Homero Martinez, PhD, Helena Pachón, Vijaya Kancherla, and Godfrey P Oakley, Jr..

Published: March 9, 2021


This publication provides an alternative paradigm to support evidence-based decision making for public health programs. Rather than relying on the strict, evidence-based pyramid used by clinicians to guide treatment decisions, which puts observational studies at the bottom of the evidence-based pyramid and relies, towards the top, on randomized clinical trials as well as systematic reviews and meta-analysis to provide stronger evidence, we assess the published literature to evaluate if the evidence meets causal criteria proposed by Sir Bradford Hill, including coherence, plausibility, temporality, consistency, magnitude of effect, and dose-response. We conclude that current evidence should suffice to motivate political will to implement large-scale food fortification programs that will save thousands of lives each year in over 100 countries.
DOI: 10.1093/aje/kwab061.