Introduction Increasing 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 analysis RISE 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. Ethics Study protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University. Trial registration number ACTRN12618000633280; Pre-results.

Integrative transdisciplinary approaches to watershed management are critical for addressing intersecting social, economic, and ecological processes that shape planetary health outcomes for humans, animals, and ecosystems. These challenges are acute in watersheds like the Citarum River in West Java, Indonesia, which suffers from severe pollution due to inadequate waste management infrastructure, and is worsened by rapid urbanisation and a changing climate, which further degrades the river ecosystem and threatens lives and livelihoods. Developing a unified approach to addressing these complex problems, and responding to real world social, governance, and biophysical conditions through integrated water management, is difficult to achieve in practice. Responding to this challenge, living labs have emerged as a mode of transdisciplinary research and implementation that incorporates the expertise of diverse stakeholders in real-world settings to learn and develop solutions to complex challenges, like those faced in the Citarum River. While living lab approaches have been used widely in Western cities, there is little research that investigates its usefulness in informal peri-urban settlements. This paper presents a case study of the Citarum Living Lab, a live action research program that aims to co-develop, test, and learn from socio-technical experiments in real-world settings in collaboration with an interdisciplinary international research consortium, government, NGOs, businesses, community leaders, and residents. With the ultimate aim of revitalising the Citarum river and its surrounding environments and communities, the program engages with community experiences, existing institutional frameworks, and changing environmental conditions. This paper identifies the conditions and factors that enable and constrain a living lab approach in a vulnerable peri-urban watershed from the perspective of the research team by employing a reflexive participatory action research methodology. Place-based, transdisciplinary responses to planetary health imperatives in this context require navigation of complex, multi-level governance contexts and novel resourcing models to support applied research, implementation, and learning.

Water sensitive cities show how holistic approaches can counter the health and wellbeing problems associated with urban dryness, write Tony Wong, Nigel Tapper, and Stephen Luby