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Health sells, not just in terms of medical care or pharmaceuticals. News about health issues is a central staple of the mainstream media, all major newspapers and tv news programmes boast a health editor and provide their customers with a regular diet of stories about the latest cures, scares and developments relating to our wellbeing. The public have a great appetite for the topic, not a surprise given that all of us have a profound interest in health. Given the nature of the media they often have a particular angle. Some outlets can be relied upon to criticise almost any new government initiative as a shocking example of the “nanny state” preventing citizens going about their lives. Others tend to the opposing position that without the strong and vigilant guidance of the state citizens are all prone to making chronically bad choices with negative consequences not just for ourselves but those around us. This is often presented as being necessary not so much for the readers or viewers of the outlet in question, who are normally assumed by the writer to be wiser than the average, but for the benefit of lesser mortals.   To be fair we all tend to think it’s someone else who needs to change their ways rather than ourselves. The media also love a controversy, it could be about the merits of substitute prescribing for opiates, whether people should pay to see a medic, the rights and wrongs of vaccination programmes, all these and more make great copy.

Does this matter? I think it does. The simple fact is that, despite the best attempts of public health campaigns around the world, most people don’t get their information about health issues from the American Journal of Public Health, the National Medical Journal of India or the Lancet. It is delivered into their homes by the tv news they watch, the newspaper they read, the websites they access. With these often tending to adopt a partisan position we lose the nuance and reason. Big issues become binary, black or white, something is either right or wrong. A catchy headline can influence thousands, maybe even millions, regardless of whether the story beneath may actually be reasonably balanced.   A fine example of this came to my attention last week while reading the health pages of a major international news service.

There were stories about the worrying increase of Ebola infections in the Democratic Republic of Congo, disappointing news about exercise programmes not slowing the progress of dementia, a decrease in US birth rates and growing concerns about antibiotic and antifungal resistance. This of course being a major, genuinely global problem. However, none of these were the headline story. No, that was reserved for the news that a 38-year-old man had died in Florida as a result of a battery exploding and causing a fire. This death is clearly a tragedy, but how does such a story become a headline thousands of miles away? Perhaps when its linked to one of the great current health controversies. The headline was “Man killed by vape pen”. Now you can understand concern relating to devices that some 9 million American citizens are using. But reading down the story discover that this is apparently the first case of its kind in the USA and there are suggestions that it was due to a modification and battery issue. Reading a linked story, a fire service officer is quoted as saying it’s not E-cigarettes themselves which are unsafe but the misuse of lithium-ion batteries.   The incorrect use of batteries and recharging of electrical equipment does pose a very real risk. However, the headline was about vaping.   A cursory glance at the headlines could see a reader believe that vaping carries a significant and acutely lethal risk. This adding to other lurid headlines creates the environment where many whose lives could be improved by switching from smoking to vaping are deterred from doing so.

Similar approaches have dogged other areas. I have already mentioned Opiate Substitute Therapy, where headlines about poor practice in methadone prescribing or the addictive properties of this substance are common. The impact on existing heroin users may not be profound but its effect on service provision is significant, making it harder to generate community support. I have had senior decision makers and health professionals tell me they “don’t like OST”. Where has this come from? Well it would be unfair to blame the media alone, but it is certainly not based on a careful examination of the evidence built up over decades.

While it may not always make for the entertaining, adversarial, tv or combative news columns the media think the public enjoy we need to try and create the space to engage in reasoned and informed debate. Complex issues deserve proper debate and understanding. We all have a role to play in this. We need to avoid only engaging with those we tend to agree with. We should try and support the media we have connections with to better understand the issues behind the headlines. If we don’t we will all too often continue to find ourselves frustrated in our dealings with the public and those who the public elect. City Health community and this year’s conference is a great place to start reaching out and consider how we best communicate on the issues we all face.

Tuesday, July 16, 2019
Last week I met with someone who, having just completed a Masters in Epidemiology, is keen to work in the health field. Over a hot chocolate I outlined my perception of the current big issues relating to substance misuse, our most vulnerable populations and the policies and structures we have in place to address these issues.
Tuesday, July 02, 2019
Absolutely outstanding. That’s my carefully considered assessment of the Global Forum on Nicotine in Warsaw that I was fortunate enough to attend two weeks back. I say this despite the mosquito bites and the fact that the weather was rather warm for me. The event was one of those that provide a buzz and an energy that comes back to the workplace with you. This was fuelled by an outstanding array of speakers and a vibrant audience mix. Discussion and argument were not limited to the auditorium or breakout rooms, but instead could be heard throughout the venue, over lunch, during coffee breaks. There were attendees from every continent (well, ok, I didn’t actually meet anyone from Antarctica). Academics, clinicians, researchers, harm reduction advocates, retailers, product developers, policymakers, and- most importantly - vapers and users of other tobacco harm reduction products, all mixed together sharing views, experiences, and- as we should expect- differences of opinion. It certainly lived up to the conference strapline Its Time to Talk About Nicotine and the rich promise of a genuinely horizontal approach.
Monday, May 27, 2019
The value of partnership approaches and joint working to tackle major health public policy issues is widely accepted, if more rarely practised. Even where there is engagement with other professions or disciplines there is a tendency to work with those whose outlook is not too challenging and are closest to us in practice and approach. City Health has been at the forefront in challenging this and others are also working to weaken the silo walls. In the last two weeks I have been a spectator and a participant in two very different events which highlighted how important it is to include the end user, the public, our communities when developing and delivering services.
Wednesday, May 15, 2019
The confidence we have in our health systems is at the core of how we use and, hopefully benefit, from them. If we lack confidence in the benefits of going to see our GP for a health check, seeing a nurse about a travel vaccination or asking advice from the local pharmacist why would we bother? In terms of dealing with drug and alcohol problems the importance of a positive therapeutic relationship or alliance is recognised not just as being a pleasant “extra” but being central to aiding recovery. It has an important role across all fields of treatment. There are also benefits where a society has faith and confidence in those that oversee and provide healthcare systems and treatments at a population level. By and large, despite many complaints and challenges, the National Health Service in the UK remains a highly valued and trusted part of our society. And rightly so. But that doesn’t mean we should shy away from acknowledging where things have gone horribly wrong.

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CITY HEALTH INTERNATIONAL EVENTS

CHI Melbourne 2019

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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.