NIHR Global Health Research Group: A syndemic approach to the prevention of diet- and activity-related NCDs - GDARSpaces A syndemic approach to the prevention of diet- and activity-related NCDs (GDARSpaces) project of the Global Diet and Activity Research Network

Progress on achieving the Sustainable Development Goal 3 non-communicable disease (NCD) targets has been inadequate. 

Despite requiring more ambitious, comprehensive and intersectoral approaches to prevention, strategies to address unhealthy diets and physical inactivity have been largely developed by the health sector, without the government-wide and society-wide engagement required to comprehensively address these NCD risks. 

The global diet and activity (GDAR) Network address the rising NCD burden in low- and middle-income countries (LMIC) by generating evidence for sustainable, resilient NCD prevention related to healthy diets and physical activity. 

We recognise that urbanisation acts alongside and synergistically with the impacts of climate change, posing risks to health by influencing 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 2 or more interacting risks. The interaction of urbanisation, climate change, and diet and physical activity 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.

Our syndemic approach aims to develop interventions that will work in 2 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.

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.

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. 

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. Objectives: 
1.	Identify and characterise exposure to syndemic hazards.
2.	Understand the adaptive capacity of community, policy and commercial institutions and actors that shape the syndemic.
3.	Evaluate the role of COVID-19-mitigation actions by policy and community actors in shaping the food and built environment and the diet and physical activity choices residents can access. 
4.	Co-design adolescent-focused, syndemic-resilient interventions that promote healthy diets and physical activity.