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.



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.