City Health International


"Without knowledge action is useless and knowledge without action is futile."
Abu Bakr

I have now worked in the drugs and alcohol policy field long enough that people have started interviewing me to provide historical context. This prompts deeply ambivalent feelings. I am reminded that I am no longer in the first flush of youth, but the opportunity to reflect on developments over the last twenty years, consider what worked and why, is something to relish. Unlike the frustration at seeing the same failed idea or approach coming around the track again (and again..)

Given the current funding climate I often end up considering the opportunities presented by the massive investment in drug treatment after 1998 with the current situation. Yet it is true that while financial resources are important there are other important ingredients in improving the health and lives of our communities. From the mid 1980’s onwards the UK made massive strides in reducing drug related harm, backed with only modest financial investment but supported by significant changes in practice.

This change itself was supported by the sharing of knowledge and experience across a range of medical and social disciplines coupled with a benign political environment. This knowledge, this education, changed not only what people knew but what they did. For over a decade we enjoyed a period where health professionals, community activists, local authority officers, service users, law enforcement professionals and others could sit together and develop new and exciting services. The success of this, and the benefits of subsequent financial investment could be demonstrated by internationally low infection rates for blood borne viruses, increased numbers of people in treatment, lower rates of drug related death and reductions in crime.

Unfortunately, recent years have seen some of these gains slip and I am convinced that while reductions in funding play a part the loss of knowledge and the reduced opportunities to share experience with colleagues has also played a part. We have less opportunity to share knowledge and learning, less time to discuss our work with colleagues from other fields. This has reduced our capacity to evolve practices to tackle new challenges. For example, we are struggling with responses for our ageing drug and alcohol using populations. More sadly we have often lost the memory of what does work. To guide health interventions, we have the wonderful Cochrane Library and Public Health England provide a repository of useful info. Unfortunately, information relating to social and community issues is often much harder to locate and those outside of particular specialist silos are often unaware of closely related resources. This too often leads to resources being misdirected on ineffective or even counter- productive activities.

Let me end on a positive. In fact, two positives. Last week I was involved in an event looking at how data sharing from hospitals could help reduce violent crime. The data in question was de-personalised but could help drive a whole range of positive activity. A wide range of partners were involved. No one agency had all the picture but together a genuinely holistic understanding could be developed, and the outcomes were of greatest benefit to some of our most deprived communities. This information is being centrally supported and is accessible by all who can benefit from it.

Open source intelligence is a popular term in law enforcement but is applicable in other settings. Basically, it can be described as sharing all you can on any particular problem to enable all parties interested to most effectively respond. It is another example of knowledge helping lead action. Good quality information and debate is valuable. Never more so than in a period of restricted funding. In terms of helping support knowledge and effective action I would suggest looking at the archives of previous City Health events. Take a lunchtime to scan through these. I would recommend choosing at least one topic you are not normally involved in to broaden your knowledge. Obviously, the live event provides much greater opportunity to engage, to develop ideas and see network, so we hope to see you in Odessa. But if you can’t join us City Health International remains committed to sharing knowledge and stimulating action.


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.