Systems Actions to Malnutrition in All Its Forms in Chinese and South-East Asian Cities - Developing Double-Duty, Population-Level Interventions

所有形式的营养不良大体上包括营养不良(如体重不足和缺乏某些关键营养素)和营养过剩(如肥胖和相关的慢性非传染性疾病，如2型糖尿病)。各种形式的营养不良是全球和东南亚(SEA)疾病和过早死亡的最大原因。它对健康的影响是吸烟和高血压的两倍。这一公共卫生挑战还伴随着沉重的社会和经济负担。不同形式的营养不良有共同的原因，特别是在促进这些不同形式的营养不良的粮食系统内，这些营养不良可能在同一时间在同一个人、家庭或国家同时发生。需要针对人们的饮食习惯和饮食文化(例如当地的食物系统)以及一般的生活环境，制定与当地相关的解决办法。因此，看似不同的营养问题可以通过针对更广泛的人们日常生活系统的共同解决方案来改善。目前的干预方法没有足够快地减少营养不良，也未能控制肥胖症和相关慢性病的上升。这些问题很少被综合起来考虑和管理。为了有效地应对这一基本上可以预防的公共卫生挑战，我们需要一种新的工作方式，在更广泛的背景下认识到不同形式和营养不良的原因之间的联系，并制定双重责任行动来共同应对它们。我们的目标是在中国和海洋城市发展公共卫生干预措施，包括：1)由多个部门联合实施，2)旨在改善多种形式的营养不良，3)预期使这些城市的每个人都受益。我们将与来自不同部门和部门的当地政策制定者以及社区代表(例如那些已经提供或接受旨在改善营养状况的现有服务或计划的人)在三个项目阶段利用一种称为小组模型构建(GMB)的现代研究方法共同开展这项工作。全球协调机制是一种有用的工具，有助于就复杂、相互关联的问题达成共同理解，并促进不同人之间的协调行动。这个研究小组的成员已经成功地将其用于在发达国家开发系统性水平的肥胖干预措施。拟议的项目(第一阶段)将通过以下方式为后续项目阶段提供坚实的基础：1)通过GMB共同开发系统干预措施，并与亚洲城市的当地决策者和社区代表组成干预交付行动小组；在随后的第二阶段项目中，我们将1)支持行动小组提供第一阶段制定的干预措施，并利用第一阶段提供的监测系统来衡量第一阶段干预措施的早期影响；2)招募海洋城市，利用GMB程序在这些城市制定干预措施，并成立行动小组。这将是第一个利用GMB在亚洲发展中国家制定营养不良干预措施的研究项目。我们的发现将重要地推动营养行动十年的工作，以实现联合国的可持续发展目标，并有助于这一促进全球公共卫生的新工作方式的方法发展和影响。

Malnutrition in all its forms broadly includes undernutrition (e.g. underweight and lack of certain key nutrients) and overnutrition (e.g. obesity and related chronic non-communicable diseases, such as type 2 diabetes). Malnutrition in all its forms is the largest cause of disease and premature death globally and in South-East Asia (SEA). Its health impacts are twice as high as that of tobacco use and high blood pressure. This public health challenge is also associated with heavy social and economic burdens. Different forms of malnutrition share common causes, especially within food systems that are promoting these various forms of malnutrition, which can co-occur in the same individual, household or country at the same time. Locally relevant solutions will need to be generated in relation to people's eating habits and food cultures (e.g. the local food systems) as well as general living environments. Therefore, the seemingly different nutrition problems can be improved through common solutions targeting the wider systems of people's daily lives. Current approaches to interventions are not reducing undernutrition fast enough and have failed to control the rise of obesity and related chronic diseases. These problems have rarely been considered and managed together in an integrated way. To effectively combat this largely preventable public health challenge, we need a new way of working that recognises the connections between different forms and causes of malnutrition within a wider context and creates double-duty actions to address them together.We aim to develop public health interventions in Chinese and SEA cities that are: 1) jointly enacted by multiple sectors, 2) aimed to improve multiple forms of malnutrition, and 3) expected to benefit everyone living in these cities. We will do this collectively with local policy makers from different departments and sectors as well as community representatives (e.g. those who have delivered or received existing services or programmes aimed to improve nutrition status) over three project phases using a contemporary research method called the Group Model Building (GMB). GMB is a useful tool to develop a shared understanding of complex, inter-related issues and to facilitate coordinated actions among different people. It has been successfully used by members of this research team for developing systemic-level obesity interventions in developed countries.The proposed project (phase 1) will provide a strong foundation for subsequent project phases by: 1) co-developing systems interventions through GMB and forming intervention delivery Action Groups with local decision makers and community representatives in an Asian city; and gaining practical insights into this new intervention development method for application in other Asian cities,2) identifying strategies to recruit SEA cities to join the project, and3) providing information needed to support the development of an internationally comparable and sustainable tools to monitor and assess impacts of developed interventions.In the subsequent, phase 2 project, we will 1) support the Action Groups to deliver the interventions developed in phase 1, and measure early impacts of the interventions in the first Asian city using monitoring systems informed by phase 1; and 2) recruit SEA cities, develop interventions in these cities using the GMB process and form Action Groups.This will be the first research project to use GMB to develop malnutrition interventions in developing, Asian countries. Our findings will importantly advance the work on the Decade of Action on Nutrition towards achieving the United Nations' Sustainable Development Goals and contribute to method development and impacts of this new way of working on public health promotion globally.