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I hope many of you had the opportunity to join in with events and celebrations to mark the new Chinese Lunar Year, that of the Pig.  I have read that the associated attributes of the Year of the Pig include a beautiful personality, good fortune and special associations with the late evening and night time.  I see this as an excellent augury for City Health 2019 which has several presentations concerning the problems linked to alcohol and the night time economy, alongside sessions looking at the links between the environment and health, a look at the role of art, reflections on what we have learnt and community initiatives.  The presentation on Public health – heroes and villains is one I particularly look forward to. Almost certainly the best £75 you will spend during the Year of the Pig. http://cityhealthinternational.org/2019/

My celebrations didn’t extend further than eating an excess of rather fine food.  However, the obligatory fortune cookie contained a particularly apt pearl of wisdom, “I am not a genius, but I am a terrific package of experience”.  A reality which I am sure many of us can relate to, although, if you are a genius please do keep reading.  Over the last two decades working in the drugs and alcohol field I have had the good fortune to have worked with some outstanding individuals.  I have also been involved in helping develop and expand national programmes (this back when such things were well resourced), witnessed the expansion and use of evidence-based approaches and seen significant, real gains for communities and individuals.  Much of this has been built on new partnerships and alliances, and a willingness to think and work differently.

Of course, I have also had less positive experiences.  The last decade has seen increased financial challenges and political interest has proven fickle.   Under such pressure there is a tendency for individuals and agencies to dig in, concentrate on what is seen as core business, and so there is a natural inclination to maintain existing approaches. Afterall we all know that our own specific specialism or work area is THE most important, don’t we?

 Now there are always some who can see the benefit of forging new approaches and alliances to deal with the challenges our communities face.  Sometimes you have to run a scheme or project to find out if it works.  Its not unusual to find unexpected outcomes for example work to help improve care for those experiencing dementia can significantly reduce demands on police resources. Sometimes we learn most from things that don’t work. To understand and evaluate complex problems, develop new ideas and determine whether they are worthwhile across a range of indicators is complex and requires a range of expertise and experience. 

Unfortunately, it is easier said than done. A major barrier is the fact we all like clinging to our professional comfort blankets.  It is easier to remain within the secure territory composed of our own experience, stick with our peers and view things from well established, comfortable, positions.  This can feel safe, it certainly provides plenty of opportunity for mutual reaffirmation, but it limits vision and impact.

I recently hosted an event looking at the range of interventions in place across England that seek to reduce the number of intoxicated people who end up in our Accident and Emergency Departments at peak times.  This is an important area of research. There are a huge range of projects of this kind, with different structures, remits and levels of resourcing.  Up until now there has been little meaningful evaluation.  Now this is no simple task, with many variables but clearly there must be some approaches which are better or more cost effective than others. Some will have better impacts in terms of demand on ambulance services, local emergency department, demands on police time, public perception and protection of the vulnerable.  There are important considerations about the safety of those who may be heavily intoxicated or injured, the degree of clinical oversight required and of course whether we are making best use of scarce finances and valuable human resources.  It is a challenge but this research is a valuable step in helping improve understanding of what these type of initiatives can deliver and some of the key issues in providing a safe and effective service (some insights on this developing area, and other approaches to trying to reduce alcohol harm, will be provided at City Health 2019 in Liverpool next month).  But one thing I did notice when speaking to those present after the event that nearly everyone was considering these projects from their own professional perspective.  There was great insight and huge expertise, but it was narrow.  It didn’t reflect the needs and experience of Council Leaders, Town Centre managers, venue owners or indeed the public.

I was given the opportunity to reflect on these thoughts a few hours later when I had to take a relative to hospital.  As a busy Friday night in Accident and Emergency wore on, I saw a succession of individuals, whose path to hospital clearly involved alcohol, be assessed and then await being patched up.  Now the NHS provides, by and large, an excellent service, for those who are seriously injured or ill (the care my relative received was excellent).  However, once you have been assessed as not being very ill or seriously injured the wait for having wounds stitched or be generally patched up can be lengthy.  So lengthy in fact that visits by the Police to take statements were a welcome punctuation relieving the tedium of waiting.    I saw people wait over seven hours to be sutured, watching their hangovers kick in and their bruising develop. 

Now how do you cost and evaluate the benefit of not having an Emergency Department full of alcohol infused walking wounding? Not having seriously ill and sick people “enjoying” the company of the inebriated?  Reducing the workload of doctors and nurses? The benefits in not having to take police officers away from town centres to wander hospital corridors and departments seeking those who may have been victims or perpetrators?  This of course must be balanced against the clinical expertise to be found within an A&E unit and the fact they are key assets requiring significant resourcing.  Clearly not an easy equation, but I am certain its one we can’t answer in isolation.   The perspective of any single agency or professional can not deliver what is needed, only by engaging with all those with skin in the game can we determine what works best in any particular locality.  This applies to a whole host of health issues, not just alcohol.  So, in the Year of the Pig I think we should make an extra effort to broaden our work networks, consider broader outcomes and increase our terrific package of experience. Being in Liverpool on 22 March would be a grand start.

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.