The article discusses the limitations of randomized controlled trials (RCTs) in evaluating public health interventions and advocates for the use of alternative methods such as plausibility and adequacy designs. RCTs are effective for clinical interventions with short, simple causal chains, but public health interventions are complex and require more nuanced evaluation. The authors argue that RCTs alone are insufficient for assessing the effectiveness of large-scale public health programs, which often involve multiple steps and are influenced by various factors. They emphasize the importance of plausibility and adequacy evaluations, which can provide valid evidence of impact. Plausibility evaluations involve comparing groups and addressing confounding variables, while adequacy evaluations focus on trends in outcomes over time. These methods are particularly useful when RCTs are not feasible due to ethical, logistical, or practical constraints. The article also highlights the challenges of external validity, noting that RCT results may not generalize well to real-world settings. Factors such as differences in intervention delivery, dose, and response can affect the generalizability of findings. The authors stress the need for evaluations that account for these complexities, using a combination of plausibility and adequacy approaches to ensure robust evidence. The authors conclude that evidence-based public health requires a variety of evaluation methods, including plausibility and adequacy designs, to provide comprehensive evidence for decision-making. They call for the development of standards and protocols for these methods, as well as the integration of these approaches into public health practice. The article underscores the importance of considering the complexity of public health interventions and the need for evaluations that reflect real-world conditions.The article discusses the limitations of randomized controlled trials (RCTs) in evaluating public health interventions and advocates for the use of alternative methods such as plausibility and adequacy designs. RCTs are effective for clinical interventions with short, simple causal chains, but public health interventions are complex and require more nuanced evaluation. The authors argue that RCTs alone are insufficient for assessing the effectiveness of large-scale public health programs, which often involve multiple steps and are influenced by various factors. They emphasize the importance of plausibility and adequacy evaluations, which can provide valid evidence of impact. Plausibility evaluations involve comparing groups and addressing confounding variables, while adequacy evaluations focus on trends in outcomes over time. These methods are particularly useful when RCTs are not feasible due to ethical, logistical, or practical constraints. The article also highlights the challenges of external validity, noting that RCT results may not generalize well to real-world settings. Factors such as differences in intervention delivery, dose, and response can affect the generalizability of findings. The authors stress the need for evaluations that account for these complexities, using a combination of plausibility and adequacy approaches to ensure robust evidence. The authors conclude that evidence-based public health requires a variety of evaluation methods, including plausibility and adequacy designs, to provide comprehensive evidence for decision-making. They call for the development of standards and protocols for these methods, as well as the integration of these approaches into public health practice. The article underscores the importance of considering the complexity of public health interventions and the need for evaluations that reflect real-world conditions.