City Health International


Across the world many cities face high levels of criminal violence and murder. A quick search will reveal that in terms of global league tables, certain regions dominate with Latin America, North America and Sub Saharan Africa providing the top 50 violent cities. However, a cursory glance tells us this is a complicated picture with huge variations between and within countries. Complex factors are at play, differing social, economic and legislative environments all have an influence. A brief historical perspective tells us that improvements can be made, that nations and cities can act successfully to reduce the levels of violence experienced by their citizens.

Public health has much to offer here. Developing an understanding of the epidemiology around a specific type of violence, considering its social determinants, a commitment to evidence-based responses and a focus on broad prevention have obvious attractions. It can provide a breadth of focus which allows an opportunity to look beyond the individual and immediate. This is a luxury not always provided to emergency responder agencies and law enforcement.

Public health approaches allow consideration of the harms of violence, for example with a murder, beyond the obvious victim, to consider the impact on their family, friends and community. It can also allow the examination of circumstances beyond the violent incident itself. What other factors may have led to the situation? Is it part of wider phenomena? Are there relevant factors going back years? Facts which might not be pertinent to a criminal justice investigation. This kind of approach is of course demanding in terms of resource, but it offers potential in terms of moving towards the prevention of, rather than merely reacting to, such tragic incidents. Unfortunately, it’s an approach that often only gains significant traction when there is a surge in violence and the political spotlight shifts on to the issue.

The increase in mass shootings within the USA has seen just such a spotlight applied. It has raised interesting and relevant debate about whether these incidents are contagious, with each incident increasing the likelihood of another. Currently in the UK we have just seen a court case conclude where two school children plotted an atrocity, apparently inspired by the Columbine massacre. The Atlantic Ocean and nearly twenty years being apparently no barrier to contagion. Violence seemingly begets violence globally and while this might appear a dismal thought it should encourage us to focus on reducing violence wherever it appears.

While the gun rights lobby remains politically potent there does seem to be movement in tightening access to the most powerful weapons. Many of those who remain committed to the Second Amendment rights (the right to bear arms) have seemingly got to the something must be done stage. We must hope that real progress will be made without the impetus of further school massacres.

However, as President Trump recently referenced, other places also experience high levels of fatal violence. So far this year London has experienced over 60 murders, 37 of these involving knives. These deaths are concentrated amongst young males, many from deprived and underserved communities. This level of tragedy has produced a significant political focus on the problem and resources are being targeted to try and reduce the number of deaths. This has seen interest in what can be learnt from other places and the potential of public health approaches.

Many of the best known and researched schemes are to be found within the USA. There is also interest in the success that Scotland, particularly Glasgow, has achieved in reducing the murder rate. This was achieved by bringing together policing and public health approaches under the auspices of the Violence Reduction Unit (VRU). There is no doubting their success, I have seen compelling presentations on their work, including at a previous City Health International conference, but I know they would acknowledge the debt to lessons learnt in other cities (e.g. Cincinnati).  They would also agree that the approaches they adopted required political bravery and a willingness to confront the gut instincts of much of the media.

There is a risk in seeing public health as somehow riding to the rescue of beleaguered law enforcement. Effective policing and a capable criminal justice system are an essential part of any response to violence within communities. Without these its not possible to begin engaging with the community, to bring in the health and education bodies, the voluntary sector and promote economic regeneration. The factors which will improve long term outcomes. Public health approaches offer the most when they recognise the vital role of non-health players and help harness these together. They also offer much in terms of being evidence based, although no City experiencing high levels of violence wants to wait a decade while an evidence base is built. Perhaps one of the most valuable tools public health can offer to tackle violence is in terms of concept.  

The importance of reducing health inequalities is now well recognised in many places, it crosses the political divides. Seeking to address inequalities in terms of criminal justice outcomes, in terms of reducing the impacts of crime on those least able to bear it offers the chance to build upon the many projects around the world which have achieved success. I look forward to the City Health 2018 session on Violence as a Public Health issue to further develop our ideas in this area.

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.