We are now just days from the 2018 City Health conference, where those attending will be the guests of the Alliance for Public Health (Ukraine), AFEW International (Netherlands), and the city of Odesa in association with Knowledge Action Change. Seven years ago, I had the pleasure to host the first of these events. It is a testament to the growing interest in how we make our cities better, heathier places to live- as well as the hard work of the organisers- that City Health has not only continued as an annual opportunity to hear and debate from a wide range of experts and commentators, but is now also a year round network where research, news and views are shared on a weekly basis. It’s been a pleasure to contribute to this process. For me, it’s been an enjoyable opportunity to reflect on a wide range of topics and share my thoughts with you. Many thanks to those who have responded, I apologise for having been London and substance misuse centric, but the last six months have helped broaden my knowledge beyond those confines!

 The programme for this year’s conference has an impressive breadth. There are sessions which remind us that we need to continue our efforts in tacking TB, AIDS, and the harms associated with drug use. We will be looking at the challenges of transportation and obesity, work to reduce the toll of violence, and the potential of technology to help promote inclusivity. Speakers will be looking at the needs of often neglected groups and individuals, as well as whole population level interventions. I have a particular interest in the presentations that will explore how we can best engage with our communities and harness the power of politics.

Health is not only a central concern for individuals daily but is also an important component of what makes a city, or country, successful.   There are various indices that rank the achievements and failings of nations and our major urban centres. However, in the political sphere what are the impacts of the massive variations that exist between those who enjoy the longest, healthiest lives and those who don’t?

An interesting angle on this issue is to be found in a study by Columbia University Irving Medical Centre that looked at voting patterns in the 2016 USA Presidential elections. This reveals a strong correlation between areas which experienced an increase in age-adjusted death rates and voter dissatisfaction. Much of this mortality was fuelled by alcohol and drug use. It also showed that, in general, cities were more successful at presiding over life expectancy gains than rural areas, thus starkly inverting the traditional image of the city as concentration of ill health (and sin) compared to the healthy and virtuous rural idyll. Before we celebrate this triumph of the modern city I suggest we all ponder how sure we are that the same issues don’t exist within our own conurbations and consider the inter relation of cities with their hinterland. Leaving communities behind, urban or rural, serves to guarantee future problems, both health and political.

In trying to address the issue of unequal progress between different communities, the recent interest in another area of health may help point the way. I am sure we have all seen the rapidly growing evidence which identifies the dangers and harm associated with social isolation and loneliness (the analogy that it’s equivalent to smoking 15 cigarettes a day is wonderfully engaging). Cities around the world are starting to look at how they can reduce this problem, including Amsterdam and Belfast (the WHO Global Network of Age-friendly Cities and Communities is worth a look).   Individuals benefit from social contact and networking. I would strongly suggest that cities also benefit from such interaction. We can all learn and benefit from others. City Health International provides a great opportunity to do just that.

D.Mackintosh photoDavid MacKintosh is the Head of Community Safety for the City of London, and has also been the Policy Adviser/Director to the London Drug and Alcohol Policy Forum (LDAPF) since 2001.  The LDAPF works to support policy delivery and promote good practice across the drugs, alcohol and community safety agendas.  He has been involved in a number of innovative campaigns around issues including drug driving, substance misuse in the workplace and improving awareness around drug safety in clubs and pubs. The LDAPF is funded by the City of London as part of its commitment to improving the life of all those who live and work in London.  For the last eight years he has also been seconded to the Greater London Authority to provide advice around substance use issues and health inequalities. 

Prior to this post David worked for the United Kingdom Anti-Drug Co-ordination Unit (part of the Cabinet Office) for two years, primarily on young people and treatment policy issues.  This followed on from some 8 years in the Department for Education and Skills where he worked in a number of areas including international relations and higher education policy. He spent ten years as chair of an East London based service provider and is currently a trustee of Adfam (families, drugs and alcohol) and the New Nicotine Alliance (which aims to improve public health by raising awareness of risk-reduced products).