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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.

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.
Wednesday, February 28, 2018
Welcome to my initial blog for City Health International. My intention over the coming months is to look at developments in research, politics and the media through the prism of urban health and what it may mean for the City Health community (so pretty much anyone reading this). While my background is in national and regional policy work around substance misuse, with a more recent interest in crime and anti-social behaviour issues, I will be looking at a much broader range of topics. Before we embark on that though I shall briefly explain how I got involved with the phenomenon that is City Health and how that helped extend my horizons beyond alcohol and drugs.
Sunday, January 27, 2019
I hope 2019 has begun well and that the year ahead proves a good one for you all. Despite the ongoing political uncertainty in the UK and increasing strain on budgets, with little hope of improvement in the near term, I remain surprisingly upbeat. It may be the result of what seems to have been a successful London Christmas alcohol campaign, once the data firms up I shall certainly share more. It could be the prospect of the forthcoming City Health International Conference in Liverpool on 22 March, which promises some great speakers. Possibly it is a result of small, but welcome, signs of a willingness to explore new ways of thinking and working to reduce health inequalities in relation to mental health and hepatitis. Perhaps it’s having just secured funding to update our Safer Nightlife guidance, which aims to reduce drug related harms in the night time economy. I am sure the money has helped, you could say it has incentivised me.
Monday, December 31, 2018
Like many I have spent the last two weeks demonstrating a casual disregard for the advice provided by health organisations in terms of food and alcohol consumption. My levels of physical activity have not been all they should have been either, although I am full of good intentions for the coming year and have started to make my overfed body walk more .

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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.