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When I was growing up in the 1970’s and ‘80’s there was a science programme on prime time television which highlighted the positive potential of new inventions and technology. In tone it was unrelentingly positive, despite the frequent mishaps as presenters and inventors experienced the challenges of demonstrating prototypes live on air. Although it attracted a degree of mockery, and no doubt much of its mass appeal did lie in watching demonstrations and experiments go wrong, it provided an upbeat vision of a future where we would all benefit. It was a distinct counterbalance against various other visions of the future we were offered via books, film or tv, which all seemed to be distinctly dystopian. There were various post nuclear apocalypse scenarios, global pandemics (the TV show Survivors had a profound impact on this eight year old) and of course there were concerns about resources running out, machines taking over, pollution threatening mankind, threats from outer space. The threats were considerable, some seeming more tangible than others. Yet you could reasonably argue that most societies looked forward with optimism (if not a little concern) and one of the big reasons for this was visible and demonstrable improvements in health.

So in 2018 what, we may reasonably ask, has changed?   Some of us enjoyed a brief reduction in the threats relating to international conflict (what did we do with the “”peace dividend”?), but there are now new threats. Global pandemics and the threat they pose continue to be good fodder for fiction as well as responsible journalism and learned journals. We are perhaps more aware of the impact we are having on our planet, we remain concerned about threats from space, the rise of the machines (or AI) is something we continue to fret about. But we still have our, improving, health, right?

As mentioned last week there is no denying the tremendous success evidenced by the massive increase in human life expectancy over the last century. However, barely had the last blog been finished than I was sent an article from the HSJ (Health Service Journal). The headline was about NHS England looking to do more to tackle health inequalities. A reasonable ambition we would all agree. A few paragraphs in I was taken aback. My work means I am very aware of recently increased death rates within the drug using population. What did surprise me was this line “in some parts of the country there has actually been a fall in life expectancy of a year or more since 2011”.   Let that sink in a moment. In one of the most prosperous countries in the world, with a universal healthcare system, life expectancy hadn’t stalled, it had gone down.

As I read more I was less surprised to see this affected mainly post industrial urban areas (but also isolated rural areas). These areas are often ones associated with the most challenging socio-economic problems and complex health issues. But I am still struck by the reduction in life expectancy. There are likely to be many causes. It seems reasonable that austerity, the reduction in funding for certain services, the pullback from the provision of “softer” services (e.g. drop in and day centres) will have played a significant role. I also wonder if something more ephemeral, but vital, is at play here.

Some of you may have heard of the “Glasgow Effect”. In brief this was an attempt to understand the phenomena as to why communities with similar levels of deprivation to those in Glasgow enjoyed better life expectancy. One of the most powerful explorations of this problem (which is not unique to the great city of Glasgow) I have heard was by Sir Harry Burns, former Chief Medical Officer for Scotland, delivered at the 2015 City Health memorial conference. Debunking many of the myths which surround the issues of health and embedded poverty he outlined the importance of looking beyond poor health behaviours and the importance of hope. Not just at individual level but within communities. Hard to measure? Perhaps, but if we allow communities to lose hope, not to have a realistic vision of a better world tomorrow we should not be surprised there are negative health consequences.   We need to work together, particularly with our most deprived communities, to keep better health for all at the forefront of our hopes for tomorrow’s world.

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.