IntroductionIncreasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.Methods and analysisRISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.EthicsStudy protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.Trial registration numberACTRN12618000633280; Pre-results.

Background Multiple bacteria, viruses, protists, and helminths cause enteric infections that greatly impact human health and wellbeing. These enteropathogens are transmited via several pathways through human, animal, and environmental reservoirs. Individual qPCR assays have been extensively used to detect enteropathogens within these types of samples, whereas the TaqMan array card (TAC), which allows simultaneous detection of multiple enteropathogens, has only previously been validated in human clinical samples.Methods In this methodological comparison study, we compared the performance of a custom 48-singleplex TAC relative to standard qPCR. We established the sensitivity and specificity of each method for the detection of eight enteric targets, by using spiked samples with varying levels of PCR inhibition. We then tested the prevalence and abundance of pathogens in wastewater from Melbourne (Australia), and human, animal, and environmental samples from informal settlements in Suva, Fiji using both TAC and qPCR.Findings Both methods exhibited similarly high specificity (TAC 100%, qPCR 94%), sensitivity (TAC 92%, qPCR 100%), and quantitation accuracy (TAC 91%, qPCR 99%) in non-inhibited sample matrices with spiked gene fragments. PCR inhibitors substantially affected detection via TAC, though this issue was alleviated by ten-fold sample dilution. Among samples from informal settlements, the two techniques performed similarly for detection (89% agreement) and quantitation (R² 0•82) for the eight enteropathogen targets. The TAC additionally included 38 other enteric targets, enabling detection of diverse faecal pathogens and extensive environmental contamination that would be prohibitively labour intensive to assay by standard qPCR.Interpretation The two techniques produced similar results across diverse sample types, with qPCR prioritising greater sensitivity and quantitation accuracy, and TAC trading small reductions in these for a cost-effective larger enteropathogen panel enabling a greater number of enteric pathogens to be analysed concurrently, which is beneficial given the abundance and variety of enteric pathogens in environments such as urban informal settlements. The ability to monitor multiple enteric pathogens across diverse reservoirs could allow better resolution of pathogen exposure pathways, and the design and monitoring of interventions to reduce pathogen load.

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Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities. Such researchers increasingly adopt collaborative transdisciplinary approaches to engage policy-makers, private citizens and other actors in identifying and evaluating potential policy solutions that will reduce environmental impacts in ways that simultaneously promote health, equity and/or local economies-in other words, maximising 'co-benefits'. This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research. The workshop, held at the 16th International Conference on Urban Health (ICUH) in Xiamen, China in November, 2019, brought together 49 participants, and covered topics related to collaboration, data and research impact. It featured research projects funded by the Wellcome Trust's Our Planet Our Health (OPOH) programme. This report aims to concisely summarise and disseminate participants' collective contributions to current methodological practice in urban planetary health research.

Institutionalizing slum upgrading as part of government-led citywide or national programmes can overcome the limitations of piecemeal, “bottom-up”, ad-hoc upgrading projects. This article presents a case study of 15 years of practice to institutionalize participatory slum upgrading in Afghanistan. The article explains the main approach and tools used in Afghanistan to mobilize residents into Community Development Councils (CDCs), undertake neighbourhood action planning, and implement civil works projects in a co-production process to improve access to basic urban services and strengthen local governance. The findings provide original insights into key elements for institutionalization in fragile contexts: (i) building support of the international community, donors, and development banks for urban investment; (ii) the role of community contributions; (iii) the need to embed upgrading with improved tenure security and municipal revenue generation; and (iv) the importance of reliable and recent data to guide decision-making and build political support for in-situ settlement upgrading.

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Informal settlements are on the frontline in the battle against climate change. Home to one billion people, their infrastructure deprivations pose challenges for the health and resilience of communities and ecosystems. Upgrading of informal settlements can improve urban services and infrastructure, strengthen tenure security, and empower local communities. This chapter examines the conceptual and practice relationships between climate resilience and in-situ upgrading. It critiques prevailing approaches, which centre upon threshold, coping, recovery, and adaptive capacities. Transformative capacity offers greater scope for addressing climate change impacts at a level commensurate with the size of the challenge, and for redressing the entrenched structural inequalities and deep socio-spatial injustices shaping cities in the Global South that perpetuate vulnerability and socio-spatial exclusion. Five elements are identified to advance transformative informal settlement upgrading: socio-technical innovation; a climate justice framing; greater attention to intersectional dimensions; inclusive governance and community empowerment; and fit for purpose finance.

The COVID-19 pandemic represents a turning point in the way things are done, globally and across sectors. We reflect on approaches to informal settlements and argue for a turn from 'upgrading' to 'revitalisation'. We conceptualise revitalisation as encompassing three core tenets: planetary health, transdisciplinarity, and a people-centred approach. In our vision, revitalisation approaches would take a big-picture view of informal settlements that recognises the inter-connectedness of people and nature within complex urban systems; integrates perspectives from various academic disciplines, non-academic sectors, and communities for knowledge generation; and centres informal settlement residents and communities as experts and partners in urban praxis.