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, 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.
Wednesday, May 15, 2019
The confidence we have in our health systems is at the core of how we use and, hopefully benefit, from them. If we lack confidence in the benefits of going to see our GP for a health check, seeing a nurse about a travel vaccination or asking advice from the local pharmacist why would we bother? In terms of dealing with drug and alcohol problems the importance of a positive therapeutic relationship or alliance is recognised not just as being a pleasant “extra” but being central to aiding recovery. It has an important role across all fields of treatment. There are also benefits where a society has faith and confidence in those that oversee and provide healthcare systems and treatments at a population level. By and large, despite many complaints and challenges, the National Health Service in the UK remains a highly valued and trusted part of our society. And rightly so. But that doesn’t mean we should shy away from acknowledging where things have gone horribly wrong.
Tuesday, April 30, 2019
In England, the Easter public holidays see many of us get a four-day weekend. Schools are on holiday, roads are jammed, airports overflowing and much of the country indulges in chocolate, either in the form of eggs or bunnies. This year we also enjoyed some great weather. Fortunately, May looms, which brings another two holidays for us to recover from previous holiday excesses/hard work (delete as appropriate).
Thursday, April 11, 2019
Let me start with a big thank you to Liverpool, and especially the team from John Moores University, for another outstanding City Health conference. The impressive surroundings of Liverpool Medical Institute- a monument to the 19 th century’s commitment to science as well as its obsession with ancient Greece- proved to be an ideal venue. It contains a wonderful historic library, a selection of surgical and medical tools that bring a tear to the eye, and portraits of those who have contributed to the development of public health and modern health care, including some rather fearsome looking characters.



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.