chi blogs

City Health International is delighted to announce we have establishing a blog on the website to promote debate and discussion around current issues of interest to the network. David MacKintosh, one of the founders of the network, will be writing a weekly piece, which will be posted here. We would also like to invite contributions to the blog from others with ideas and opinions on issues relating to health behaviours and urban health and well being and who wish to share with others. If you would like to contribute something, please send your contribution to chiblog[at] and we will ensure it is posted on the site and placed in the weekly City Health alerts sent to those in the network.

David's blog #15: Wheels of Good Fortune and Postcode Lotteries

We all know there are many factors involved in any individual’s health, there are environmental factors, the physical circumstances in which they live, their behaviours and genetics. Access to good medical services, for both prevention and treatment are also recognised as being important. But the processes by which it is decided which services are provided where, be that at a national, regional or local level are, perhaps, less frequently considered. Yet we all know there are significant variations in everything from cancer survival rates (good to be in the USA, Canada, Australia, Finland or Iceland) to access to good quality ante-natal and early years care, where Western Europe general does well as do Japan, Singapore, Hong Kong and Macau but the USA does relatively badly.

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David's blog #14: You may not take an interest in politics, but it will take an interest in you (with apologies to Pericles)

I was recently involved in a visit to London by a group from Washington DC. They were drawn from the offices of both Republican and Democrat members, and all shared an interest in learning more about UK harm reduction approaches. While my contribution was limited to illegal drugs and alcohol, they also met those involved in promoting tobacco harm reduction approaches. I am always struck by how much more difficult and complex we make harm reduction around legal substances than illegal. Providing advice on how an injecting heroin user might reduce risks to themselves and those around them is, by and large, pretty uncontroversial. Start talking about offering practical advice to those who drink above the government recommended guidelines or to those who smoke or otherwise consume nicotine (despite the efforts of Public Health England), and you can quickly find yourself in hot water.

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David's blog #13:Violence comes not from genes but from ideas (Edward Bond)

Across the world many cities face high levels of criminal violence and murder. A quick search will reveal that in terms of global league tables, certain regions dominate with Latin America, North America and Sub Saharan Africa providing the top 50 violent cities. However, a cursory glance tells us this is a complicated picture with huge variations between and within countries. Complex factors are at play, differing social, economic and legislative environments all have an influence. A brief historical perspective tells us that improvements can be made, that nations and cities can act successfully to reduce the levels of violence experienced by their citizens.

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David's blog #12: Read All About It

Health sells, not just in terms of medical care or pharmaceuticals. News about health issues is a central staple of the mainstream media, all major newspapers and tv news programmes boast a health editor and provide their customers with a regular diet of stories about the latest cures, scares and developments relating to our wellbeing. The public have a great appetite for the topic, not a surprise given that all of us have a profound interest in health. Given the nature of the media they often have a particular angle. Some outlets can be relied upon to criticise almost any new government initiative as a shocking example of the “nanny state” preventing citizens going about their lives. Others tend to the opposing position that without the strong and vigilant guidance of the state citizens are all prone to making chronically bad choices with negative consequences not just for ourselves but those around us. This is often presented as being necessary not so much for the readers or viewers of the outlet in question, who are normally assumed by the writer to be wiser than the average, but for the benefit of lesser mortals.   To be fair we all tend to think it’s someone else who needs to change their ways rather than ourselves. The media also love a controversy, it could be about the merits of substitute prescribing for opiates, whether people should pay to see a medic, the rights and wrongs of vaccination programmes, all these and more make great copy.

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David's blog #11: The Distant Outskirts of Our Cities

Nearly all cities struggle with providing good quality and affordable homes for all their citizens. In some it’s become an existential challenge, fundamentally linked to the ability to continue to succeed or even survive. Our cities often have pockets of incredibly luxurious and expensive housing, beyond the reach of even those working in relatively well paid and secure jobs. It is sadly all to frequent that you can observe fellow citizens living in doorways, parks and underpasses in close proximity to these homes for the wealthy. In all measures other than geography they live lives very distant from the urban idyll. The issue of people ending up sleeping on the streets of our cities is to be found world-wide, from Osaka to Sao Paulo, from Auckland to Stockholm. The underlying reasons that lead people to living on the streets are often multi-faceted and can be linked to particular local or regional factors. Health issues, both physical and mental are more common than in the general population. Research from the UK indicates the significant role played by alcohol and drugs. There is a strong correlation in terms of individuals who have experienced some form of significant trauma. We also cannot ignore the impact of national and municipal policies. Across the globe, policies intended to reduce government expenditure have made many millions more vulnerable to becoming homeless. 

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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).