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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.

The use of contaminated blood products in the 1970s and 1980s, which exposed thousands to HIV and Hepatitis C, the responses of successive governments and the ongoing battle by campaigners to expose the truth and get help for those harmed, provides an upsetting and dismal tale. One which asks questions of the role of private companies, the Civil Service and healthcare professionals. Forty years on the current Infected Blood Inquiry is the latest to try and provide answers.

I have crossed paths with this health disaster several times, the first few long before beginning work in the drugs field. During the 1980’s my mother worked as a senior nurse in a busy, East London Accident and Emergency Department. By the nature of their condition haemophiliacs tend to be well known at their local Emergency Department. Back in 1987 I recall my Mum talking to me about the fact that many of their well-known haemophiliac patients had died. Some had succumbed to HIV/AIDS, which though recognised, was a terribly frightening and effectively untreatable condition. Others were dying in less well understood circumstances (a test for Hepatitis C was not available prior to 1989). What was clear to a front-line nurse was that something had gone terribly wrong, and the toll in lives was significant, with over 2,000 haemophiliacs dying due to contaminated blood products. I had an additional interest as a friend of mine had the condition. Fortunately, he didn’t develop any serious illness at the time but did find out many years later that he had been infected.

Roll forward a few years and I was working within the Civil Service and one of the earlier attempts to detail exactly what had gone wrong was established. This, according to informed gossip, soon ground to a halt due to the failure to locate key documents. Eight years later I started work in the drug field and one of the first meetings I attended was about the need to do something about Hepatitis C, this time with the focus on those who had contracted the virus via intravenous drug use. Nearly two decades after that we, are at last, making real progress, thanks to the development of highly effective and tolerable drugs. There is a sense of optimism that we could be on the verge of eliminating this disease, the first time we would have achieved such a feat by treatment alone. Yet there remains the issue of how we face up to the fact that thousands of our citizens died because they were given contaminated products, even after problems became apparent. Further injury and insult have been caused by the failure to properly support or compensate the bereaved or those whose health has been compromised. Many victims have been left dependent on charity for financial support. Government responses have often seemed reluctant and mean spirited. No organisation, department or senior individual has ever admitted responsibility.

Yet it was clear by the late 1970’s that there were grounds for significant concerns about the way blood products were being produced and imported into the UK. Overseas donors, including prisoners, were being paid, no screening was being conducted and production methods meaning that tens of thousands of individuals blood were being mixed together. A recipe for inevitable disaster. In 1982 the Centre for Disease Control in the USA reported the first suspected AIDS deaths due to contaminated products. The US authorities warned their UK counterparts, but little was done. Importation and use of contaminated products continued, with many professionals rationalising the situation on the basis that the potential risk of infection was outweighed by the certainty of serious harm or death if they were not used.

Previous investigations and interviews have demonstrated that many records and documents relating to this scandal have been lost or destroyed. A former Health Office Minister stated he believed there had been acts of negligence. The current testimony of those infected provides a horrifying insight into professional attitudes with people experiencing considerable stigma. The attitudes and actions of members of the public are also pretty horrific where some were subjected to abuse in the street, including being spat upon. No one can deserve this. Least of all when it is a result of essential medical treatment.

My hope, and that of all those more directly involved than me, is that there is a proper accounting and explanation of how this situation arose. I have no doubt that the protection of profit lines and reputations are a factor. We must also hope that the Government and health service move quickly to provide the full range of financial and treatment support these individuals clearly deserve. I also hope that there are some lessons here in terms of professional humility and the importance of not losing sight of individuals within large systems. We should all applaud the bravery and persistence of those who have fought for forty years to right this wrong.

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!

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CITY HEALTH INTERNATIONAL EVENTS

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 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.