NIHR Global Health Research Group on Diet and Activity -A syndemic approach to the prevention of diet- and physical activity-related NCDs

RESEARCH QUESTION

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? BACKGROUND

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. AIM, OBJECTIVES AND METHODS The project aims to inform resilient healthy diet and active living interventions in LMIC cities.

Specific objectives are to: •MEASURE SYNDEMIC HAZARD EXPOSURE BY: OBJ 1 Investigating the spatial clustering of a.syndemic hazards and the association with neighbourhood deprivation. b.unhealthy diets and PA and the association with household deprivation. c.Assessing the reliability of virtual assessment tools to measure exposure to syndemic hazards.

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. •ASSESS VULNERABILITY TO SYNDEMIC HAZARDS BY: OBJ 2 Understanding the adaptive capacity of community, policy and commercial institutions to syndemic hazards.

Methods: Policy space, corporate political activity and community resilience strategy analyses (reviews, in-depth interviews (IDI), focus group discussions (FGD)).

OBJ 3 Evaluating the sensitivity of community and policy initiatives influencing built and food environment responses to the COVID-19 syndemic.

Methods: Community initiatives: surveys, FGD, key informant IDI, food environment audit; policy initiatives: policy review (Comprehensive Analysis of Policy on Physical Activity framework). •CO-DESIGN DOUBLE-DUTY BUILT AND FOOD ENVIRONMENT INTERVENTIONS: OBJ 4 Adolescent-focused, syndemic-resilient interventions and policies that promote healthy diets and PA.

Methods: PRACTIS guide to identify intervention targets; FGD; intervention prioritisation. TIMELINES FOR DELIVERY

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.

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). Yr3 Data analysis and write up (Obj 1&2); data collection and analysis (Obj 3&4); conduct pilot studies.

Yr4 Stakeholder consultation 3; data analysis and write up (Obj 3&4); network evaluation. ANTICIPATED IMPACT AND DISSEMINATION

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