City Health International


For the last two weeks I have been on my travels, combining a holiday with visiting friends and family. This has seen me enjoying the sunshine in Florida, the cherry blossom of Washington DC and the delights of Pittsburgh. This former steel city is visibly reinventing itself after some twenty years in the doldrums. Political and civic leadership aided by a strong academic sector, tech industries and redevelopment of its riverside has given Pittsburgh a tangible air of optimism. It so happens that my arrival here coincided with the anniversary of the development of the first successful polio vaccine at the University of Pittsburgh by Dr Jonas Salk (announced to the world on 12 April 1955). Truly a major milestone in global public health. When asked about who owned the patent to the vaccine, Dr Salk replied, “Well the people I would say. There is no patent. Could you patent the sun?” A man of great ideals as well as medical expertise.

Travelling around has given me the luxury of reading more newspapers and magazines than usual, not to mention watching lots of rolling news on TV. There is certainly no shortage of political theatre currently and much of it genuinely headline stuff, but I have been struck by the amount of coverage concerning health issues. I have also often seen the demand that politics should be taken out of health issues. Presumably because politics is somehow bad for health policy.

In the UK we are used to stories about the NHS, waiting times, shortages of staff as well as the regular features on how much (or little) alcohol or fatty food we dare consume, or the amount of exercise we need, to mention just a few of the most popular topics. Each of these has various political angles, not least in terms of funding. The tension between the role of the state and that of the individual is evident but often not placed centre page.

The dynamics in the USA can appear very different. Every TV commercial break has its quota of adverts for a new drug that you should ask your doctor for. There are plenty of adverts for medical insurance, and should it all go wrong, there are an amazing array of lawyers with exceptionally white teeth ready to fight your case of medical negligence. These are, though, in many ways rather superficial observations. In Florida I watched a politician being interviewed where a key topic of debate was seeking federal funds to improve access to medical care. This was clearly held up on party political lines. In Washington I was surprised to learn that enrollment under the Affordable Care Act (or Obamacare) was still proving popular, when my, mistaken, understanding was that it had been scrapped.

An issue I had better knowledge of was the tragic toll relating to the current US opioid epidemic. In 2017 over 66,000 people died as a result of overdose. This is a public health disaster on a massive scale. It’s also a failure in leadership as it is well evidenced what steps could be taken to help save these lives and aid the affected communities.

But that kind of action requires political leadership. Before me I have a copy of the South Pittsburgh Reporter, a small local paper. The front page story is about a residential community concerned about an addiction facility in their area. All the issues you’d expect are mentioned but I was heartened to see that the public panel addressing these concerns included local politicians as well as drug specialists.

Providing leadership and making decisions around health provision are implicitly political. What is needed is greater knowledge and understanding by the public and politicians. Helping improve understanding of various health issues by communities builds engagement and reduces the reluctance of politicians to provide a leadership role. Professor Geoff Gallop provided a stand out presentation at last year’s City Health Conference (available at the City Health website) that identified one way to progress this in terms of the potential of deliberative democracy. What is really needed is more, but better, politics in health.

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.