City Health International


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).

A treat associated with Easter is the hot cross bun. Not only do they enjoy a specific association with the religious element of the Easter festival they are also delicious (toasted, with butter, never margarine). More relevant for this blog though they also generated a fabulous newspaper headline. The South African Herald newspaper ran with a story under the banner Relax – hot cross buns will not make you drunk. Traffic Police had issued a statement that motorists could enjoy their hot cross buns without fear of failing breathalysers tests. This followed an apparent “panic” on social media after a video showed individuals failing a breath test after eating just three bites of a hot cross bun. It is a fine example of how panics and urban myths get started. Eating or drinking a range of substances immediately before blowing into a breathalyser can create false positives. This had been evidenced on a police training video which had then been shared on social media. No apparent malicious intent but the story caused such concern that the police felt obliged to issue a press release to quell concerns. If only all such media storms were so benign in impact. I must also comment that the wonder of the internet ensured that the accompanying advert to this news piece provided the Easter trading hours for a local chain of liquor stores!

Sadly, the relationship between news stories and health issues are not always harm free. Looking at current news stories about measles we see a situation that says much about the issues and problems facing public health in the 21st century. The issue of vaccinations, especially for children, has long been a subject of controversy. It evokes powerful emotions and raises legitimate questions about the rights of the individual, religion, the duty and role of the state and the value and trust people place in medics and science. Possibly more recently the desire for an attention-grabbing headline, or need for clickbait, has also become a factor.

Yet we should not forget that resistance to vaccination predates Jenner. There is an English engraving from 1802 showing individuals who had been exposed to cowpox (which then provided protection against smallpox) having cow heads erupting from their body. There was concern that vaccination was an attempt by man to interfere in God’s will and that messing with the natural order of things could have all manner of undesirable consequences. Clearly, vaccination was not considered by many to be safe. In England, the Vaccination Act of 1853 made smallpox inoculation mandatory for children. Penalties could include prison. There was popular opposition and even riots, which led to the eventual repeal of the criminal sanctions in 1898.

More recently though the developed world has seen a phenomenon where the readily available and apparently obvious benefits of vaccination are being increasingly spurned by parents. This can be seen in the USA, Canada, Brazil, Italy, Japan, Australia and many other countries including the UK. Confidence in vaccines, faith in established medicine and the state are in apparent decline. Now let us be clear. In some countries, bad hygiene practices or problems with specific vaccines have occurred. These have sometimes had tragic results. Almost any vaccine programme has some potential degree of risk, very little in life can be 100% guaranteed to be risk-free, what is evident is that in many countries the understanding of the realities of risk against the potential benefits are ill understood or have been misrepresented. Which brings us back to the role of the media. In the UK one of our popular tabloids generated massive interest by promoting concerns that the MMR vaccine was causing autism. Repeatedly the public was told there was insufficient evidence that the existing vaccine programme was safe. I remember it well as a parent who at that time had to make the decision on whether to “risk” having my child inoculated or not. We were blessed with an excellent and reassuring Health Visitor who placed risk in perspective and didn’t neglect to highlight the harm measles itself could cause.

Now the research that some journalists picked up and which fuelled massive public concern on has since been entirely debunked. The main newspaper responsible has in more recent times promoted the importance of vaccination against measles, but it and its peers remain hungry for attention grabbing headlines which often create concern, fuel despair or reduce complex issues to simplistic right/wrong positions. This causes enough problems when dealing with mainstream health stories. They can also wreak havoc when dealing with more sensitive issues such as substance use, youth violence and protection of sex workers.

But we are not helpless, we should promote evidence-based approaches, interventions that support individuals and communities in overcoming adversity. Harm reduction doesn’t need to be shy or seem lacking in aspiration, we don’t all need to agree, and we should be careful of our use of headlines and facts. To end on a positive note, a recently appointed head of another British tabloid when interviewed said he had thought to reduce the brutality of its news coverage and stopped “promoting dubious stories about miracle cures for cancer”. We all have a role in helping new and old media produce less dubious health stories and in doing so improve public confidence in what can be achieved.

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.