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In 1960 one third of the global population was to be found living in urban settings. Now, more than half the population lives in cities and this trend is accelerating. The future is increasingly urban. Of course, cities are frequently viewed as a being a source of problems, be that as crime generators, dens of sin, blighted by pollution or scenes of great poverty. From the tale of Babel onwards we seem to be programmed to focus on the “big city” as being at odds with the peace, calm and implied health of the rural idyll. 

Of course, the reality is that tremendous potential exists within our cities to help positively shape the global future. Around the world it can seem that the traditional nation state is struggling to respond to the challenges of the 21st century. Conversely a number of cities are breaking new ground in addressing the wellbeing and physical concerns of their citizens. The recognition of this phenomena is what led to the founding of City Health International (CHI) in 2012. Composed of a disparate range of organisations and individuals the last 6 years has seen CHI promote the sharing of experience from cities around the world as well as challenging some established thinking.

This was very much brought home to me while reading a recent report by the King’s Fund (an independent charity that aims to improve health and care in England). The role of cities in improving population health: International insights looks at the conditions required for cities to deliver on improving population health. Naturally enough it has a focus on London and what more can be done in this city, but it does also provide some fascinating insights into activity and ideas from Amsterdam, Barcelona, Berlin, Copenhagen, Curtiba, Mexico City, New York, Paris, San Francisco, Seoul, Turkey and Vienna. I should also mention that it looks at some of the developments happening in Greater Manchester, where powers have been devolved and new ways of service delivery are being developed. Now, at some 80 pages long, I don’t have the space here to cover all the issues the report raises but it is well worth a look. City Health International aficionados may wish to tick off the cities and topics CHI has itself covered.

What I do want to look at, however, is some of the conditions identified to help cities improve the health of their populations. It identifies the importance of bold political leadership, and globally we are seeing an increasing profile and ambition of city leaders. Coupled to this is a need for clear governance, which is often easier said than delivered. As an example, London has 33 local authorities, a regional strategic structure and enough other quangos and agencies to keep the keenest bureaucrat happy. I have been working in London for 20 years and I am still, often, confused as to who exactly is responsible for what.

Making use of available powers and regulations is clearly important, as planning and licensing powers can support significant improvements in the well being and health of the local community. Expertise is clearly important, as is co-ordination. There is also an acknowledgement of the importance of engaging and mobilising the population. This is an area ripe for considerable development in my view. This isn’t just taking the community with us, but also listening to their priorities and taking them into account. We should avoid “doing” health to people and recognise they are the key stakeholders and our most valuable resource.

There are two further points I want to finish on. The first of these is Connectivity, both internally and within other cities. Many cities are blessed with universities and research institutions and vibrant civic society agencies, yet many do not maximise these resources on their doorstep. The benefits of sharing experience with other cities are significant and links to the final element, innovation. Collaboration provides not only fertile ground for fresh ideas but also the confidence for politicians and others to embrace the new. City Health International in Odessa provides a great opportunity to further advance the role cities are playing in addressing the challenges faced globally in terms of health and behaviour. Helping to keep our urban areas successful and attractive places to live in the 21st century is a great challenge. Working together we can achieve so much more. See you in Odessa?

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.