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Like another 1.5 million Londoners my commute to and from work regularly involves reading the Evening Standard, a free newspaper that enjoys a rich heritage and is almost a part of the fabric of the City. This despite its politics and editorial stance often being at odds with London’s inclinations. It does benefit from some quality journalism and has a breadth of coverage which reflects London’s status as a world city. Last Monday there were three articles which ensured I didn’t doze off on my journey, and which captured three of the key issues facing our major global centres.

The first that caught my eye was the headline Megacities can offer a better standard of living to people. This was contained within the business pages, which don’t normally hold my attention, but on this occasion, there was an interesting piece based on a recent Euromonitor report. I am a sucker for good futurology and this had plenty to make me sit up. By 2030 Jakarta is to be the biggest global city (it’s currently Tokyo for those prepping for their next pub quiz) with a projected population of 35.6 million.  However, it is Africa, not Asia that will see the largest rise in megacities with Dar Es Salaam and Luanda joining Cairo and Lagos. What will it mean for the future of global cities that these advancements will be taking place in the developing world? It will certainly mean a shift in focus from New York, London, Tokyo and Paris. Certainly, there will be huge challenges, in providing infrastructure, services and utilities, but the article is upbeat in asking us to think of cities as a solution to population pressures, and as places that generate the wealth and investment to overcome their own problems and still provide attractive locations for people to live and thrive. I love an upbeat story to start the week.

However, the next item I read was anything but uplifting with its focus on the massive challenge we face in tackling homelessness and rough sleeping in London. Local authorities in London, as across the United Kingdom, have experienced an unparalleled period of reduced income while taking on new responsibilities for public health in the context of increased demand for key services. Against the backdrop of austerity over the last five years and the challenges of integrating new services it is of little surprise that the hoped-for promise of placing public health at the core of local government has yet to be realised.  That is not to say that great efforts are not being made. There are some great initiatives going on and I know of many individuals working at local, regional and national levels in a range of governmental and NGO agencies who are doing a great job. Yet you don’t have to travel far in London to see that we need to do much more to ensure that, in one of the world’s great cities, we don’t leave our citizens behind. The negative consequences of failing to address these challenges don’t just fall on the most vulnerable but impact on all citizens. The Mayor of London’s new Health Inequality Strategy sets out his ambition in this area and I dearly hope we will one day look back upon this as a watershed in improving health for all Londoners https://www.london.gov.uk/what-we-do/health/health-inequalities-strategy.

The wealth and success which cities are good at generating but, in most cases, are less adept at sharing amongst their citizens brings me to the final of the three articles. This touches on the dread subject of Brexit. I have no desire to get embroiled in that particular snake pit but Stephen King, HSBC’s Senior Economic Adviser highlights how London has political leanings and an economic nature increasingly at odds with much of England. In terms of attitudes towards the EU and immigration London is very different from other parts of the country. Though much of the wealth that London generates goes to providing services elsewhere, house prices and salaries place an increasing gap between the capital and its hinterland. Of course, many capitals and major cities have a distinct character from their surrounding regions, but as cities develop at rapid pace we need to consider the relationship between cities and nations. Unless we envisage a new world of independent city states (which was proposed tongue in cheek – I think – within the article), then the benefits they generate need to be effectively shared.

Next blog I am going to look at some of the historic heroes of urban health, starting with the memorial to Liverpool’s first Medical Officer of Health. A place I plan to visit when attending City Health 2019 in March…

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.
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.

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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.