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Because public health must operate at scale in widely diverse, complex situations, randomized controlled trials (RCTs) have limited utility for public health. Other methodologies are needed. A key conceptual backbone is a detailed "theory of change" to apply appropriate evidence for each operational component. Synthesizing patterns of findings across multiple methodologies provides key insights. Programs operating successfully across a variety of settings can provide some of the best evidence. Challenges include judging the quality of such evidence and assisting programs to apply it. WHO and others should shift emphasis from RCTs to more relevant evidence when assessing public health issues.

A letter to the editor is presented in response to the article "A Public Health Approach To Global Management of Hypertension," by Sonia Y. Angell, K. M. De Cock, and T. R. Frieden in the February 28, 2015 issue.

The author offers insights about health achievement in Bangladesh, covering topics like health coverage approach and problems amenable to further public health approaches.

Assesses provision of condoms in African countries, which are used in the prevention of HIV. Methods; Results; Conclusion that more condoms are needed to provide all African countries with a level equal to that of the six highest providing countries.