Three key transitions leading to a “safe and just” operating space, with a focus on food systems, emerged during the development of a Foresight study promoted by SCAR (Standing Committee on Agricultural Research1): (a) sustainable and healthy diets for all; (b) full circularity in the use of resources; (c) diversity as a key component of stable systems. As consequence of COVID-19, food emerged again as a central element of life, along with health, after decades in which food security was taken for granted, at least in most developed countries. The COVID-19 outbreak offered the opportunity for a reflection on the importance of resilience in emergencies. Sustainable and healthy diets for all, was shown, during the pandemic, to depend much more on social and economic conditions than on technical aspects of food production and processing. Agriculture and the agro-industry have now a potential to absorb, at least temporarily, workers laid out in other sectors; the pandemic could be an opportunity to re-think and re-value labor relationships in the sector as well as local productions and supply chains. A full circularity in food systems also would benefit from stronger links established at the territorial level and increase the attention on the quality of the environment, leading to the adoption of benign practices, regenerating rather than impoverishing natural resources. Diversity is a key component of a resilient system, both in the biophysical sphere and in the social sphere: new business models, new knowledge-sharing networks, new markets. The three transitions would operate in synergy and contribute to the resilience of the whole food system and its preparation for a possible next emergency. Science can support policy making; however, science needs to be better embedded in society, to have a clear direction toward the grand challenges, to address the social, economic, behavioral spheres, to aim clearly at the common good. We need to re-think the conundrum between competition and cooperation in research, devising ways to boost the latter without sacrificing excellence. We need to improve the way knowledge is generated and shared and we need to ensure that information is accessible and unbiased by vested interests.
This paper is a study of the role of local ecological knowledge (LEK) as lay-expert knowledge in the urban land use planning process in Finland. The research addresses the importance of LEK, and the ways LEK is obtained and used. To obtain data, planning officials, biologists, and representatives of resident and nature associations were interviewed in the Helsinki metropolitan area. The results indicate that LEK exists among nature enthusiast, as well as local residents, and planners can obtain the knowledge in several ways, most notably through networks of knowledgeable key informants and local nature associations. Considering LEK in urban planning is important because it complements scientific ecological data and indicates places important to locals. Some of the challenges of using LEK include collecting it through participatory planning processes, distinguishing it from other information, valuing subjective knowledge, and empowering planning officials to use LEK. To enhance communication between stakeholders, social scientists should be integrated in the planning process. Furthermore, technical improvements, such as registers of key informants and more efficient use of nature associations' knowledge, would be useful in applying LEK.
Background
The StopDia study is based on the convincing scientific evidence that type 2 diabetes (T2D) and its comorbidities can be prevented by a healthy lifestyle. The need for additional research is based on the fact that the attempts to translate scientific evidence into actions in the real-world health care have not led to permanent and cost-effective models to prevent T2D.
The specific aims of the StopDia study following the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework are to 1) improve the Reach of individuals at increased risk, 2) evaluate the Effectiveness and cost-effectiveness of the digital lifestyle intervention and the digital and face-to-face group lifestyle intervention in comparison to routine care in a randomized controlled trial (RCT), and 3) evaluate the Adoption and Implementation of the StopDia model by the participants and the health care organizations at society level. Finally, we will address the Maintenance of the lifestyle changes at participant level and that of the program at organisatory level after the RCT.
Methods
The StopDia study is carried out in the primary health care system as part of the routine actions of three provinces in Finland, including Northern Savo, Southern Carelia, and Päijät-Häme. We estimate that one fifth of adults aged 18–70 years living in these areas are at increased risk of T2D. We recruit the participants using the StopDia Digital Screening Tool, including questions from the Finnish Diabetes Risk Score (FINDRISC). About 3000 individuals at increased risk of T2D (FINDRISC ≥12 or a history of gestational diabetes, impaired fasting glucose, or impaired glucose tolerance) participate in the one-year randomized controlled trial. We monitor lifestyle factors using the StopDia Digital Questionnaire and metabolism using laboratory tests performed as part of routine actions in the health care system.
Discussion
Sustainable and scalable models are needed to reach and identify individuals at increased risk of T2D and to deliver personalized and effective lifestyle interventions. With the StopDia study we aim to answer these challenges in a scientific project that is fully digitally integrated into the routine health care.
Trial registration
ClinicalTials.gov
. Identifier:
NCT03156478
. Date of registration 17.5.2017.
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