Historical and epidemiological transitions in urban Caribbean foodscapes: understanding the past to enhance future healthy eating

目前的公共卫生战略未能有效促进人群的充足营养，因为它们侧重于个人的行为和选择，而没有解决诸如饮食文化和粮食系统等更大的影响。相反，需要创造健康的环境，使人们能够轻松获得健康和营养的食物。日益城市化的世界中的城市是进行这种转型的理想场所。加勒比区域已确定糖尿病和心脏病等慢性非传染性疾病是对人口健康、社会和经济发展的主要威胁，并已作出一致承诺，通过包括城市规划在内的全面、多部门对策来解决这一问题。为了为他们的努力提供信息并加快行动，我们提出了一个跨学科项目，以了解两个相邻但截然不同的城市金斯敦（牙买加）和太子港（海地）的历史和流行病学转变，以便能够确定低收入和中等收入国家的城市如何影响其人口的饮食习惯、机会，进而影响健康。我们的目标是深入了解导致“不健康”空间（例如快餐密集的社区）或“健康”空间（例如城市花园）的潜在机制。通过调查这些营养的社会、政治和经济决定因素是如何发展并形成当代食品环境的，我们项目的目标是通过加强健康饮食策略来预防慢性疾病。该项目将把健康数据映射到历史数据上，以制作一幅食物景观演变的交互式地图，该地图将用于与决策者和公众接触，作为一种工具，帮助创造健康环境，使人们能够轻松获得健康和营养的食物。在著名历史学家和全球卫生研究人员的指导下，西印度群岛大学的早期职业研究人员将合并历史和卫生研究方法进行可行性研究。一个历史工作包将利用在线报纸档案，并创新地结合对当地专家的采访，研究城市人口增长和城市不平等的变化及其对粮食生产和消费的影响，从第二次世界大战至今，食品销售点的可用性，以及饮食习惯。卫生工作包将审查同一时间段内营养方面的主要流行病学趋势，并通过对现有公共卫生调查和常规数据的分析，评估其对非传染性疾病的影响，并将这一分析与关于当代饮食习惯和选择的焦点小组数据结合起来。这项可行性实地工作将在牙买加金斯敦和海地太子港进行，以便为拟订扩大到更广泛区域和类似情况的更大规模后续赠款提案作准备。这项可行性工作将在牙买加的项目共同发展讲习班期间进行，我们将邀请来自学术界、政府和民间社会（例如卫生非政府组织）的区域利益攸关方就与当前做法和政策项目（例如金斯敦部分地区的再生计划）相关的共同研究目标达成一致；它将在最后的项目联合分析研讨会上得到巩固，以分析数据并制定可持续的合作研究战略和未来的项目。结合人文和流行病学的方法和专业知识，我们提出了一个高度创新的项目，在这两个领域的研究问题小说，并基于一个独特的合作。它将建立必要的方法能力，以了解在低收入和中等收入国家的城市地区产生“不健康”和减少“健康”食物环境的机制，这对致力于创造健康城市食物环境的城市规划者至关重要。

Current public health strategies fail to effectively promote adequate nutrition in populations, because they focus on individuals' behaviours and choices without addressing larger influences such as food cultures and food systems. Instead, healthy environments need to be created that enable easy access to healthy and nutritious food. Cities in an increasingly urbanising world are ideal places for such transformation. The Caribbean region has identified chronic non-communicable diseases such as diabetes and heart disease as a major threat to population health, social and economic development, and has made a concerted commitment to address this problem through a comprehensive, multi-sectoral response that includes urban planning. To inform their efforts and accelerate action, we propose a cross-disciplinary project to understand historical and epidemiological transformations in two neighbouring but contrasting cities, Kingston (Jamaica) and Port-au-Prince (Haiti), to be able to identify the ways cities in low and middle income countries impact on their populations' food practices, opportunities and in turn health. We aim to develop an in-depth understanding of underlying mechanisms that have led to both 'unhealthy' spaces (e.g. fast food dense neighbourhoods) or 'healthy' spaces (e.g. urban gardens). By investigating how these social, political and economic determinants of nutrition have developed and shaped into contemporary foodscapes, the goal of our project is to inform the prevention of chronic diseases by enhancing healthy eating strategies. The project will map health data onto the historical data to produce an interactive map of the evolution of foodscapes, which will be used to engage with both policymakers and the public as a tool to aid the creation of healthy environments that enable easy access to healthy and nutritious food.Under the guidance of leading historians and global health researchers, early career researchers at the University of the West Indies will conduct feasibility research merging methods from historical and health research. A historical work package will use online newspaper archives, and innovatively combine with interviews with local experts to examine changes in urban population growth and urban inequality and its impact on food production and consumption, the availability of food outlets, and dining habits from the Second World War to present. A health work package will examine major epidemiological trends in nutrition for the same time frame and assess its impact on NCDs through an analysis of existing public health survey and routine data, and combine this analysis with focus group data on contemporary food practices and choices. This feasibility fieldwork will be carried out in Kingston, Jamaica, and Port-au-Prince, Haiti, in preparation for the development of a larger follow-up grant proposal expanding to the wider region and similar settings. This feasibility work will be prepared during a Project Co-Development Workshop in Jamaica to which we will invite regional stakeholders from academia, government and civil society (e.g. health NGOs) to agree on common research goals that tie into current practice and policy projects (e.g. regeneration plans for parts of Kingston); and it will be consolidated in a final Project Co-Analysis Workshop to analyse the data and develop a sustainable collaborative research strategy and future projects.Melding humanities and epidemiological methods and expertise, we propose a highly innovative project with a research question novel for both fields, and based around a unique collaboration. It will build the methodological capacity needed to understand the mechanisms that have produced 'unhealthy' and reduced 'healthy' foodscapes in urban areas in low and middle income countries, which is essential for urban planners working to create healthy urban food environments.