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Everything is changed. COVID-19 and responses to it have seen dramatic and fundamental changes to how life is lived around the globe. International travel has come to a near complete halt, much of the world is under some form of lock down with businesses, schools, shops, pubs and cafes shut. Our economic and social reality is now unrecognisable from that of only weeks ago.

When this novel Coronavirus reared its head at the end of 2019 it attracted some media interest and those who think about epidemics and pandemics sat up. A global pandemic has long been at the top of the list on national and institutional risk registers, yet there has been a pattern, repeated around the world, of an understandable reluctance to see normal life turned upside down by a virus. Whether it was school headteachers calling for exams to be allowed to go ahead, politicians saying there was no need to change planned elections, pub chain owners saying they couldn’t see why there premises needed to close, or some of us realising our holiday was not going to happen, the reality of what we face has taken a time to bed in. Ideas about pursuing herd immunity, of taking the short term hit but protecting economies have been swept aside by the very real prospect of health services being totally overwhelmed. Many countries acted as if they would avoid these outcomes through some form of national exceptionalism. As I write it seems that only Belarus and Brazil are maintaining this approach. I fear they too will find that the virus doesn’t acknowledge their perceived uniqueness.

We will likely see significant variations as regards infection rates, treatment outcomes and broader social impacts. This will reflect political and societal responses in different countries, regions and cities, though not just those made in the last few months. Ratios of doctors, nurses, beds and ventilators to populations will be up for examination, as will stocks of personal protective equipment. Systems that were considered highly efficient in 2019 may come to be seen as having had a dangerous lack of resilience. It is also clear that the pandemic has the potential to see a wholescale revaluation of the value placed on a range of jobs, of how we protect vulnerable communities and the way we engage and communicate with our citizens on health matters.

Front-line medical staff have rightly been praised, with outbursts of public appreciation to be seen around the world. Looking forward, how they are valued and recognised by the systems in which they work is going to be a fundamental issue, especially given the sacrifice many of them have made. The profile of hospital support staff has also been increased, cleaners, technicians, porters, admin and catering staff are now much more visible. Outside of the medical sphere those stuck within their house are enjoying a new appreciation of postal staff, refuse collectors and delivery drivers. Many parents have certainly gained a greater appreciation of the value of teachers. When we undertake our essential shopping there is now a greater appreciation of the work of shopworkers, especially should we discover stocks of toilet roll or hand sanitiser. We are getting an enforced opportunity to re-evaluate what is important to us and our lives.

Many countries have taken steps to try and protect their elderly or immune-compromised citizens. This has seen some tremendous community responses, with volunteers taking on the delivery of food, medicines and working to help counter isolation. Ballachulish, a village in the Highlands of Scotland was one of the first to organise this kind of approach in the UK, but many other areas have done similar. This impulse to help others shows the strength of communities and many governments, including in the UK, are now seeking to harness this.

Of course, the homeless and rough sleepers are highly vulnerable. Sleeping on the street, there is no effective way to self-isolate and your underlying health is also more likely to be impaired. In many cities, including London, Edinburgh, Paris and Toulouse, there has been rapid action to establish specific accommodation to support people in this situation. Those who have complex health conditions, including substance misuse, pose particular challenges but it has been impressive to see civic authorities and the voluntary sector combining to tackle these.

We are all guilty of choosing the medium of communication we are personally most comfortable and familiar with. And we certainly can’t fault any individuals or organisations for struggling to find the right approaches when dealing with an unprecedented situation. But COVID communications across the world reveal a lot of learning points. Not every citizen watches every news broadcast, some rarely watch it at all. Messages to the general public have developed rapidly and some of it has contributed to what has been described as panic buying. We also need to think about the impacts of lock downs on those experiencing domestic violence and children at risk. What can we do to support those with mental health issues? There has been some great work in recent weeks to address these by government agencies and the voluntary sector, but more will need to be done as we go forward.

