ArticleJournal of epidemiology and community health2020
Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head.
Article in Journal of epidemiology and community health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 103 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
103 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Effects of active travel interventions in the UK on disadvantaged population groups and their potential to reduce health inequalities: systematic review.Journal of epidemiology and community health · 2026Pooled it
- Operationalizing and Measuring Informed Choice in Health Care: An Umbrella Review.Medical decision making : an international journal of the Society for Medical Decision Making · 2026Pooled it
- Impacts of built environment changes on physical activity in Canada: a systematic review of natural experiments.Health promotion and chronic disease prevention in Canada : research, policy and practice · 2026Pooled it
- A systematic review of the influences of food store product placement on dietary-related outcomes.Nutrition reviews · 2020Pooled it
- The impacts and effectiveness of support for people bereaved through advanced illness: A systematic review and thematic synthesis.Palliative medicine · 2020Pooled it
- Using natural experiments to improve public health evidence: a review of context and utility for obesity prevention.Health research policy and systems · 2020Pooled it
- Trial
- Implementation of a UK supermarket intervention to increase purchasing of fresh fruit and vegetables: process evaluation of the WRAPPED natural experiment.The international journal of behavioral nutrition and physical activity · 2024Trial
- Move for Life an intervention for inactive adults aged 50 years and older: a cluster randomised feasibility trial.Frontiers in public health · 2024Trial
- Rethinking children's physical activity interventions at school: A new context-specific approach.Frontiers in public health · 2023Trial
- A School-Based Randomized Controlled Trial to Promote Cycling to School in Adolescents: The PACO Study.International journal of environmental research and public health · 2021Trial
- How to do (or not to do) realist evaluations to advance theory, practice, and justice in health systems research.Health policy and planning · 2026Article
- Evaluating the Effectiveness of the School-Based Sustainable Innovation for Children Transporting Actively Intervention: Protocol for an Age-Cohort Study.JMIR research protocols · 2026Article
- Applying a complex systems-informed approach to population health interventions: a methodological case-study example of traffic restriction schemes outside schools.BMC public health · 2026Article
- Towards a new model of population mental health research and policy translation in the UK: establishing a National consortium.International journal of mental health systems · 2026Article
- Long-term impacts of co-designed sustainable park improvements on physical activity and other wellbeing behaviours: a 7-year natural experimental study in a deprived urban area.The international journal of behavioral nutrition and physical activity · 2026Article
- Natural experiments in the built environment: evaluating impacts on health.Health promotion and chronic disease prevention in Canada : research, policy and practice · 2026Article
- Precision public health: A natural experiment on chronic high-contrast PM2.5 exposure and pulmonary function among older adults.PloS one · 2026Article
- Use of quasi-experimental studies to evaluate causal effects of public health interventions in Portugal: a scoping review.BMC medical research methodology · 2025Article
- Highlights from the Manifesto on the Health Economics of Cardiovascular Disease Prevention.PharmacoEconomics · 2025Review
43 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population-wide and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate 'definitive' evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.