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, 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.