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

各种形式的营养不良广义上包括营养不足（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地区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营养不良的粮食系统内，这些营养不良可能同时发生在同一个人、家庭或国家。需要根据人们的饮食习惯和饮食文化（例如当地食物系统）以及一般生活环境，制定与当地相关的解决方案。因此，看似不同的营养问题可以通过针对人们日常生活中更广泛系统的共同解决方案得到改善。目前的干预方法不能迅速减少营养不良，也未能控制肥胖和相关慢性疾病的增加。很少以综合的方式考虑和管理这些问题。为了有效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的营养不良和原因之间的联系，并采取双重责任行动，共同解决这些问题。我们的目标是在中国和东南亚城市制定公共卫生干预措施，这些干预措施是：1)由多个部门共同制定，2)旨在改善多种形式的营养不良，3)期望使这些城市的每个人受益。我们将与来自不同部门和行业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）在三个项目阶段共同开展这项工作，使用一种称为团体模型构建（GMB）的当代研究方法。小巴是一个有用的工具，有助于就复杂的、相互关联的问题达成共识，并促进不同人之间的协调行动。该研究小组的成员已成功地将其用于发达国家制定系统性肥胖干预措施。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共同制定系统干预措施，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；并获得将这种新的干预措施开发方法应用于其他亚洲城市的实际见解；2)确定招募东南亚城市加入该项目的策略；3)提供所需的信息，以支持开发具有国际可比性和可持续性的工具，以监测和评估已开发干预措施的影响。在随后的第二阶段项目中，我们将1)支持行动小组实施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，在首个亚洲城市衡量干预措施的早期影响；2)招募东南亚城市，利用GMB流程在这些城市制定干预措施，并组成行动小组。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。我们的研究结果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，并有助于方法开发和这种新的工作方式对全球公共卫生促进的影响。

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.