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Now I don’t want to tread on the toes of my friends and colleagues on the Nicotine Science and Policy blog but, as it was National No Smoking Day on 14 March, I am going to reflect a little on smoking in the UK. It was first held in 1984, just after I had started my first job, and I was, I confess, a smoker. 34 years on what stands out most is not the money spent, the clothes damaged, accidental burns endured (smoking with a crash helmet on is not something I would do again) or the other risks associated with smoking tobacco.  No, it’s the fact the world was very different.

I started work as a Counter Clerk for the Post Office and was given a key piece of  equipment.  A large glass ashtray, with ERII etched into its base.  Staff smoked at the counter, customers smoked as they queued. We travelled on busses where the top deck was a smoke dense location, or in the smoking carriages of the Underground.  These, especially in winter with the windows closed, could provide a glimpse into a circle of hell Dante forgot to describe.  But that is, of course, with the benefit of hindsight. At the time it was normal.  It was what people did.   Inevitably it was matched by the scale of illness, premature death and misery associated with smoking.

Fast forward to 2018 and less than 16% of adults’ smoke in the UK, under half the number in 1984.  This is a great public health gain. Yet within that success sit some real challenges. Those from better off backgrounds are most likely to have given up. The rate of decrease in smoking has slowed, even stalled in some populations. While many individuals are undoubtedly living longer, healthier lives our gains around smoking have done nothing to reduce the gradient of health inequalities.

As in so many areas it is easiest to reach and help those who are in the least need. This raises fundamental questions about how we approach at risk and vulnerable populations. How do we avoid leaving people behind? In the UK we are taking some steps forwards in this regard and Public Health England’s work in this area, supported by some enlightened local practitioners provides grounds for hope.

Because we do need to think about the fundamentals of this. In the last week in the UK we have had major stories in the media about the risks posed by excessive salt in food, too much sugar in our diet and micro plastics in our water. Issues about obesity are omni present. Alcohol problems are regular news fodder. None of these are trivial issues. All deserve responses from governmental and health agencies. They all generate conversation and provide marketing opportunities for some. Worryingly they all risk failing to engage the populations who could benefit the most.

All too often we develop approaches that fuel the sense that public health is something the state does to you. Something to make, often demanding lives, that little bit harder and, seemingly, less enjoyable. Before I upset too many people I know there are many excellent campaigns and local initiatives that focus on the positive but the majority of these operate at a micro level and the mood music at macro level often drowns these out. The tragic result is that attempts to improve population health are often helping to drive the alienation of communities from those agencies which seek to help them. Politicians often sense this at visceral level and become weary of engaging with health issues.  This is an issue being explored within the Politics and Public Health; Friends or Enemies session at City Health 2018. It reflects a reality I recognise, one that can be professionally frustrating but more importantly hinders approaches that could help millions of people globally. We need to all think about the role we can play in reconnecting and creating the links between communities, politicians (and policy makers) and public health that allow us to realise the goals of improving health and societal wellbeing. To achieve these will require understanding, compassion, courage and the willingness to change existing practice. These pose serious and complex challenges, but it is necessary if we are to take people with us when we tackle the health challenges facing our cities. After all, helping people enjoy a better life is our objective and they should be our greatest resource.

Monday, September 23, 2019
Sometimes things just work out. Last Monday, I was involved in three separate events which each highlighted the potential of urban areas to effectively tackle health issues when there is political leadership to do so. The day also provided a timely reminder of the importance of harm reduction, and how this needs to be at the heart of health approaches in our cities. With so many countries and agencies forgetting the lessons of harm reduction, or actively turning their back on them for narrow ideological reasons, it was uplifting to hear examples which delivered quantifiable gains in terms of lives, better health, and human rights.
Monday, September 09, 2019
With City Health 2019 in Melbourne now only weeks away, a headline in the papers caught my eye. According to the annual Global Liveability Index- whose criteria include stability, healthcare, culture, education, environment, and infrastructure- the Austrian capital Vienna narrowly beats Melbourne to the top spot. Of course, such rankings are open to debate and dependent on what you choose to measure but it’s fair to say the occupants of city halls take a degree of pride in seeing “their” cities topping the charts.
Monday, September 02, 2019
This is not the blog I was planning to write. My intention was to look at developments in managing the Night Time Economy across a number of cities, an area where there is innovation and positive developments. Instead I feel compelled to look at an issue where the UK and others are demonstrably going backwards. Battles we thought had been won in fact appear lost, progress has not just stalled but been significantly reversed. It poses hard questions for many organisations and for individuals, including myself. So, come with me as I look at drug related deaths.
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?

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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.