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The City Health Conference in Liverpool starts in less than two weeks. I am looking forward to revisiting a City I knew well in the late 1980’s but have only visited briefly since.  The main attraction though is an opportunity to listen to a range of excellent presenters and engage with my fellow attendees. As well as hearing from those working in areas I am familiar with it will also provide an opportunity to learn about subjects I rarely get an opportunity to engage with or consider. It promises a brief escape from the community safety/drug misuse bubble I normally inhabit. However, based on previous City Health experiences I expect to come away with some inspiration and some ideas around practical application. 

And we could all benefit from some inspiration.  On a daily basis the media highlights health issues facing our communities. Just looking at a two day snap shot of the national media there are concerns around knife crime and violence, the challenges of providing effective social care for our ageing populations, questions about how we better support peoples mental health, concerns over the number of drug related deaths and questions as to why improvements in life expectancies have halted (which apparently is good news for some investment funds!).  An immense range of complex problems which those working in the communities and health sectors are expected to help improve. At a time when financial resources are scarce.

Public health is often described as being essentially interdisciplinary, yet it often seems as prone as many other fields to the allure of specialism and of creating narrow spaces where only individuals of similar training and background gather to share ideas and pontificate on what should be done. Now expertise is essential, but having a broader understanding of health issues, social policies, politics and communities can only help in terms of delivering positive change. We may all have a piece of the jigsaw but we need at least an idea of what the big picture looks like.

I recently read an excellent critique of the trend toward ultra-specialism, that the amount of information available on the internet was pushing professionals toward ever narrower, more restricted, fields where they can develop unassailable and comfortable command. This leads to deepening ruts and a failure to develop and a decrease in relevancy to rapidly changing situations. We can all help counter this by getting out into the wider world of urban health, of exploring some new territory now and again, even if it feels a little scary and odd on occasion! (I should disclose that it was the historian Norman Davies whose concerns about ultra-specialism I have “borrowed here).

As we know the breadth of challenges, we face in our urban environments is massive but so is the opportunity. We perhaps need to occasionally remind ourselves of the examples where apparently intractable and insoluble problems have in fact been countered. The venue for the conference in Liverpool is just around the corner from where the UK’s first needle and syringe programme was opened. A brave step that helped the UK become one of the international leaders in harm reduction for injecting drug users.

Currently in London one of the biggest political priorities and greatest cause of public concern is knife crime and the tragic toll of lives lost.  A recent tragedy has had a very visible impact on the area I live. Violence and the fear of violence is incredibly corrosive to communities. Naturally people are looking for an understanding of what is driving these incidents and ideas relating to prevention are at a premium.  There is a great deal of talk about the need for a public health approach, often without much comprehension of what that means or looks like. The media and others have spoken about the need to learning from the Scottish experience, and the establishment of the Violence Reduction Unit in 2005 which did oversee a dramatic reduction in knife crime. Now London’s problems are different from those that the Scottish Violence Reduction Unit (VRU) faced in Glasgow but the genuinely multi-disciplinary approach they developed and the emphasis on establishing and sharing expertise clearly paid dividends and is something to be emulated as is the key ethos that violence is preventable not inevitable.

Currently there is a well-worn path from London to Glasgow as officials and politicians travel up to improve their understanding of the VRU’s work.  Colleagues there have always been generous with their time in terms of sharing experience, and Karyn McCluskey, a former Director of the VRU is a previous recipient of the Paolo Pertica Award (always a highlight of the conference). Partnerships are core to what the VRU achieved, and of course are central to how we can respond to the other challenges we face. But partnerships need a starting point, some common understanding, shared language and values. City Health International is a great opportunity to lay some of those foundations, to help avoid the ruts and keep the wheels turning in the right direction. Hope to see you in Liverpool.  

Monday, May 27, 2019
The value of partnership approaches and joint working to tackle major health public policy issues is widely accepted, if more rarely practised. Even where there is engagement with other professions or disciplines there is a tendency to work with those whose outlook is not too challenging and are closest to us in practice and approach. City Health has been at the forefront in challenging this and others are also working to weaken the silo walls. In the last two weeks I have been a spectator and a participant in two very different events which highlighted how important it is to include the end user, the public, our communities when developing and delivering services.
Wednesday, May 15, 2019
The confidence we have in our health systems is at the core of how we use and, hopefully benefit, from them. If we lack confidence in the benefits of going to see our GP for a health check, seeing a nurse about a travel vaccination or asking advice from the local pharmacist why would we bother? In terms of dealing with drug and alcohol problems the importance of a positive therapeutic relationship or alliance is recognised not just as being a pleasant “extra” but being central to aiding recovery. It has an important role across all fields of treatment. There are also benefits where a society has faith and confidence in those that oversee and provide healthcare systems and treatments at a population level. By and large, despite many complaints and challenges, the National Health Service in the UK remains a highly valued and trusted part of our society. And rightly so. But that doesn’t mean we should shy away from acknowledging where things have gone horribly wrong.
Tuesday, April 30, 2019
In England, the Easter public holidays see many of us get a four-day weekend. Schools are on holiday, roads are jammed, airports overflowing and much of the country indulges in chocolate, either in the form of eggs or bunnies. This year we also enjoyed some great weather. Fortunately, May looms, which brings another two holidays for us to recover from previous holiday excesses/hard work (delete as appropriate).
Thursday, April 11, 2019
Let me start with a big thank you to Liverpool, and especially the team from John Moores University, for another outstanding City Health conference. The impressive surroundings of Liverpool Medical Institute- a monument to the 19 th century’s commitment to science as well as its obsession with ancient Greece- proved to be an ideal venue. It contains a wonderful historic library, a selection of surgical and medical tools that bring a tear to the eye, and portraits of those who have contributed to the development of public health and modern health care, including some rather fearsome looking characters.

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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.