Cities in low- and middle-income countries are piling the risks of poor diets, physical inactivity, and climate disruption on top of each other, and this project will map exactly where those hazards cluster. The problem is that urbanisation and climate change do not act in isolation—they combine to make it harder for people to eat well and stay active, especially in poorer neighbourhoods. This research will measure how these overlapping hazards are distributed across cities, assess how well local institutions and communities can adapt, and then work with adolescents to co-design interventions that strengthen both the built environment and the food environment. If successful, the findings could reshape how city planners, policymakers, and health programmes prioritise investments—for example, by targeting green spaces, safe walking routes, or affordable fresh food access to the most vulnerable areas. The project is primarily applied and intervention-focused, building directly on an existing global research network, with no claim to fundamental discovery.
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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
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