City Health International


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.

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.