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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…

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.