City Health International


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, 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!
Wednesday, December 18, 2019
It has been a little while since I managed to produce a blog. Workwise things have been especially hectic as we end the year. Not least in helping get another London Christmas alcohol campaign organised. You can see the resource produced here . Early next year I will share our experience of this year’s campaign. Looking back 2019 has been a year when the headlines relating to drugs have been consistently negative. Record drug related deaths, some worrying prevalence data, growing concerns around crime and financial pressure on service delivery. On the positive side there is some sense that drug issues are getting back on to the agenda. Hopefully this will continue. A personal highlight of 2019 was getting to hear and speak with so many fascinating people at City Health Melbourne.
Wednesday, October 30, 2019
When I hosted the first City Health conference in 2012, my hope was we might manage three or four events in different cities. I never dreamt we’d get to nine (and counting) or that City Health would reach the great city of Melbourne. Great credit must go to the Progressive Public Health Alliance for hosting a fascinating two days that provided energy, enthusiasm and challenge. Personally, I learnt a great deal and found myself questioning somehow of my own views. I met people doing amazing things in the most challenging environments. I heard of situations that made me feel a sense of despair but came away reassured that we have the knowledge, networks and commitment to positively change lives for the better.
Monday, September 23, 2019
Sometimes things just work out. Last Monday, I was involved in three separate events which each highlighted the potential of urban areas to effectively tackle health issues when there is political leadership to do so. The day also provided a timely reminder of the importance of harm reduction, and how this needs to be at the heart of health approaches in our cities. With so many countries and agencies forgetting the lessons of harm reduction, or actively turning their back on them for narrow ideological reasons, it was uplifting to hear examples which delivered quantifiable gains in terms of lives, better health, and human rights.



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.