This topic aims at supporting activities that are enabling or contributing to one or several expected impacts of destination 3 “Tackling diseases and reducing disease burden”. To that end, proposals under this topic should aim for delivering results that are directed, tailored towards and contributing to most of the following expected outcomes:

• Health care practitioners and providers in low- and middle-income countries (LMICs) and/or those in high-income countries (HICs) serving vulnerable populations have access to and use specific guidelines to implement health interventions that decrease risk factors of non-communicable diseases (NCDs) associated with city^[1] environments.
• Public health managers and authorities have access to improved insights and evidence on the NCDs caused or impacted by city environments and which factors influence the implementation of preventive actions that address risk behaviours in concerned city populations. They use this knowledge to design improved city planning policies to diminish health associated risks.
• Adopting an implementation science approach to studying interventions in different city contexts, researchers, clinicians and authorities have an improved understanding how specific interventions can be better adapted to different city environments and how the interventions could be scaled within and across cities taking into account specific social, political, economic and cultural contexts.
• Public health managers and authorities use evidence-based strategies and tools for promoting population health in equitable and environmentally sustainable ways, enabling cities to better address the challenges of rapid urbanisation, growing social inequalities, and climate change.
• Communities, local stakeholders and authorities are fully engaged in implementing and taking up individual and/or structural level interventions and thus contribute to deliver better health.

The European Commission is a member of the Global Alliance for Chronic Diseases (GACD)^[2]. This topic is launched in concertation with the other GACD members and aligned with the 8^th GACD call.

The topic is focused on implementation research with the potential to reduce the risks of NCDs in cities in LMICs and/or vulnerable populations in HICs. Proposals should focus on implementation science around evidence-based interventions that promote healthy behaviours, and that have the potential to profoundly reduce the risk of chronic diseases and multi-morbidity.

Non-communicable diseases, such as diabetes, cardiovascular disease, neurological diseases, respiratory diseases, certain cancers, and mental health disorders, are the leading cause of morbidity and mortality in both LMICs and HICs^[3]. The COVID-19 pandemic has brought these chronic diseases further into the spotlight, as the majority of those who have experienced severe illness and/or death have had one or more underlying NCD. Reducing the burden of NCDs is therefore critical to building more resilient, equitable, and healthier societies.

Air, water, and soil pollution; lack of greenspace; urban heat islands; lack of safe infrastructure for walking, cycling, and active living; and wide availability of tobacco, alcohol, and unhealthy foods and beverages drive the NCD epidemic in city environments^[4]. More than half of the world’s population currently live in cities and this number is projected to rise to 68% by 2050. There is an urgent need to equip local authorities and policymakers with strategies for maximising the health-promoting potential of cities, while minimising or reversing environmental degradation and health inequities.

Cities provide tremendous social, cultural, and economic opportunity, and have the potential to become engines of good health and support climate change adaptation^[5]. Innovative health-focused programmes, policies, and infrastructure, such as public smoking bans, bikeable streets, greenspace, and vehicle emission laws, can shape the behaviours of millions of people and decrease exposure to environmental contaminants. Applicants to the current call are invited to conduct implementation research that leads to improved understanding of how specific interventions can be better adapted to different city environments and/or scaled within and across cities, taking into account unique local social, political, economic, and cultural contexts.

The proposed implementation research must be focus on addressing NCD risk factors associated with city environments and related health inequities. In all cases, the selected study population(s) must live in cities, which may include informal settlements near urban centres, peri-urban environments, and city centres. The study population may include people with existing NCDs, those without existing NCDs, or a combination of both. Applicants are encouraged to take a life course approach, adapting the intervention to one or more key life stage(s) critical for reducing lifelong NCD risk.

Proposals should address all of the following activities:

• Select one or more city/ies in which the research will be conducted. Applicants must justify why a particular context is considered a city.
• Select one or more evidence-based interventions known to reduce NCD risk factor(s) associated with city environments. Applicants should justify the choice of intervention(s) and provide evidence of the intervention’s effectiveness, acceptability, feasibility, and potential for long-term health and other impacts. Applicants may also wish to consider implementation research focusing on the WHO Best Buys, though this is not a requirement.
• Adapt these intervention(s) for selected study population(s) based in one or more city/ies, taking into account the unique social, political, economic, and cultural context(s). Applicants should justify why these adaptations will not compromise the known effectiveness of the selected intervention(s).
• Provide a research plan for investigating how to promote the uptake and/or scale-up of the intervention(s) in the selected study population(s), using validated implementation research frameworks.
• Specifically address issues of equitable implementation to ensure interventions reach the populations that need them the most.
• Have an appropriate strategy for measuring both implementation research outcomes and real-world effectiveness outcomes and indicators (related to NCD prevention and, if feasible, planetary health and/or non-health sectors).
• Demonstrate a commitment to stakeholder engagement.
• Demonstrate a commitment to planetary health in that the proposed intervention, implementation strategies and research practices minimise the consortium’s ecological footprint.
• Provide a sustainability plan or describe a pathway to sustain the proposed intervention after the funding ends.

