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 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. 

For me some of the highlights were sessions that looked at vulnerable groups: those who are homeless, experience mental health problems, or have substance misuse problems. These are individuals who are so often left behind by the health improvements that the rest of society benefit from. As one presenter starkly put it “my clients don’t get cancer from smoking, they don’t live long enough”. The direct health gains and engagement potential of helping people switch from smoking is massive. If we had a means of reducing the harms from alcohol or heroin in anything like the magnitude offered by vaping or snus, we’d be wildly celebrating one of the great public health gains of the last 50 years. The reality is a number of excellent small-scale projects but a failure of systems to grasp the massive potential to transform lives and health costs.

Peter Hajek pointed out the often-overlooked history of the use of oral tobacco, including for crews of submarines, and outlined the concerns of many whose objections to alternative nicotine products were hinged on concerns about young people. Many speakers considered the issue of competing science and research, and how this was relayed in the media. There is no doubt that many individuals continue to smoke because they have read scare stories on the “dangers” of vaping. Ronald Dworkin delivered the Michael Russell oration, with a powerful critique of public health systems that often seem to lose sight of the reality of being human. He also outlined the use, and potential abuse, of science and the value of professionals being humble in dealing with individuals’ adversity.

The issue of science, evidence and its application was one of the recurring themes of GFN, hardly surprising in one of the most contested and polarised areas of current health debate. Funding dictates a great deal and it is something of a tragedy that we lack a vigorous, independent framework that can assesses and analyse research, be it from the tobacco or nicotine industry or from those whose funding or ideological positions predetermine their opposition. As Dr David Abrams put it, we need to overcome belief and convictions. It fell to a “pure scientist”, Dr Roberto Sussman, GFN’s resident Theoretical Cosmologist, to sum it up neatly - most of those resisting tobacco harm reduction approaches don’t “see themselves as authoritarian nanny staters, but rather as warriors and crusaders for the greater good, fighting the evil tobacco industry”. And how can we blame people for seeking to punish Big Tobacco? My thoughts on this are that if you can jump in your time machine (Roberto can possibly assist with the theoretical aspects) then by all means go back and punish them. What we should not be doing is fighting that war now, when the price is not paid in reduced profits, dividends or salaries of big tobacco but in the health and lives of our most vulnerable citizens. We do not protect young people from nicotine by allowing their parents and carers to die prematurely of avoidable smoking related disease. You benefit no-one (other than cigarette manufacturers) by establishing regulatory systems that make it easier to buy smokable tobacco than safer alternatives.

Back in London I am looking to try and help those reaching out to spread tobacco harm reduction and deliver real and achievable gains for individuals, their families and communities. We have a great opportunity and we can overcome the obstacles. I am also starting to think about the next event which adopts the same kind of approach to delivering an enriching event: City Health International Melbourne, 3 and 4 October 2019. Hope to see some of you there, just as soon as I can work out which London underground line it’s on….

 

 

 

 

 

 

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.
Monday, September 09, 2019
With City Health 2019 in Melbourne now only weeks away, a headline in the papers caught my eye. According to the annual Global Liveability Index- whose criteria include stability, healthcare, culture, education, environment, and infrastructure- the Austrian capital Vienna narrowly beats Melbourne to the top spot. Of course, such rankings are open to debate and dependent on what you choose to measure but it’s fair to say the occupants of city halls take a degree of pride in seeing “their” cities topping the charts.
Monday, September 02, 2019
This is not the blog I was planning to write. My intention was to look at developments in managing the Night Time Economy across a number of cities, an area where there is innovation and positive developments. Instead I feel compelled to look at an issue where the UK and others are demonstrably going backwards. Battles we thought had been won in fact appear lost, progress has not just stalled but been significantly reversed. It poses hard questions for many organisations and for individuals, including myself. So, come with me as I look at drug related deaths.

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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 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.