City Health International


In an earlier blog I mentioned that in addition to failings around mental health dual diagnosis there was another subject where lack of action made me angry. In truth on occasion it has also brought me to something approaching despair. The issue in question was Hepatitis C (HCV), a virus I have seen afflict friends and colleagues and let’s not forget the well over 100 million people worldwide living with the infection. It is a major contributor to the rising toll of liver related death.

One of the very first meetings I ever attended when I started work in substance misuse was about this Blood Borne Virus (BBV). There was a sense of urgency and I left the meeting with a sense of optimism. Over the next 15 years or so this would be eroded as there was always another priority or lack of agreement on what should be done. The successes achieved in preventing HIV within populations who injected drugs was not being replicated with HCV.

Recent years have seen great progress made in terms of treatment. Big pharma and research have provided drugs which offer the tantalising prospect of effectively eradicating this virus. Gone is the horrendous treatment and its uncertain outcomes. However, there remain huge challenges in creating the systems that can reach those with the virus, finding the funds to pay for treatment, plus the need to educate policymakers, medical professionals and the public on why HCV matters. My frustration, was if anything, growing.

It is therefore with a sense of relief that I have recently discovered what appears to be an international competition to start making real progress. This is not a formal competition, not a world cup of public health, but there is a real sense of cities and countries wanting to be first in eradicating HCV. Now I was aware of some fraternal rivalry between Scottish colleagues and those in England on who was doing best in this area (Scotland being able to claim some early leads), but it was the surprising figure of Barcelona FC striker Lionel Messi who introduced me to a much broader competition. He has helped promote Egypt’s health tourism offer to treat HCV. This programme has attracted some criticism but the domestic goal of eradicating the virus by 2020 doesn’t lack ambition.

This set me looking. The World Hepatitis Alliance identified nine countries on track to eradication by 2030, Australia (yet again leading the world in harm reduction), Brazil, Egypt, Georgia, Germany, Iceland, Japan, the Netherlands and Qatar. But there are other competitors, New York State, Hong Kong, Philadelphia, the State of South Australia, San Francisco are also looking to compete. Indeed, one city within South Australia is hoping to be the first HCV free City in the world (take a bow Murray Bridge). There are of course many more and there are many challenges to be overcome. Indeed, there is a risk if we don’t get this right we could end up in a cycle fighting drug resistant HCV but let’s remain upbeat. This is bold, optimistic and in the main, pragmatic stuff. Having read many of the strategies there is a clear understanding of the populations to be reached and acknowledgement of the importance of maintaining or improving needle exchange programmes, Opiate Substitute Treatment (OST) and engagement.

Its not a surprise to see Australia at the forefront here. One of the first countries to really deliver good harm reduction around drug use, they have a track record of innovation and getting on and doing it. The Kings Cross injecting room set up in the 1990’s by City Health veteran Dr Ingrid Van Beek has not just helped the people who use it. Its impact goes much further in terms of encouraging others all around the world to see what they can to help improve what can seem hopeless problems.   I strongly suspect that Ingrid has directly inspired more work and action to reduce BBVs than Lionel Messi will but the idea of cities, regions and countries competing to tackle major health problems, with or without a superstar’s endorsement, has a strong appeal. I am also confident that there will be plenty of inspiration available in Odessa this September.

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.