City Health International


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 19th 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.

Under their steely gaze the 8th City Health Conference provided a wide ranging and mentally stimulating day. While a number of scheduled contributors had to pull out due to ill health, attendees were treated to excellent presentations in plenary and parallel sessions. There were also some very impressive poster presentations (the quality of these improves year on year). Inevitably, everyone will have had their own views on which sessions they found most interesting, engaging, or thought provoking. However, I am sure many will have been impressed by Jim McVeigh’s presentation entitled Public Health – heroes, villains and others. Top Trumps was a popular game when I was a kid. You could compete with your friends to compare everything from buses, to motorcars, to football teams. But I don’t believe anyone has previously considered some of our leading public health figures in this way! Beyond the entertainment aspect, it did allow for a degree of reflection on what really has a positive impact, and who has helped to make the major impacts.

This presentation, and that of Dr Hannah Timpson, also raised the issue of the doughnut effect in cities. Liverpool is far from unique in having seen regeneration create a situation where much of the population is moved out from the centre. In many cases now we see the well-off moving back into City centres, often enjoying riverside redevelopment. Those on lower incomes tend to remain located beyond the ring roads, or in some cases, satellite towns, which often experience many of the problems traditionally associated with urban centres but possess little of their vitality. This was the first time I recall hearing the expression” decanting ill-health”, but it accurately reflects what I have seen in London and elsewhere. Regeneration is vital for cities; it has seen many cities transformed. Liverpool is a great example, but when problems of poverty, and its attendant sins, are moved out of the centre I wonder how much harder it is to attract the resources to tackle the underlying causes? Perhaps we need to start incentivising our urban planners and their colleagues to consider addressing these human issues where they are rather than just moving them to the outskirts or into another municipal area. Regeneration surely needs to be about more than shiny shopping centres and revamped heritage sites?

One of the things that struck me most was the exploration of things that didn’t work and why. And of how well-intentioned actions get in the way of good outcomes. I have been involved in several activities which, in hindsight, it would have been better to have never started. Possibly a topic here for a future blog, but the sage advice I picked up was that sometimes its as important what you don’t do as much as what you do. Certainly, it can sometimes be very hard to resist the demands that “something must be done” when we have yet to really understand or consider the problem before us.

The morning also saw a very moving and powerful presentation, involving a degree of acting, on changes over the last 200 years in terms of support for those with mental health or learning disabilities. Anita Maestri-Banks and Denise Parker deserve great credit for their efforts in reminding us of how often and easily people within these groups are neglected. The presentation is on the City Health website and it provides an interesting perspective on the impact of urbanisation and changes in attitudes.

Other highlights for me included some interesting and innovative practice around reducing the harms caused by alcohol. The work being undertaken in Liverpool to reduce intoxication was especially interesting given the positive engagement of licensed venues in the work. It was a valuable reminder that a pragmatic approach and a willingness to work with other stakeholders can produce demonstrable gains. The work of Sefton Council and the Public Health Institute (part of LMJ) demonstrated that some individuals and areas are acting in response to the record numbers of drug related deaths in the UK. This kind of approach is essential if we are to better understand the steps needed to prevent these tragedies: they are resource intensive, but the rewards are significant.

Violence, trauma, and public approaches are regular media fodder currently, but the presentation by Nikhil Misra was outstanding in proving context and the reality of serious injury. Trauma is the most common cause of death for those aged 1-40 in the UK. For every death two other people will suffer a permanent disability. Gun and knife related injuries were significant problems but so are falls (specific personal learning points include ill-fitting footwear and wandering around at night without lights on), and road traffic accidents. Improving the quality and use of data can be a powerful force to help develop prevention initiatives. A lot here for colleagues in local public health and community safety to consider.

City Health events conclude, just like the Olympics, with a handover to the next host, Melbourne, for City Health Australia over 3rd and 4th October. It is an innovation for CHI to run two conferences in a year, this reflects the global interest in the issues and unique approach to discussion and information sharing that it has developed since 2012. Time to start working on those submissions for presentations and posters!






Tuesday, July 16, 2019
Last week I met with someone who, having just completed a Masters in Epidemiology, is keen to work in the health field. Over a hot chocolate I outlined my perception of the current big issues relating to substance misuse, our most vulnerable populations and the policies and structures we have in place to address these issues.
Tuesday, July 02, 2019
Absolutely outstanding. That’s my carefully considered assessment of the Global Forum on Nicotine in Warsaw that I was fortunate enough to attend two weeks back. I say this despite the mosquito bites and the fact that the weather was rather warm for me. The event was one of those that provide a buzz and an energy that comes back to the workplace with you. This was fuelled by an outstanding array of speakers and a vibrant audience mix. Discussion and argument were not limited to the auditorium or breakout rooms, but instead could be heard throughout the venue, over lunch, during coffee breaks. There were attendees from every continent (well, ok, I didn’t actually meet anyone from Antarctica). Academics, clinicians, researchers, harm reduction advocates, retailers, product developers, policymakers, and- most importantly - vapers and users of other tobacco harm reduction products, all mixed together sharing views, experiences, and- as we should expect- differences of opinion. It certainly lived up to the conference strapline Its Time to Talk About Nicotine and the rich promise of a genuinely horizontal approach.
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.



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.