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Hello again to the City Health community after my few weeks away. I hope some of you have also had the opportunity to enjoy a holiday. My batteries are recharged, and I am looking forward to the City Health conference in a month’s time. If you haven’t yet, have a look at the programme, I am sure you will find topics of interest. There really isn’t another event like City Health in terms of opportunities to learn from other cities and across professional disciplines. This all helps to provide a fertile environment to reflect upon individual areas of interest and activity.

Personally, I am particularly looking forward to the session entitled Politics and Public Health, friends or enemies? This relates directly to what I see as one of the greatest challenges facing those who seeking to improve population health; that of engaging our communities, and those who represent them, in a way that health benefits are owned and valued by all concerned, not something done unto them for their own good.

Being on holiday I deliberately limited my exposure to the news. However, this was not always successful and via the radio I was kept informed of the latest developments concerning Brexit, Trump, a dolphin with sunburn (it has recovered well) and a survey on where in Scotland you get too many chips in a portion (an interesting take on tackling obesity). Another news item did grab my attention and make me reflect on the relationship between citizens, health and the state.

We all know there is a significant variation in life expectancy between those who live in the most deprived areas and those residing in better-off locations. This is often most starkly revealed in our cities, where geographic proximity emphasises this gap: a short journey in many UK cities can see a difference in life expectancy of seven years or more. The chasm in terms of years of good health is even deeper. This issue is now well recognised and attempts to address it are central to an increasing number of health strategies. That no group should be left behind by the improvements in health is the underlying principle. But what happens if the whole populations health improvements stall?

In the UK we have become conditioned to seeing life expectancy and projections for future longevity increase year on year. We may occasionally glance at certain other countries with a degree of envy or wonder at how they do better, but there has been comfort in knowing that there is ongoing and seemingly continuous improvement. As a nation we have accepted the apparently inevitable consequences, that if we are living longer then we need to pay more into our pensions and work longer (significantly so for many). But supposing this is not actually the case?

There have been some indications that these positive trends were coming to an end. Several academic institutions flagged this first. There was then further analysis which indicated that some of our former industrial centres and isolated rural communities were seeing actual falls in life expectancy. Specific, vulnerable groups, such as drug users, were also seeing negative trends. This raised some eyebrows. Yet it caused little surprise, affecting areas associated with significant economic problems or marginalised groups.

What grabbed my attention and, I hope, will get the attention of our politicians and policy makers once they return from their holidays, is number crunching by the Office for National Statistics which shows that we have been witnessing a slow down in life expectancy gains over the last 12 years. This phenomenon has been recorded in several countries, but it is particularly pronounced in the UK (and the USA it seems). Inevitably there is a need to analyse the data and to consider the causes, just as inevitably there will be political dispute over these findings. But here is, surely, an issue we should start a dialogue with our communities about. Paying and preparing for a long (and hopefully healthy) life which may not, in fact, be on offer should generate interest.

Cities have advantages in terms of scale and often structure that allows them to initiate these kinds of discussions. We also know that cities can be incubators and promoters of health improvement, if we develop them in the right way. While many of us think of a rural idyll as being the ultimate healthy location there is growing evidence that cities, with their economic potential, can provide great opportunities, especially for those on lower incomes. The work of Professor Raj Chetty shows some fascinating links between urban communities and life expectancy. It poses some challenges to established views on health care provision and social capital. It strongly reinforces the value of education and high levels of local government spending. Thriving cities are good for all its citizens. Not a surprise, but our cities have valuable lessons we might want to share with our national political masters. After all, regardless of political inclination, we all want our communities to live longer and prosper.

 

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.