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Ignorance is a lot like alcohol: the more you have of it, the less you are able to see its effect on you – Jay Bylsma

It’s been a very busy few weeks.   I have been involved in finalising and rolling out a London wide alcohol campaign aimed at those out celebrating in the run up to Christmas.   Let me thank all who have contributed, especially my colleague Jess.  It’s been a serious piece of work getting partners on board and materials out on time.  No mean feat. You can find out more about Eat, Pace, Plan here https://www.cityoflondon.gov.uk/services/community-and-living/safer-city-partnership/Documents/christmas-toolkit-2018.pdf

On 3 December we hosted a major conference looking at how we can move to eradicate Hepatitis C.  It was a great event that attracted over 200 attendees, a positive indication of the growing interest in this issue.  It was also the biggest audience for one of our events since the first City Health Conference back in 2012.

Within the City of London, we have also been working to put in place advice and resources to help ensure those out celebrating in the run up to Christmas and the New Year have a safe and enjoyable time.  I am pleased that after many previous attempts we have in place an SOS bus (a vehicle manned by a highly trained paramedic and volunteers) to help those who may be intoxicated, need minor treatment or just need a safe space.  It is being run as a pilot, but I very much hope we can demonstrate the value of this kind of intervention and expand it for future years.  I have also had the pleasure of meeting with overseas visitors to London who have an interest in how we are managing and developing our Night Time Economy.  It’s always useful to share experiences and helps spur on further development and innovation.  

The Norwegian delegation I met with had also visited colleagues at Liverpool John Moores University, our hosts for the forthcoming City Health conference.  Liverpool has a strong history in developing fresh approaches to problems in the Night Time Economy, reducing drug harms and improving sexual health.  More than once London has collaborated with colleagues from Liverpool or borrowed some of their concepts with pride.   City Health 2019 will be held at the Liverpool Medical Institution on 22 March 2019, get it booked and in your diary now   https://cityhealthinternational.org/2019/ .

The above is, in part, something of an explanation, for the gap since my previous blog.  A few people have been in touch to say they had enjoyed some of my previous offerings.  I will confess to a sense of discomfort that anyone actually reads them! They have provided me with a great opportunity to think through some issues and to air some of my concerns and frustrations.  I have tended to forget I am sharing these with City Health colleagues, but thank you for the comments, I will try and ensure that they are, at least on occasion, of interest.

As you have seen much of my recent work has been related to alcohol.  Seeking to encourage what we often describe as “responsible drinking”, putting in place some mitigation measures for when people have over consumed and supporting good licensing practice.  On this latter point we need to ensure sight isn’t lost of some simple facts.  Effective local licensing benefits from the input of a range of partners, including public health colleagues, and that where it is done well, it has real positive effects: on those who use licensed premises local residents; blue light services and our hospital emergency departments.  I am hoping in 2019 to support some further work around improving our entertainment and night time sectors as regards responses to drug issues.

Currently England is still waiting to see a new alcohol strategy, promised back in May.  This, we were promised, will look again at the introduction of Minimum Unit Pricing (MUP).  A not uncontentious issue but a proposal I can support in principle as long as we take steps to protect the most vulnerable, dependent, drinkers.  It is an example of where overall population benefits have the potential to increase acute harms in certain populations.  We need to be considering how to reduce these risks and avoid worsening our health inequalities.

In recent years Scotland has developed its own approaches, in part because of the very high levels of alcohol harm seen within its population.    In May this year Scotland introduced a 50 pence minimum unit price.  It is far too early to identify any impacts from this but recent figures show that Scotland has seen a significant drop in alcohol related deaths since 2000.  While Scottish males are still dying of alcohol related causes at twice the rate of those in England, there has been a 21% reduction over the previous 17 years.  Why? Well it clearly predates the introduction of MUP, and other, earlier, Scottish Government measures on stopping discounts on multi buys seem unlikely to generate such a significant impact.  There is some great work going on in trying to help disadvantaged and vulnerable communities, Drink Wise Age Well, with older drinkers for example, but again there would seem to be something larger influencing this change. 

A great deal has gone on in Scotland over the last two decades, but I wonder if what we are seeing is, at least in part, an effect of the debates and arguments that have played out in the Scottish media and society about the effects of alcohol on individuals and communities.   Whatever the causes, the benefits are to be welcomed, but I hope to see some analysis as to what prompts population change beyond the often-blunt tools of governmental regulation.  That is something to ponder as we enjoy our peak party season.

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
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.