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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?

Thursday, April 11, 2019
Let me start with a big thank you to Liverpool, and especially the team from John Moores University, for another outstanding City Health conference. The impressive surroundings of Liverpool Medical Institute- a monument to the 19 th century’s commitment to science as well as its obsession with ancient Greece- proved to be an ideal venue. It contains a wonderful historic library, a selection of surgical and medical tools that bring a tear to the eye, and portraits of those who have contributed to the development of public health and modern health care, including some rather fearsome looking characters.
Wednesday, February 28, 2018
Welcome to my initial blog for City Health International. My intention over the coming months is to look at developments in research, politics and the media through the prism of urban health and what it may mean for the City Health community (so pretty much anyone reading this). While my background is in national and regional policy work around substance misuse, with a more recent interest in crime and anti-social behaviour issues, I will be looking at a much broader range of topics. Before we embark on that though I shall briefly explain how I got involved with the phenomenon that is City Health and how that helped extend my horizons beyond alcohol and drugs.
Sunday, January 27, 2019
I hope 2019 has begun well and that the year ahead proves a good one for you all. Despite the ongoing political uncertainty in the UK and increasing strain on budgets, with little hope of improvement in the near term, I remain surprisingly upbeat. It may be the result of what seems to have been a successful London Christmas alcohol campaign, once the data firms up I shall certainly share more. It could be the prospect of the forthcoming City Health International Conference in Liverpool on 22 March, which promises some great speakers. Possibly it is a result of small, but welcome, signs of a willingness to explore new ways of thinking and working to reduce health inequalities in relation to mental health and hepatitis. Perhaps it’s having just secured funding to update our Safer Nightlife guidance, which aims to reduce drug related harms in the night time economy. I am sure the money has helped, you could say it has incentivised me.
Monday, December 31, 2018
Like many I have spent the last two weeks demonstrating a casual disregard for the advice provided by health organisations in terms of food and alcohol consumption. My levels of physical activity have not been all they should have been either, although I am full of good intentions for the coming year and have started to make my overfed body walk more .

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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.