City Health International


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, 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.