NIHR Global Health Research Centre for Non-communicable Diseases and Environmental Change

Background The WHO Global Strategy on Health, Environment and Climate Change and the Sustainable Development Goals articulate an unparalleled need, opportunity and framework to advance the case for dual benefit actions and building health system resilience to meet the NCDs prevention and care needs of populations most affected by rapid environmental change.

Despite the imperative for action there remains a paucity of evidence on cost-effective strategies and interventions to address these dual challenges in LMICs.

Aim Our aim is to be a recognised centre of excellence on NCDs and global environmental change in LMICs, co-producing world-leading implementation research with local communities, strengthening research capability, advocacy, and policy for health equity.

Research Strategy and Methods Based on WHO's comprehensive PHC model, a primary healthcare strengthening intervention (Theme 1) and a multi-sectoral intervention (Theme 2) at the nexus of the environment and NCDs will be co-developed and co-evaluated with communities especially vulnerable to environment change.

Our multi-sectoral interventions will address water salinity in Bangladesh, dietary diversity in India and air pollution in Indonesia. Our target NCDs are hypertension, diabetes, CVD, CKD and COPD. Our interventions will be evaluated through a series of quasi-experimental implementation trials.

Evaluation will be grounded in the 2021 Medical Research Council guidance for developing and evaluating complex interventions and includes the following steps for activities in Themes 1 and 2: Formative research Intervention co-production Intervention implementation Mixed methods intervention evaluation to assess effectiveness, process outcomes (implementation fidelity, acceptability, sustainability and scalability) and economic evaluation.

We will evaluate how and how well the CEI activities have been implemented across our research activities (Theme 3). This will involve a process evaluation co-designed and implemented with community members.

We will undertake a comprehensive policy analysis to investigate existing mechanisms for CEI at the environmental/health policy nexus at local, regional and national levels.

RCS RCS activities are integrated with our research programme in multiple ways to strengthen research capability at individual, institution, network and ecosystems levels to enable LMIC-led production and use of high-quality evidence.

We will deliver several training and development opportunities targeting three critical career periods: (1) pre-doctoral, (2) early post-doctoral, and (3) transitioning to senior leadership with key programme leadership opportunities.

Our systematic and rigorous evaluative of our CEI activities (Theme 3) will ensure collective learning for improvement across all collaborators and institutions.

Anticipated Impact As outlined in our Centre s Theory of Change our anticipated impacts are:- (1) enhanced health equity, wellbeing and environmental sustainability across Asia (SDGs 3, 5, 10, 13, and 17); (2) strengthened research infrastructure for generating high-quality evidence on NCDs in populations most vulnerable to environmental change; (3) mobilised CEI capability to ensure evidence, advocacy and policy action is community-centric and benefits the most vulnerable.