City Health International


The main summer holiday season is coming to an end in London.  Traditionally, August is a quiet time where we catch up on long overdue administrative tasks and discuss potential collaborations for the coming months.   However, with City Health in Odesa less than two weeks away, I find myself in a reflective mood.   The last few months have seen a range of health stories in the media. Some got barely five minutes of interest, others generated coverage on television, and debate online.  What, I have been considering, are the actual impacts on our populations of this media interest?  People are exhorted to stop smoking, eat healthier, avoid sugar, drink less (if any) alcohol, be more active, avoid too much sun, and practice safe sex. No doubt there were also a few other topics that slipped passed me. How effective is this kind of advice?

These stories originate from a variety of sources.  Government departments, public health teams, charities, advocacy groups, and researchers all produce campaigns or materials which are aimed at the media. For many, I suspect, a key measure of success is getting the item on the radio or tv news or an article in the newspapers.  At this point I shall confess my own sins.  There have been many occasions where I have been involved with campaigns and have been delighted when an event or campaign has been picked by the media.  In the drugs world there are specific angles that are newsworthy.  New drugs, associated with extreme behaviours, are particularly popular.  Regrettably, I have to acknowledge that the level of media interest does not equate to less harm affecting individuals or communities.  Worryingly, in fact, there is some evidence that this coverage even increases harm in some cases.  For example, online searches for buying novel psychoactive substances rocket after newspapers highlight the “horrors” of the latest new substance.  While we were basking in the warm glow of media interest, the truth is we were achieving little for our vulnerable groups, although we might have enhanced our status with our peers and helped secure future funding.

The same dynamic doesn’t perhaps apply to all health areas, but I rather think we underestimate the impact and harm that headlines and attention-grabbing messages can wreak.  One example from this summer springs to mind.  A report on the potential for e-cigarette vapour to damage lung cells got mass media coverage.  Now this is an important issue, and I am glad it is being researched.  What was unfortunate is that in many cases the coverage suggested that previous efforts to suggest vaping is safer than smoking was flawed.  This is a real life, real harm situation.  Vaping has potential risks, but they are significantly lower than smoking.  It is a tragedy, and I use that word with consideration, that the broader health community can’t just align behind a simple, publicly acceptable, message that if you can’t give up nicotine then vaping is a better choice than smoking.

Similarly, discussions about the health risks and potential benefits of alcohol consumption have been media fodder for many years.  The recent Global Burden of Disease study is to be welcomed in terms of its clarity about there being no safe level of alcohol consumption, although I doubt it will stop future headlines suggesting red wine is good for your heart or commenting on drinkers living longer than the abstinent.  My concern here is that I don’t think we have developed the nuanced messages that might engage with those who drink, to help them do so safer.  I worry that many will be tempted to turn a deaf ear to health messages about alcohol.  

I don’t want to leave out obesity.  A fish shop in Glasgow gained national prominence for its “Crunch Box”.  This contained battered, deep fried, fish, sausages, burgers, chicken nuggets, onion rings, chips and a bottle of Irn Bru (a sugary soft drink). All this for £10.  This became an internet sensation and was picked up by the mainstream media.  Unsurprisingly, its health implications were raised. But here we had an interesting phenomenon. Although nearly every story mentioned public health, or obesity, it does seem professionals resisted the bait. Sadly, this didn’t stop the news making it into a case requiring some form of intervention or the nanny state trying to interfere with the enjoyment of ordinary people.  In fairness, I should make it clear that the Crunch Box was intended as an occasional treat for friends or family.  What the comment sections and on line discussion show is  that many people feel that public health is hell bent on interfering with their lives and enjoyment, that they are another problem to be faced rather than a means of improving lives.

Lack of appropriate messages and exasperation that health bodies are committed to taking pleasure from life is a major barrier to our engagement with our populations. We need to support the understanding that people can improve their health without giving up all of life’s pleasures.  Several studies (including one from Pennsylvania State University) highlight the benefits of adding a little hope to our health messaging.  Perhaps we should start working with communities to identify what works for them in their real-life environments, listen to their ideas, and prove to be real allies, rather than foes.  The benefits for all concerned would be significant.


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!
Wednesday, December 18, 2019
It has been a little while since I managed to produce a blog. Workwise things have been especially hectic as we end the year. Not least in helping get another London Christmas alcohol campaign organised. You can see the resource produced here . Early next year I will share our experience of this year’s campaign. Looking back 2019 has been a year when the headlines relating to drugs have been consistently negative. Record drug related deaths, some worrying prevalence data, growing concerns around crime and financial pressure on service delivery. On the positive side there is some sense that drug issues are getting back on to the agenda. Hopefully this will continue. A personal highlight of 2019 was getting to hear and speak with so many fascinating people at City Health Melbourne.
Wednesday, October 30, 2019
When I hosted the first City Health conference in 2012, my hope was we might manage three or four events in different cities. I never dreamt we’d get to nine (and counting) or that City Health would reach the great city of Melbourne. Great credit must go to the Progressive Public Health Alliance for hosting a fascinating two days that provided energy, enthusiasm and challenge. Personally, I learnt a great deal and found myself questioning somehow of my own views. I met people doing amazing things in the most challenging environments. I heard of situations that made me feel a sense of despair but came away reassured that we have the knowledge, networks and commitment to positively change lives for the better.
Monday, September 23, 2019
Sometimes things just work out. Last Monday, I was involved in three separate events which each highlighted the potential of urban areas to effectively tackle health issues when there is political leadership to do so. The day also provided a timely reminder of the importance of harm reduction, and how this needs to be at the heart of health approaches in our cities. With so many countries and agencies forgetting the lessons of harm reduction, or actively turning their back on them for narrow ideological reasons, it was uplifting to hear examples which delivered quantifiable gains in terms of lives, better health, and human rights.



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.