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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, 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.