We should not be surprised when people buy more when they are confronted with imminent lockdowns and the nuances about still being able to shop for essentials get lost in alarming headlines. Complaints about people using public spaces two days after senior figures have been advising people to make use of them reflects an under developed policy. Telling people, they should exercise in their own gardens reflects a limited grasp of many people’s reality. I have a particular issue about the repeated claims that all answers, useful advice and access to life’s essentials is to be found on the internet. For sure there is an enormous amount of good stuff out there, but also lots of spurious advice, food delivery slots are limited, and IT access is not universal. Not every older citizen in the UK is a “silver surfer”, not everyone can afford unlimited internet access or the kit to take advantage of it. We need to make use of a range of mediums and provide appropriate messages for specific audiences. This will aid understanding, support positive engagement and so bring communities with us on this fight. We must continue to share and discuss what we do, drawing strength from each other’s experience. Down that path we can hope to get back to not just the world we knew a few months ago, but one where some important lessons have been learnt.

Wednesday, April 01, 2020
Everything is changed. COVID-19 and responses to it have seen dramatic and fundamental changes to how life is lived around the globe. International travel has come to a near complete halt, much of the world is under some form of lock down with businesses, schools, shops, pubs and cafes shut. Our economic and social reality is now unrecognisable from that of only weeks ago.
Tuesday, March 10, 2020
Clearly the current health focus is strongly centred on Covid- 19 and related issues, as it has been for the past few weeks. It is a demanding situation for politicians, officials, and indeed all of us, especially those working in our healthcare system. One of the major challenges we face is increasing understanding and encouraging changes in behaviour, while also avoiding panic and overreaction. Trusted and accurate information is clearly essential, both for those who have a key role and for the general public. We are certainly seeing more of England’s Chief Medical Officer and Chief Scientific Adviser in the media than usual. In the current situation, politicians are not only keen to hear from experts, but also happy to let them step into the spotlight. While we still see sensationalist headlines, there are also visible benefits of this approach, with more measured and informed elements within the media coverage- though this is less evident on the outer reaches of the online universe. Before I move on to other topics, let us reflect on the significant additional pressures being placed on our frontline health providers. They deserve our gratitude and, in many instances, much improved terms and conditions. Let’s hope that when this coronavirus issue passes the staff that so many rely on are not overlooked.
Monday, February 10, 2020
Public health is front and centre of the media currently, with concerns about the coronavirus outbreak, which was first identified in the Chinese city of Wuhan, splashed across almost every front page. With confirmed cases now reported in numerous countries across the world, we face the possibility of a pandemic. As several experts and commentators have pointed out, in our modern, highly interconnected world no epidemic remains a local concern. This, of course, makes for frightening headlines- which, in turn, calls for calm and informed responses.
Wednesday, January 15, 2020
So here we are: 2020. Let me start by wishing all of you the very best for the year ahead. I have, occasionally, been accused of an inclination toward cynicism and a failure to look on the bright side of things. So, for my first blog of the year, at least, I am going to be determinedly upbeat. You can judge for yourself how long it lasts. This sense of optimism is influenced by the fact that the end of 2019 saw some positive signs in the world of substance misuse. While it was something of a mad scramble against time, we managed to pull together a high quality and well-supported pan-London Christmas alcohol campaign. I am very grateful to colleagues who delivered the key elements of this work and to everyone who supported it. Some, in fact, went well beyond the call of duty to engage with our colleagues in the blue light services. Although we will not have any data in terms of its reach and impact for some months (I will update you), what I can confidently say is that many individuals and organisations liked the messaging and tone. I like to think it is helping contribute to Londoners having a more considered and healthier relationship with alcohol, though there is a way to go yet!

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CITY HEALTH INTERNATIONAL EVENTS

CHI Melbourne 2019

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CHI Liverpool 2019

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CHI Odessa 2018

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CHI Basel 2017

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CHI London 2016

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CHI Barcelona 2015

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CHI Amsterdam 2014

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CHI Glasgow 2013

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CHI London 2012

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City Health International
Founded in 2012 City Health International is a network of individuals and organisations engaged in the study of and response to structural health issues and health behaviours in the urban environment.
For the first time in history the majority of the world’s population now live in urban environments and the proportion continues to grow. As national governments struggle to deal with the pressures and demands of growing urban populations against a backdrop of financial deficits and uncertainty, it is increasingly left to those working at a city level to provide the leadership and support needed to tackle key health issues.