. Amid discussions on the sustainability of health systems and the context of multiple crises, a critical perspective on this debate is imperative. In this essay, we present initial criticalreflective notes on the context of knowledge production within the framework of modern science and the use of scientific evidence in health policy decisions. We adopt historical-dialectical materialism and critical realism as theoretical, methodological, and ontological frameworks, supported by a rapid review of the scientific literature on the topic. We discuss elements of the dominant scientific paradigm, which neglects the ontological foundations of science as a socio-historical praxis; the landscape of evidenceinformed policy production in Latin America, its advancements, and its emphasis on methods and techniques; and critical realism as an alternative capable of supporting the social character of science and the existence of an objective reality independent of interpretation. The realization of health as a right served as the guiding objective-image for the discussion. We argue for the necessity of shifting the emphasis from methodological concerns and epistemological disputes to an ontological approach.