City Health International


As I write we are about to enjoy a long weekend, Monday is a public holiday and the weather forecast promises warm weather and sunshine. This will inevitably see many people enjoying a BBQ and a significant amount of alcohol consumed as people have fun with friends and family. It is also certain we will see an increase in alcohol related accidents, violence, and many of us may make another down payment on potential future health problems. Yet alcohol does play a central role in how many of us socialise and, lets be frank, we enjoy it.

This week has also seen the introduction of a new approach, by a government with very limited powers, to try and reduce the harm associated with our over fondness of alcohol. It was strongly resisted by elements of the alcohol industry, taking 5 years to progress through an obstacle course of legal and political challenges. The measure is acknowledged by its proponents as being “no silver bullet”, public support is very evenly split. Its hard to see any votes in it. It is enough to make you wonder why politicians would bother with it.

Of course, the global burden of death and ill health associated with alcohol is massive. According to the World Health Organisation alcohol is responsible for over 3 million, nearly 6%, of all global deaths. It is also responsible for 5% of the global burden of disease and injury. Millions are affected by alcoholism, As with nearly all public health issues these harms do not fall evenly across nations or within them.

So, while Belarus may come top of many international league tables for alcohol consumption, the equivalent of over 17 litres of pure alcohol per adult per year, there are many countries where this falls to 100ml. It doesn’t actually tell us much about the scale or the nature of the harms associated. Low population prevalence can disguise very high rates of harm is specific communities. In Europe, which dominates this league table, alcohol consumption is relatively high amongst the well off. Yet the burdens of ill health and harm fall on the least well off and the young. Around a quarter of all deaths in the 20-39 age group worldwide are linked to alcohol.

Now in Europe, certainly within the UK, we have been talking about alcohol related harm for many years. Progress has been made in many places to improve how, where, when and to who alcohol is served. There are restrictions on driving under the influence. Efforts are made to encourage “responsible drinking”, with national guidance and occasional public information campaigns. Possibly this is bearing some fruit. Younger populations are drinking less. But the toll on health, the burden of crime and harm associated with alcohol remains disturbingly high.

In 2016 the UK saw 7,327 alcohol-specific deaths. This figure has been similar for the last few years. These deaths were significantly higher in the most deprived areas. Within the UK, Scotland saw alcohol related deaths at some 50% higher than in England and Wales. These deaths were six times higher in the areas which have the greatest deprivation than in well off areas. Cheap alcohol outlets proliferate. Strong cider and lager are as accessible as milk. It is the way things have become. However, there is not much sign of mass, popular demand to change things, no 21st century temperance movement. Voices of concern come from health bodies and the voluntary sector, not residents.

So, is the decision by the Scottish government to introduce a minimum unit price (MUP) for alcohol an example of politics and public health being good friends (the topic for plenary two at this years City Health Conference) or will it join the ranks of well intentioned policies that achieved little or proved to worsen a problem? Time will tell, but it is promising that the Scottish Government recognise other approaches will be needed and are supporting these. At a visceral level it has seemed wrong to me that alcohol can be cheaper to purchase than water. Especially in a country as rich in H2O as Scotland. So, while enjoying the promised good weather, I will raise a glass, responsibly, to Scotland this weekend and watch with interest the impact of MUP and whether it encourages others to improve our relationship with alcohol.

(Slainte Mhath is Gaelic and literally means good health, but is most commonly used as a toast when drinking)

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.