Urban climate–NCD syndemics in LMICs: a transdisciplinary framework for Health action

BACKGROUND: Climate change poses a major threat to global health. Its synergistic interaction with non-communicable diseases (NCDs), responsible for 74% of global deaths, demands urgent, integrated action. OBJECTIVES: This study critically examines how transdisciplinary approaches can uncover and address structural determinants underpinning climate change-NCD syndemic hazards, while accounting for power dynamics through meaningful stakeholder engagement in urban contexts.action. METHODS: A mixed-methods design combined quantitative data (syndemic variable counts, stakeholder categories, pre- and post-workshop surveys) with qualitative inductive analysis of stakeholder narratives to identify themes on health impacts of syndemic factors, climate events, and adaptive strategies across seven cities in South Africa, Nigeria, Jamaica, Brazil, Kenya, and Cameroon. Syndemic relationships were analyzed through five critical lenses: structural determinants; climate-health linkages as manifestations of structural vulnerability; stakeholder power dynamics; transformative community engagement; and critical reflection on transdisciplinary processes. RESULTS: A total of 172 diverse stakeholders prioritized 24 predefined syndemic variables across three domains - climate and natural hazards, built environment and physical activity, and food environment - and contributed 71 additional context-specific variables. Validated relevant crosscutting variables included healthy food outlets, walkability, sidewalk presence, and air pollution. Stakeholders emphasized the need for comprehensive, context-specific strategies and inclusive community engagement to address the broad health consequences of climate events. CONCLUSION: Transdisciplinary approaches enable deeper understanding of syndemic relationships by fostering counter-hegemonic knowledge production. We propose an Integrated Syndemic Climate-Health Framework to refine transdisciplinary processes for enhanced research, localized interventions, and iterative evaluation in Low- and middle-income countries.