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The year is ending at a gallop.  Brexit may have pretty much paralyzed the government in Westminster but in national, regional and local administrations the wheels still turn.  Health issues still feature in the media, some, such as rough sleeping and alcohol intoxication, being seasonal fixtures.  Universities and experts continue to provide new analysis, information and fresh angles on key subjects.  This may all sound very self-evident to colleagues outside the UK, but it is reassuring, at least to me, to take a moment and remind ourselves that the earth has not stopped turning on its axis as issues over the backstop, second referendum, votes of no confidence etc. etc. dominate the news and conversation.

Last week provided a very welcome reminder of the broader world with an invitation to the launch of a new book, Collapse of the Global Order of Drugs. In the interest of openness, I should declare that I have known the editors Axel Klein and Blaine Stothard, as well as some of the contributors, for many years.  However, I can assure you that my views on the value of the book were not influenced in any way by the lavish hospitality, as this was entirely absent (not even water!).  What the evening did provide was an opportunity to reflect on the fundamental changes that have occurred across the globe in terms of drug reform and the challenge this poses for the current United Nations framework.  In the audience were a range of experts including friends, colleagues and a former boss, collectively a wealth of expertise and wisdom.

Most present were in favour of the reforms undertaken in Uruguay, the phenomena of cannabis reform happening within US states and the recently enacted changes in Canada.  Within the UK there has also been some movement around the use of medicinal derivatives of cannabis.  An increasing amount of evidence is also amassing to suggest that a number of drugs currently seen as substances of abuse may have clinical application (MDMA for example).  One of the guest speakers did sound a note of caution and asked us to consider the situation in various countries where governments were not only showing no interest in reform but were pursuing hard-line, draconian policies.  While these are likely to see increases in health-related harms (e.g. Blood Borne Virus infection rates) we should not lose sight that in many countries and cultures these policies are popular.  What to us in that room is a powerful evidence base which combines human rights, health-based approaches, pragmatism and clear benefits is to others socially corrosive defeatism that leaves the vulnerable abandoned to their fate.  The latter view is not one I hold but it’s foolish to ignore opposing views.   One element of the support for drug reform that does stand out for me is that many supportive of the moves to legalise cannabis are hostile to proposals that would reduce the harm associated with the use of nicotine.  We shall see how this apparent contradiction develops.

Now one attribute I am blessed with is contraryism.  Some would say that I am just unnecessarily argumentative (this may also be true) but I can see various sides of most contentious issues.  It was a useful skill as a civil servant when preparing briefs for parliamentary debates. It can help advance a cause or position as it allows for approaches beyond the butting of heads with opponents, which rarely changes minds and often leads to deeper entrenchment of opposing views.  And its just not people with opposing views we need to engage better with.  I have often seen those who should be allies arguing amongst themselves over matters of degree, often based on an internal philosophy or approach that doesn’t adequately value the role of others.  Where this is compounded by competition for scarce resources be these financial, political or staff, its recipe which normally hinders or prevents initiatives and delivery.    This has often afflicted projects which aim to reduce harm in Night Time Economy settings.  The priorities and demands of law enforcement, licensed venues, public health, emergency departments, local authorities, partygoers and residents can all appear an overwhelming mix.  However, we have example that with the right mechanisms in place, mutual respect and a willingness to work with others and maybe try something a bit different that real and demonstrable improvements are possible.

So, my Christmas suggestion is that we all make the effort to engage with colleagues from differing fields and backgrounds. Challenge our own understanding and biases, how do they look to those outside our particular silo?  Maybe even reach out and engage with opposing views, you don’t need to engage in twitter warfare (at least not over the season of goodwill), just improve your understanding of how other views are sustained.   Who knows it may lead to some new allies and fresh advances. 

For those celebrating Christmas I wish you a fantastic time. If you get any holiday, I hope you enjoy it.  To all of my best wishes and thanks for being part of City Health International.

Monday, July 29, 2019
I write this on a day when London is experiencing, what is for us, exceptional temperatures. Overhead power lines and train tracks have warped. On some routes passengers have been advised to avoid travelling if possible, and many employers have encouraged staff to work from home. I suspect many who did travel to their workplaces were drawn by the prospect of effective air conditioning as much as personal work ethic. This great City was unusually quiet, apart from the pubs and bars who were doing a roaring trade. Who would begrudge people a pint of beer or a glass of wine when it’s so damn warm, especially when by delaying travelling an hour or two, the journey home may be made a little more tolerable?
Tuesday, July 16, 2019
Last week I met with someone who, having just completed a Masters in Epidemiology, is keen to work in the health field. Over a hot chocolate I outlined my perception of the current big issues relating to substance misuse, our most vulnerable populations and the policies and structures we have in place to address these issues.
Tuesday, July 02, 2019
Absolutely outstanding. That’s my carefully considered assessment of the Global Forum on Nicotine in Warsaw that I was fortunate enough to attend two weeks back. I say this despite the mosquito bites and the fact that the weather was rather warm for me. The event was one of those that provide a buzz and an energy that comes back to the workplace with you. This was fuelled by an outstanding array of speakers and a vibrant audience mix. Discussion and argument were not limited to the auditorium or breakout rooms, but instead could be heard throughout the venue, over lunch, during coffee breaks. There were attendees from every continent (well, ok, I didn’t actually meet anyone from Antarctica). Academics, clinicians, researchers, harm reduction advocates, retailers, product developers, policymakers, and- most importantly - vapers and users of other tobacco harm reduction products, all mixed together sharing views, experiences, and- as we should expect- differences of opinion. It certainly lived up to the conference strapline Its Time to Talk About Nicotine and the rich promise of a genuinely horizontal approach.
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.

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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.