City Health International


Around the world many are working on how we develop support for ageing populations. In South Korea they are looking to restructure jobs to make them more suitable for older workers. Brazil has established older people’s councils to consider the issues and generate ideas. The World Health Organisation has identified ten priorities towards making 2020-2030 a decade of health ageing. One of these priorities is sharing information and experience.

Last year’s City Health conference in Basel provided some great presentations on how the challenges and needs of ageing populations can be considered and successfully addressed in urban settings. Issues considered included security and perceptions of vulnerability, access to local amenities and overcoming social isolation. This issue of isolation is enjoying increasing prominence, within the UK our public health body is highlighting the importance of improving the social environment to support people meeting with others and having positive experiences.   The evidence is overwhelming, the benefits can be measured in terms of both physical and mental health. At last year’s Annual Convention of the American Psychological Association delegates heard that a meta-analysis of over 200 separate studies indicated that high levels of social connectedness are associated with a reduction of up to 50% in premature death.

But the quote that has really caught the imagination, and which engages politicians and policy makers, is that isolation is equivalent of smoking 15 cigarettes a day in terms of its health-related harms. Rather like economists use the Mars bar standard to measure relative wealth and inflation over time it may be that smoking equivalence could become how we compare relative health harms?

It is of course one thing to identify a problem and quite another to address it. Last week I was involved in a conference looking at response and challenges to alcohol problems. Several of the sessions touched on older drinkers, with one focusing on a major UK wide project, Drink Wise Age Well. This project is operating in five sites, two of which are the urban centres of Glasgow and Sheffield. It was established in response to very specific concerns.

The over 50’s are the only age group where hazardous and harmful drinking is going up within the UK. Scotland has just recorded the highest ever number of alcohol related deaths. The toll on individuals and the burdens on health provision is clear. The reasons cited by those on the programme for drinking more were: retirement; loss of sense of purpose; finances; bereavement; and lack of social opportunities. I don’t think these surprise us, nor the fact that individually, or in combination they can see social drinking escalate into something more problematic.

Let’s look at some of the key characteristics of this group. 77% drank at home alone; 64% have a diagnosed mental health condition; 55% are on one or more medication, 58% are separated, divorced or widowed, 70% felt lonely, 64% isolated and 53% say they have no sense of purpose. But the figure that jumped out at me are the 51% who smoke, this being three times the national average.   How many anti-smoking campaigns and traditional cessation approaches have these people experienced? How many other health interventions?

As part of the Drink Wise Age Well project they work to bring together all those in the health and social care sector who can work with these individuals. Yet this is not what happens for most people, where conditions and problems are likely to be dealt with in isolation. We shouldn’t blame individual service providers or those working in demanding circumstances, we normally commission and resource services along narrow lines, effectively discouraging attempts at developing holistic approaches.   We need to look at how we can make better use of increasingly scarce resources to really improve health and social connectivity. We should also be more open to the fact that success in addressing one issue can often help improve outcomes in other domains. For example, this project shows clearly that reductions in alcohol consumption saw significant improvements in cognitive impairment for many participants.  

The benefits for the individual, their community and services are obvious, but we have seen many alcohol services for older drinkers close in recent years.   We need to do more to raise understanding about the benefits and pathways to improving health in ageing populations. There are significant global examples of good and innovative practice, and this is a topic included within the agenda for City Health in Odessa this September. We need to use these opportunities to strengthen understanding, build the evidence base and so shape policy making and resourcing, moving from modest projects to addressing the needs of hundreds of millions.

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.