The proposed interventions of focus may fall under one or both of the following themes:

Theme 1: Behavioural change interventions

These interventions comprise of innovative approaches to helping people live in cities maintain good physical and mental health despite infrastructural, environmental, climate, and social challenges. Behavioural interventions might include, but are not limited to, programmes and policies that target alcohol and tobacco use, sleep, exercise promotion, healthful nutrition (e.g. in school canteens), addressing the psychosocial impacts of climate change and climate change related disasters, and reducing exposure to environmental contaminants.

Theme 2: Interventions that focus on modifying the built environment^[6]

These interventions focus on modifying the built environment to improve its health-promoting potential^[7]. Proposals should aim to inform urban design such that it reduces NCD risks; for example, by improving a city’s walk- or bike-ability, increasing green space to reduce the health impacts of air pollution or extreme heat, reducing environmental toxins, addressing homelessness or unsafe housing, improving accessibility of healthy foods, decreasing widespread advertising for tobacco and alcohol, or reducing noise and air pollution from road traffic. For proposals that focus on modifying the built environment, applicants should demonstrate that the intervention will be able to withstand expected impacts from climate and/or improve resilience to the health impacts of climate change in city environments.

Applicants should be able to show that the city government or community-based organisation that they partner with has a dedicated budget for the construction, maintenance, and/or scale up of the proposed intervention(s), especially for large infrastructure projects. Applicants should also be able to show that the timelines of the research and construction of infrastructure projects will align such that it will be possible to answer the proposed implementation research questions over the proposed duration, and such that the research results will be available in time to inform stakeholder decisions about how the project is implemented, improved, and/or scaled up.

Proposals should include a plan on how to measure implementation research outcomes and the intervention’s real-world efficacy in preventing NCDs. In case health outcomes might not be apparent over the duration of the study period, and applicants may therefore instead include plans to measure the intervention’s impact on upstream health indicators, such as those related to the social determinants of health, or to measure other proxy health outcomes. Where feasible and relevant, applicants should also describe a plan for evaluating the planetary health and/or climate impacts of an intervention’s implementation. Applicants are also encouraged to develop a plan for measuring outcomes or indicators relevant to non-health or environmental impacts, especially when working on projects with multi-sectoral themes (for example, themes that cut across health and transportation, social services, waste management, etc.).

Projects should consider the structural and social determinants of health and discuss their potential impact on the effective implementation of the intervention(s) in city environments. Of interest is also the EU Mission on Climate-Neutral and Smart Cities^[8].

Projects should be gender-responsive and consider socioeconomic, racial or other factors that relate to equitable impacts of the intervention or barriers to equitable implementation. The aim should be to adapt and scale-up the implementation of these intervention(s) in accessible and equitable ways in order to prevent or delay the onset of chronic diseases in real-life settings. Poverty, racism, ethnic discrimination, physical and mental ableism, ageism, and other inequities are directly associated with reduced potential for health promotion and disease prevention. If there is a focus on a particular population in this context, then the reason for this should be justified.

This topic requires the effective contribution of social sciences and humanities (SSH) disciplines and the involvement of SSH experts, institutions as well as the inclusion of relevant SSH expertise, in order to produce meaningful and significant effects enhancing the societal impact of the related research activities.

Proposals should present a strategy to include the relevant policymakers, local authorities, as well as other stakeholders such as community groups, or other individuals or organisations involved in the implementation of the intervention, from the development to the implementation knowledge translation phase.

Applicants are encouraged to propose activities to increase research capacity and capability in the field of implementation research among researchers, health professionals, and public health leaders through skill building, knowledge sharing, and networking. In this regard, they may propose plans for capacity building within their proposal, especially, but not exclusively, for early career researchers and for members from lower resourced environments, such as LMICs or indigenous communities.

Applicants envisaging to include clinical studies should provide details of their clinical studies in the dedicated annex using the template provided in the submission system. See definition of clinical studies in the introduction to this work programme part.

[1] Non-rural settings; a densely populated urban or peri-urban environment. Cities may also include informal settlements and slums surrounding city centres. Applicants can justify why a particular context may be considered a city.

[2] https://www.gacd.org/

[3] WHO. Noncommunicable Diseases. 2021. https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases.

[4] WHO Urban health 2022 and https://www.who.int/news-room/fact-sheets/detail/urban-health

[5] https://www.who.int/publications/i/item/WHO-NMH-PND-2019-9

[6] The man-made components of the environment, such as building, traffic, sewage, parks, and other infrastructure.

[7] Proposals are intended for research that helps guide the implementation and/or scale up of the proposed intervention. Therefore, the execution of infrastructural interventions (e.g., constructing bike lanes or housing, etc.) is not in the scope of this topic.

[8] https://ec.europa.eu/info/research-and-innovation/funding/funding-opportunities/funding-programmes-and-open-calls/horizon-europe/eu-missions-horizon-europe/climate-neutral-and-smart-cities_en