193 Natural experiments: A Nobel Prize awarded research design increase, whereby most evidence is available for interventions that were easiest to study and to publish [10]. We need institutional changes where researchers are acknowledged for the societal relevance of their studies, not primarily on the quantity of publications. These risks are even larger for PhD candidates with strict timings and output objectives, possibly demotivating early career researchers from devoting their projects to evaluate natural experiments. Ultimately this may lead to less senior researchers being experts on natural experiments, and moving it forward in public health. Better understanding of the use and value is needed to ensure that brave researchers more often evaluate the interventions that hold large promise to inform decisions about population health. In conclusion, natural experiments provide opportunities to inform policy-making on exposures that are impossible to randomise. While successful evaluations are available in literature, much can be learned from the barriers ultimately leading to unexplored opportunities, ceased projects, and unpublished manuscripts. As long as barriers are not addressed jointly by the research and policy environments, opportunities to provide evidence on global health challenges with extensive societal impact will continue to be missed. 6
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