Title: NIHR Global Health Research Group on Diet and Activity_x000D_ -A syndemic approach to the prevention of diet- and physical activity-related NCDs
Funder: Department of Health and Social Care

Abstract: RESEARCH QUESTION _x000D_ How can a better understanding of urbanisation and climate-change (syndemic)-related NCD hazards inform the design of resilient built and food environment interventions to support healthy diets and active living in LMIC cities?_x000D_ _x000D_ BACKGROUND_x000D_ The global diet and activity (GDAR) Network addresses the rising NCD burden in low- and middle-income countries and is focused on built and food environment determinants of diet and physical activity (PA). Urbanisation acts in tandem with climate risks to influence diet and PA, especially those living under precarious urban settings at higher risk of climate-change disruptions. We propose a syndemic approach to address built and food environment vulnerabilities due to urbanisation and climate change (syndemic) hazards to equitably and sustainably support and enhance healthy diets and PA._x000D_ _x000D_ AIM, OBJECTIVES AND METHODS _x000D_ The project aims to inform resilient healthy diet and active living interventions in LMIC cities. _x000D_ Specific objectives are to:_x000D_ •MEASURE SYNDEMIC HAZARD EXPOSURE BY:_x000D_ OBJ 1 Investigating the spatial clustering of _x000D_ a.syndemic hazards and the association with neighbourhood deprivation._x000D_ b.unhealthy diets and PA and the association with household deprivation._x000D_ c.Assessing the reliability of virtual assessment tools to measure exposure to syndemic hazards._x000D_ Methods: Field and virtual audits of built and food environments; spatial analysis of individual, household and neighbourhood data on diet, PA, NCD risk and deprivation from existing cohorts._x000D_ •ASSESS VULNERABILITY TO SYNDEMIC HAZARDS BY:_x000D_ OBJ 2 Understanding the adaptive capacity of community, policy and commercial institutions to syndemic hazards._x000D_ Methods: Policy space, corporate political activity and community resilience strategy analyses (reviews, in-depth interviews (IDI), focus group discussions (FGD)). _x000D_ OBJ 3 Evaluating the sensitivity of community and policy initiatives influencing built and food environment responses to the COVID-19 syndemic._x000D_ Methods: Community initiatives: surveys, FGD, key informant IDI, food environment audit; policy initiatives: policy review (Comprehensive Analysis of Policy on Physical Activity framework). _x000D_ •CO-DESIGN DOUBLE-DUTY BUILT AND FOOD ENVIRONMENT INTERVENTIONS: _x000D_ OBJ 4 Adolescent-focused, syndemic-resilient interventions and policies that promote healthy diets and PA._x000D_ Methods: PRACTIS guide to identify intervention targets; FGD; intervention prioritisation._x000D_ _x000D_ TIMELINES FOR DELIVERY_x000D_ Yr1 Collaboration agreements; stakeholder consultation 1; impact indicators; training and leadership needs analysis; research protocols and ethics (Obj 1&2); recruitment; access secondary data, equipment (Obj 1) and policy documents (Obj 2&3), desktop reviews (Obj 2&3); engage collaborators as co-designers._x000D_ Yr2 Data collection and analysis (Obj 1&2); stakeholder consultation 2; finalise research protocols and ethics approvals (Obj 3&4); design collaborator pilot studies (Nigeria, Brazil, South Asia); data collection (Obj 3&4)._x000D_ Yr3 Data analysis and write up (Obj 1&2); data collection and analysis (Obj 3&4); conduct pilot studies. _x000D_ Yr4 Stakeholder consultation 3; data analysis and write up (Obj 3&4); network evaluation. _x000D_ _x000D_ ANTICIPATED IMPACT AND DISSEMINATION _x000D_ We will build on GDAR’s successful co-production of evidence with partners, adapt methods, embed impact activities, and build Network capacity, informed by recommendations from the Network’s independent evaluation in 202

Lay abstract: Established in 2017, the Global Diet and Activity Research Network (GDAR) works to prevent non-communicable diseases (NCDs) such as obesity, diabetes and heart disease. These are a major and growing cause of death and disability in low- and middle-income countries (LMICs). Two important causes of this trend are unhealthy diets and physical inactivity (PA), both associated with urbanisation. The fastest growing cities globally are in LMICs. Here, unplanned urbanisation often means growth in unhealthy built and food environments, particularly for the urban poor. This pattern of growth is shaped by a wide range of policy, community and commercial actors: from city planners to food advertisers._x000D_ _x000D_ The current GDAR research (to be completed May 2021) has been co-created by researchers, communities and policymakers. It explores how policy, community and commercial systems shape diet and PA environments and behaviours in urban LMICs. As well as urbanisation, the Network has identified climate change as an important driving force behind environmental hazards that have negative implications for diet and PA. These hazards are increasing in LMICs and disproportionately affect the urban poor. _x000D_ _x000D_ The proposed work therefore builds on current research to consider the risks of urbanisation and climate change and their effect on diet and physical activity. Collectively we refer to these risks as ‘syndemic hazards’. The concept of a ‘syndemic’ (from ‘synergistic epidemic’) describes the co-occurrence of two or more interacting risks. The interaction of urbanisation, climate change, and diet and PA behaviours is one such example. Together these forces increase the risks of NCDs. Without considering all these forces, we cannot create effective, sustainable interventions to improve health in LMICs now and in the future._x000D_ Our syndemic approach aims to develop interventions that will work in two ways: first by reducing the exposure of individuals in cities to these syndemic hazards, and second by reducing the vulnerability of the wider built and food environments to these hazards._x000D_ As the urban poor are most affected by these hazards, we will build understanding of individual exposures by examining how the hazards cluster with household and neighbourhood deprivation. The broader questions will be approached by exploring the ways that policy, community and commercial forces shape the built and food environments in these growing cities. This way we can understand exactly how and which environments are most vulnerable. Research methods will be varied and tailored to contexts: for example, audits of built and food environments, surveys and focus groups, reviews of policy documents and practice, and collection of household and neighbourhood-level data on diet, PA and NCD risk._x000D_ We will work in Cameroon, South Africa, Kenya and Jamaica, as well as collaborating with UN Habitat, the University of Lagos, Nigeria, the Federal University of Minas Gerais, Brazil and Imperial College’s South Asia study. _x000D_ Contributions of non-academic stakeholders will guide activities throughout the research process and co-design of syndemic interventions. This co-design will draw on existing community and policy actions being taken in response to COVID-19, which is an example of disruption to diet and PA that is made worse by urbanisation and climate change. This will help to identify the policy and community actions and characteristics that can support future interventions.

Research activity codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE