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We all make mistakes. These will be of varying degrees and seriousness, but all of us can look back on judgements that proved to be wrong, decisions made in error or things we would, in hindsight, have done differently. Sometimes it may be that we just didn’t understand the impact of a particular factor or event. The same also applies to organisations. Neither good intentions nor past success provides immunity. Of course, the larger and more influential an organisation, the more the consequences of mistakes are likely to be magnified. Businesses may pay for these mistakes in terms of profit, share value or even their survival. We may want to ponder the consequences when health bodies make significant errors.

Work to reduce the massive toll of death and illness caused by smoking is an important component of national and global public health strategies. The rationale driving this is simple. A 100 million premature deaths in the 20th century were due to smoking tobacco. Currently its responsible for around 7 million deaths per year. The toll in life and disease is immense. Despite some successes this figure is predicted to continue rising. As countries such as Denmark, Iceland, Norway, Paraguay, Argentina and the UK have seen significant drops in smoking rates as many parts of the developing world are seeing rates rise. The World Health Organisation suggests that in many low and middle-income countries big tobacco is able to frustrate government and health agency attempts to reduce smoking. But there are other factors to consider.

In the UK we have seen great success in seeing smoking rates drop. Those who do smoke are consuming less cigarettes. But rates of smoking are higher amongst those who earn least, and pockets of very high usage can be found within vulnerable groups, for example the homeless or those with a mental health diagnosis. It has become clear that traditional approaches; increasing taxes, restrictions on smoking, limiting advertising and public health information campaigns are starting to deliver diminishing returns. Traditional approaches appear to have run their course. Concern and focus increasingly dwell on the illicit cigarette markets, which of course, in part, being driven by the significant increases in taxation.

But over the last few years we have seen a new phenomenon emerge, vaping. This is arguably one of the greatest contributions to reducing smoking we have seen in many years and, with the honourable exceptions of Public Health England and a few far sighted individual areas and practitioners, it has occurred outside the realm of traditional tobacco control.   While there are other tobacco harm reduction products with an impressive pedigree, look at the Swedish experience of snus (and please do look this up), this is geographically limited to Scandinavia. Vaping is a global phenomenon which has unsettled the established order.

The fact tobacco companies themselves have seen the potential for these less hazardous products has allowed many to oppose these products as being just another work of the devil (and I hold no brief to defend their historic record). However, this leads to some abysmal and tragic positions. It also makes the mistake of ignoring the different aspects, views and interests of a complex range businesses and individuals. We see many countries where public health officials have worked to ban or restrict access to lower risk products, indeed somewhere those selling e-cigs risk jail, yet cigarettes remain freely available and often poorly controlled. This situation benefits traditional big tobacco, it may make some public health officials feel virtuous, it certainly ensures that there will continuing avoidable deaths and illness.

Last weekend I overheard a conversation where advocates of smoking cessation where lamenting the adversarial situation that had developed between the world of tobacco harm reduction and the tobacco control world. With the toll of smoking related disease set to increase as the century progreses, with the harms disproportionately felt within the developing world and in vulnerable communities it is surely time to embrace all approaches which offer the chance to significantly reduce harm. This should always be led by evidence, but not losing sight of the costs of delay. Public health needs to move at pace, slowing and delaying changes plays in to the hands of their opponents. It also comes at massive human cost. Millions of lives a year are surely enough of a prize to encourage some fresh thinking around nicotine?

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.

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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.