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

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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.