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.


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?



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.