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, 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.