484 www.thelancet.com Vol 384 August 9, 2014

World ReportWorld Report

The Wellcome Trust has recently announced the fi rst round of grants under its Sustaining Health Initiative, funding fi ve new projects. Each aims to answer diff erent questions about how the planet can sustain the healthy lives of its growing population, estimated to reach 9 billion people by 2050.

The fi rst will investigate potential alternatives to palm oil, a food ingredient that has brought economic benefit to Asia but has also been linked to negative cardiovascular health outcomes, deforestation, and greenhouse-gas emissions. This project, led by Bhavani Shankar, School of Oriental and African Studies, University of London, UK, and Richard Smith, London School of Hygiene & Tropical Medicine (LSHTM), UK, will investigate the health and economic aspects of palm oil and model different scenarios to adjust for the impact of possible policy changes. “Potential health and environmental benefits flowing from careful policy development to alter edible oil consumption profi les in the region are substantial, but need to be balanced against economic impacts”, says Shankar.

A second project will examine the impact of urban living on health, since half of the world’s population lives in urban environments and this is set to grow further, especially in cities that currently have a population of less than 1 million. “The environments and governance of those urban environments will play an important role in influencing the exposures and health-related behaviours of their populations. Cities also have a demand for resources beyond current limits of sustainability”, says project leader Paul Wilkinson, LSHTM. Named the Sustainable Healthy Urban Environments project, the work aims to build up a detailed database

of a globally distributed selected sample of cities and their populations with the aim of identifying the inter-relationship between city characteristics, their use of energy and other resources, and health-related behaviours and exposures. The resulting database will be an open access resource for the research community and can be expanded over time.

The third project addresses spatial, social, and environmental determinants of malnutrition in Africa, and will begin with a pilot in Kenya, says Jay Berkley, KEMRI-Wellcome Trust Research Programme and University of Oxford, UK. The group will apply well-established methods developed for infectious diseases such as malaria to understanding and visualising the burden, spatial distribution, and determinants of both over-nutrition and under-nutrition in sub-Saharan Africa. “The project will produce maps that clearly characterise the current burden and distribution of malnutrition, predict future trends, and provide tools to directly guide strategies to improve health, and for advocacy”, adds Berkley.

In the fourth project, Alan Dangour, LSHTM, will investigate the health and environmental implications of low-carbon, climate-change resilient diets in India. Part of this work will focus largely on staple crops (cereals, tubers) and will model the eff ect of substituting current staple crops in the diets with staple crops cereals that are likely to be more resilient to climate change in India. This will use work from Tim Wheeler, University of Reading, UK, and others that estimate how different crops will adapt to climate change (in terms of yield and nutritional content) in diff erent parts of the world. “We don’t have any specifi c examples of these diets

for India yet, but they might include aspects such as reducing the amount of wheat in particular diets and replacing it with rice—which appears at least in Asia to be less aff ected by rising temperatures. We will also investigate the social and cultural implications of these potential changes.”

Environmental and nutritional interventions for improving car-diovascular health in rural China is the subject of the fi fth project, led by Majid Ezzati, Imperial College London, UK. Cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of death in China’s ageing population. Elevated blood pressure and its nutritional determinants are important risk factors for cardiovascular diseases in China, as is household air pollution from biomass and coal burning and tobacco smoke, which are risk factors for elevated blood pressure, cardiovascular diseases, and COPD. Exposure to these risks varies geographically within China. “There is a real need for data on risk factor exposures and their health effects, and for developing interventions that reduce exposures, at the regional level”, says Ezzati. The pilot study will measure the geographical and seasonal diff erences in blood pressure and other markers of cardiovascular function and health, and their environmental and nutritional risk factors. It also aims to identify novel biological markers for exposure to household air pollution and nutritional risks and for the mechanisms and pathways of their hazardous effects on cardiovascular diseases. Plans for a subsequent intervention study include developing region-specific effective interventions that reduce household air pollution and improve nutrition.

Tony Kirby

Research FocusFunding: Wellcome Trust selects sustainable health projects

Tom

Mar

tin/JA

I/Cor

bis

Ian

Trow

er/JA

I/Cor

bis

Fat T

ony/

Auro

ra P

hoto

s/Co

rbis

Rein

hard

Kra

use/

Reut

ers/

Corb

is