City Health International


The fact that cities and urban centres can increase stress in individuals is well recognised.  There is a correlation between living in a city and a range of mental health problems, although this doesn’t automatically mean urban life has to have a negative impact on our wellbeing.  Cities concentrate on a range of factors, both positive and negative. So, a city may suffer from pockets of deprivation, high rates of crime and pollution, but also provide good educational opportunities, access to modern medical care and stimulating public spaces.  However, as anyone who commutes through a big city will know there is a lot of stress about.

This was brought home to me this week as I attended a two-day training course.  Other attendees came from across London and the south-east of England.  The organisers had clearly worked hard to identify a location within the Greater London region that meant regardless as to where your journey began reaching the venue would provide a challenge of navigation and endurance.  It is perhaps a good thing that the topic being covered was Mental Health First Aid.

Fortunately, the course was exceptional. It offered a great deal to managers or those whose work areas brought them into contact with mental health issues even if they had not had any formal training in the subject. There is also a lot about looking after your own mental health.  If you get an opportunity to go on a course like this I recommend grabbing it.

Travelling to this non-exotic and highly inaccessible location did provide me with more time than usual to reflect and think.  Naturally enough I was considering about the progress made in terms of mental health.  Certainly, there is now greater recognition of the issue.  A number of high profile individuals have been very open about their experience with mental ill health.  Time to Change and Thrive LDN have done much to help reduce discrimination and stigma.  The statistic that one in four people will have a mental illness in their lifetime is embedded in the public consciousness. It can sometimes feel like improvements in treatment services are lagging behind, but profile raising, encouraging people (and politicians) to talk about the issue does help secure resources. So overall it feels like progress is being made.  I was feeling generally positive until I thought about dual diagnosis.

There are two subjects which always trigger a stress response with me.  Sometimes this can even lead to a degree of aggression (albeit normally revealing itself as noisy exasperation).  Dual diagnosis is one.  Hepatitis C the other.  Both were issues I became aware of early on in my drug and alcohol policy work.  Twenty years later I struggle to understand why we have not made better progress.  It can make me angry. This is especially true in regard to Hep C, where new drugs offer so much promise, but that is for another week.

So dual diagnosis.  It is far from uncommon.  Indeed, for many drug and alcohol services most of their clients will have a mental health issue.  Likewise, mental health services have significant numbers of clients with existing or a history of substance use problems (although it varies massively depending on the diagnosed condition).    Obviously, many people within this group have complex problems and require specialist and long-term support.  But for many people seeking help they find themselves falling between services. 

This partly reflects the discussion over which issue has primacy.  Should the mental health issues be treated first?  Or do we need to deal with the drug use or drinking first.  This debate is reflected in a mountain of research which consider whether drug use caused a specific the mental health condition, or has it perhaps aggravated or triggered an underlying problem. Or is it the case that the drug use may be self-medication?   These are all valid questions and the accompanying arguments are good in terms of attracting grant funding, stimulating debate and progressing professional careers.  Of course, I recognise that these are not just abstract points and can have important benefits in guiding more effective treatment and approaches.  But from my perspective the plight of the individual, the family and friends has too often been lost.  We have not focused enough on closing the gaps between services (often unintentionally encouraged by commissioning practices), of bringing different disciplines and professions together.  If professionals often struggle to navigate treatment pathways, then something has gone seriously awry. Drug and alcohol treatment and mental health services should not be in competition.  

We live in demanding and rapidly changing times.  Our populations will experience various stresses and threats to their physical and mental health and effective, resource, smart, responses to these stresses and threats requires new ways of thinking and new collaborations, but we must never lose sight of the individual.

Monday, July 29, 2019
I write this on a day when London is experiencing, what is for us, exceptional temperatures. Overhead power lines and train tracks have warped. On some routes passengers have been advised to avoid travelling if possible, and many employers have encouraged staff to work from home. I suspect many who did travel to their workplaces were drawn by the prospect of effective air conditioning as much as personal work ethic. This great City was unusually quiet, apart from the pubs and bars who were doing a roaring trade. Who would begrudge people a pint of beer or a glass of wine when it’s so damn warm, especially when by delaying travelling an hour or two, the journey home may be made a little more tolerable?
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.



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.