by José Luis Cárdenas Tomažič

Adapted from the Spanish column originally published in El Economista on October 10th, 2025 (Políticas de salud sin evidencia: el acuerdo OPS–UNITE como punto de inflexión)

During the 80th United Nations General Assembly, held in New York, health once again took center stage on the global agenda. The spotlight was on non-communicable diseases (NCDs) and mental health—two persistent challenges affecting millions of people worldwide. However, it was the signing of a strategic agreement between the Pan American Health Organization (PAHO) and the Global Health Parliamentarians Network “UNITE”—comprising more than 500 legislators from 119 countries—that could mark a meaningful step forward in how public health policies are designed, enabling value creation, as I argued in a previous column.

The PAHO–UNITE Agreement: Why Does It Matter?

Signed on September 23, 2025, on the sidelines of the General Assembly, this agreement establishes a strategic alliance to support legislators in Latin America and the Caribbean in the formulation of public health policies through informed debate, evidence-based decision-making, and alignment with international standards.

PAHO has committed to providing technical assistance, sharing data, and organizing seminars, workshops, and high-level events. UNITE, for its part, mobilizes a global network of parliamentarians committed to public health and the Sustainable Development Goals (SDGs). While the immediate focus is on the Americas, the challenge addressed by this agreement is global and cross-cutting: too many public policies—not only in health—are designed without sufficient evidence, under short-term pressures, without impact analysis, or without ex post evaluation mechanisms.

Where Are We—and Where Must We Go?

International literature and comparative experience agree that evidence-based health policymaking, particularly from the legislative branch, remains more an aspiration than a concrete reality.

Reports from the OECD and the World Bank highlight that Congresses and parliaments bear the responsibility of incorporating ex ante and ex post evaluations into the public policy cycle, allowing for impact anticipation, policy adjustment, and accountability for outcomes. However, recent studies identify persistent structural barriers: insufficient technical capacity among legislators, institutional weaknesses, a limited evaluation culture, and, above all, short-term political incentives that hinder the adoption of strategic and sustainable approaches. The OECD Recommendation on Public Policy Evaluation emphasizes that overcoming these obstacles requires making evaluation a permanent legal mandate of the legislative branch, supported by regulatory frameworks that transcend electoral cycles and promote transparency and accountability.

Several countries have made progress in institutionalizing policy evaluation within the legislative branch, integrating mechanisms that go beyond executive action and strengthen evidence-based decision-making.

In France, the Constitution grants both the National Assembly and the Court of Auditors (Cour des Comptes) key evaluation functions. The Court of Auditors assists the Assembly in evaluating public policies by conducting analyses either at the request of Parliament or on its own initiative. The National Assembly, through its Committee for the Evaluation and Control of Public Policies, can also conduct and commission independent evaluations. Since 2018, an annual program requires all ministries to present evaluation results and be publicly questioned about policy performance, fostering transparency, accountability, and institutional learning within the legislative branch.

In Sweden, the National Audit Office (Riksrevisionen) plays a central role in promoting a culture of evaluation and evidence. It conducts both direct evaluations and reviews of the national evaluation system, with results discussed in Parliament. In 2022, it published a comprehensive analysis of Sweden’s evaluation system, and more recently reviewed the monitoring and evaluation system for development assistance, issuing recommendations to strengthen evaluation practices.

The United Kingdom has developed the What Works Network, a network of 12 independent centers that support legislators and public officials with evidence on “what works” in public policy. This network produces evidence reviews and syntheses and is coordinated by the UK government’s Evaluation Task Force, ensuring integration of these insights into internal government evaluation processes. This model facilitates access to robust evidence and promotes informed decision-making within both the legislative and executive branches. In addition, institutions such as the National Institute for Health and Care Excellence (NICE) and the Parliamentary Office of Science and Technology (POST) produce reports and recommendations for Parliament on evidence-based health policies.

In the United States, Congress relies on independent and highly specialized institutions that strengthen public policy evaluation and evidence-based decision-making. These include the Government Accountability Office (GAO), which supports Congress through audits, performance evaluations, and cost-effectiveness analyses of federal programs; the Congressional Budget Office (CBO), which provides independent economic and budgetary analysis of the fiscal impact of legislative proposals; and the Congressional Research Service (CRS), which produces technical reports and comparative studies for lawmakers. These institutions are internationally recognized as best practices, enabling the legislative branch to exercise effective oversight, base decisions on evidence, and promote transparency and accountability in public management.

Breaking the Incentives of Short Political Cycles

One of the greatest challenges identified in the literature (OECD, World Bank, among others) is the tendency of governments to prioritize short-term, high-impact policies driven by electoral cycles, at the expense of structural and sustainable reforms. To counter this, it is recommended to:

• Institutionalize ex ante and ex post evaluation as a requirement for policy approval and continuation.
• Establish independent evaluation bodies that transcend changes in government.
• Promote transparency and citizen participation in priority setting and accountability.
• Adopt flexible and adaptive regulatory frameworks capable of responding to changing contexts and lessons learned.

The signing of the PAHO–UNITE agreement is not only good news for the region; it is also a signal that the world is beginning to take seriously the need to professionalize health policymaking. In times of uncertainty, evidence is not a luxury—it is a necessity. If we want public policies—both in health and beyond—to deliver real impact, they must be grounded in reliable data, rigorous analysis, systematic evaluation, and a long-term vision.

References and Cited Studies

• World Bank – Better Policies: The Nuts and Bolts of Monitoring and Evaluation Systems
• OECD – Guidebook on Best Practices in Public Health; Recommendation on Public Policy Evaluation; Public Governance Monitor of Sweden
• Pierre Moscovici – The experience of the French Cour des Comptes
• What Works Network – GOV.UK
• U.S. Government Accountability Office (U.S. GAO)