City Health International


Many years ago, I began work at the Department of Education.  At around the same time the government of the day introduced school league tables. They were soon joined by rankings of colleges and universities as well as comparisons of different age groups. There was always great political interest in these and no little controversy. The intention was to allow comparison, inform the potential customer, and to encourage competition. They were deeply unpopular with most education professionals. In many ways they failed to highlight those institutions or individuals making the most impressive contributions, and encouraged all kinds of gamesmanship. These tables are still produced on an annual basis, attract considerable media interest, where all the associated pros and cons are revisited and debated.

What has this got to do with City Health you ask? Well, in recent months there have been several surveys published which claim to identify the healthiest city. Undertaken by different agencies, using different criteria, there is a significant degree of conformity- but also some fascinating variations. The methodology used to rank cities is also worth a quick examination.

One of the first surveys I saw measured cities against ten distinct criteria. These included life expectancy at birth, air and water quality, green space, fast food outlets, and obesity in adults. It also looked at some factors not always seen in a typical public health survey, such as access to gyms, electric car charging points, annual sunshine hours, and annual vacation days. This process saw Amsterdam come top of the pile, followed by Oslo and Munich. In fact, eight of the top ten are in Europe, with Adelaide and Perth filling the other two spots. Perhaps no great surprise in a survey which is clearly aimed at younger professionals who value their vacation time.

A July study looked at just three, more traditional, health measures; infant mortality, life expectancy, and exposure to air pollution. This resulted in Shiuoka, Japan coming top. Indeed, Japan did well, as did Spain, with Bilbao coming third. Oslo and Stockholm scored highly. Vancouver just made the cut in 25th place. So far, no great surprises. Economically well-off and highly developed cities comparing well in terms of health is no great surprise, although on the measures used so far, the Americas were very under represented. This omission is partly addressed if we look at the survey carried out for CitiesJournal. Hong Kong comes first, driven by its high ratio of doctors to population, and the central role walking plays in people moving around the city. Santa Fe in New Mexico scores highly due to its clean air, but with a population of under 200,000 is of very modest size. Curitiba in Brazil- a much more sizeable city- comes in third, driven by its ambitious commitment to sustainability. Seattle does well because of its clean air and water, whilst several other cities- Ottawa, Denver, Honolulu, and Minneapolis-St Paul- do well because, apparently, they have active, sporty residents. While it is good to see some variation in this survey, it does appear to be more subjective and reliant on self-reporting than some of its peers.

A fascinating piece of work commissioned by Deutsche Bank looked at quality of life, with a specific measure around overall quality of healthcare. Interestingly, this puts Johannesburg and Cape Town into the top thirty places (incidentally beating London, Paris and New York in the process). Wellington, New Zealand, wins overall here, chased closely by a pack of European cities.   Of course, this is a very subjective list aimed at a specific demographic.   If you change the criteria you get some very interesting results. Worry less about gyms and more about cancer rates and Niamey in Niger appears on the radar.

So where does this leave us? Well, I would argue that comparing cities in terms of their health outcomes can provide clear benefits for us all. But we need to bring analysis and thought to bear to explore each situation and understand its context. Done properly, comparisons can aid progress and let us particularly look at apparent positive deviance, where there can be real gems waiting to be discovered.

All the above takes a great deal of statistical work and cold analysis. Let me finish by recommending you look up the aerial images taken by drone photographer Johnny Mille. He began his work In South Africa capturing scenes from Cape Town and Johannesburg. He has now moved on to Mexico City and Baltimore as well as India, Tanzania and Kenya.   His pictures capture in stark contrast the inequalities that disfigure many of our cities.   It would be good to see a tackling inequality criterion appear on future league tables for our global cities.

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!



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.