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A confession. As much as I would hate to be without my iPad or laptop and can barely remember how we got by before the internet opened access to a mind-boggling range of material I still like to read and hoard hard copies of important documents. Over two decades I have built a significant collection of reports, strategies and reviews. I couldn’t call it a library (it lacks much in terms of organisation) but it’s a resource where I can find a great deal of what was happening around drug policies and allied fields during the 1990’s and into the 21st century. In terms of external validation, I have had many individuals and agencies come to me for assistance, including central government, who had somehow lost copies of their own policy documents while switching to digital formats.

Digital provides many advantages in terms of access, reducing the number of trees converted to pulp and cost of production. But there are downsides. Viewpoints, beliefs and small-scale studies compete on a near equal footing with rigorous, scientific study. Indeed, the more professional approach can be hampered by a desire to be nuanced and cautious and so lack the immediate impact of the more polemical. Digital resources can also be less robust than printed documents. The UK experienced this in 2010 when the incoming government removed vast number of useful documents from Departmental websites. It wasn’t just those of an overtly political nature. Many useful reports and practical toolkit guides intended to support local activity, disappeared over night. Most eventually reappeared in the UK web archive. But only the determined were likely to find them and they were robbed of much of their influence and value by being divorced from their “live” policy environment.

I have also been involved in a number of projects, some well-funded, which have produced useful guidance and advice. This nearly always placed on a website, which often ceased to exist within a few years. Now at a time when authoritative, useful guidance is at a premium, needed to help support front line workers whose training budgets are a slim shadow of former years, if extant at all, my frustration on this issue had reached boiling point. So, at the recent City Health conference I was delighted to Chair a parallel session on E-health and e-learning: ensuring public health and well being at a local level. We had four excellent presentations, which covered violence prevention, a practical example of how digital approaches can support effective first aid responses, ways to address the problems associated with sex addiction and one on the Sustainable dissemination of information from EU funded projects. Dorota Król’s presentation set out the problems and ways of overcoming the problem, not least thinking about legacy early on in project development.

We need to also think far more about providing credible and accessible information for public use not just our professional peer groups. Political establishments, the world of business and finance, indeed nearly all our structures, including health, are being subject to a unique degree of scepticism which often spills over into actual hostility. I would argue in the health sector that the seeds of this distrust have often been sown by a failure to engage with the populations we claim to be helping and poor, at times inaccurate, messaging.

This was brought home to me recently while watching a television debate on the increasing strength of the anti-vaccine movement across many countries (and how this maps onto support for various so-called populist parties). The presenter asked one of the contributors, who was a proponent for vaccination as to what had gone wrong. His response? “A lot of Public health practitioners are one trick pony’s. Experts are often arrogant and scare tactics can be counterproductive”. Now this is an incredibly harsh judgement on thousands of dedicated, hard working and committed individuals. But I do think there is kernel of truth in there. As we think about making better use of new technology we need to remember to communicate with people in a way that relates to them and always be on our guard against hectoring, lecturing and be wary of scaring people. We can be more than one trick ponies.

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.