City Health International


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.

Unsurprisingly, given current circumstances, it was not a wholly positive picture. Progress in some areas, for example TB, are matched by record drug related deaths and, for the first time in many years, worrying drug prevalence data around the use of opiates and crack cocaine. Despite my naturally cheery character (honestly) I could have ended up quite depressed if it wasn’t for the fact that I was talking to someone brimming with enthusiasm and energy to see what they could contribute to tackling some of our most glaring health inequalities. And certainly, enthusiasm and optimism, coupled with knowledge and understanding, are essential requirements when seeking to navigate the current landscape where financial resources are increasingly hard to find, and structures can often seem to hinder rather than help.

One of the subjects we discussed was the problems faced when people are seeking to access various health services. Many of us who are, allegedly, relatively organised, with some knowledge of the health system and considerable resources in terms of access to the internet, telephones or a secure postal address, have stories about the problems we or loved ones have experienced when trying to get treatment and services, being passed from clinic to clinic, with different consultants and specialists dropping in and out. Tests, scans and medication are often determined within a silo, continuity of care is hard to ensure.  Appointments are cancelled at short notice, administration is often poor (this applies as much to the private sector as the NHS, the only difference often seeming to be more comfortable seats and a water cooler in the waiting rooms of the former).  How much harder for those with less personal resources and social capital?

Healthwatch, the independent champion for those who use health and social care services, produced a report last December which highlighted the additional problems faced by those who are experiencing homelessness. These included being unable to register with a General Practitioner because they didn’t have proof of address. Accessing any service was difficult, this could be again be linked to identification issues, but also ringing up to make appointments or being contactable could prove impossible. Homeless people often felt that their situation was poorly understood and that there is a reluctance to invest time and resources in their needs. They experienced significant problems in getting the range of help needed and often felt that they were penalised for struggling to comply with health advice or treatment regimes.

While a depressing tale, it is, in many ways, hardly surprising. But given the community as well as the individual consequences this situation is clearly of concern. Also, if we have a genuine commitment to addressing health inequalities, we surely need to focus on a group whose health out comes and life expectancy are so poor, with homeless men in England dying on average at 47, for women its even worse at 43.

Some great work has been undertaken. The Kings Fund are undertaking a major piece of work looking at access to health services for rough sleepers and the impact of ill health in preventing people getting off the streets, this is due to report in the autumn. At a practical level Pathway have developed models of care for the homeless and rough sleepers. Over the last decade they have brought together a network of professionals who are involved in the health care of excluded groups, including vulnerable migrants and sex workers. Their work combines compassion with the highest professional standards. I have met some of those who have benefited from the work of Pathway and the results have been truly transformative. In 11 hospitals they have established homeless healthcare teams. These help those in need deal with the whole range of problems they are coping with, be it physical ailments, mental health issues, substance misuse etc. It’s a system that seems to work. So, what are the magic ingredients?

Of course it is essential to have highly trained specialist doctors and nurses, the Pathway teams include a specialist GP, links to community services, someone who can help access accommodation and the immediate basics of fresh clothes and shoes can be provided, they have also established Pathway Care Navigators, someone with lived experience who can not only relate to the individual but guide them through the maze of officialdom and service structures.

The idea of a care navigator has utility way beyond dealing with the well-recognised marginalised groups. Parts of the NHS are exploring how it may not only help patients but also reduce demand on GPs. Let’s hope that the great work of Pathway, Find and Treat and other services leads to wholesale improvements that help people experiencing homelessness live significantly longer, healthier and happier lives. It may well be the case that this is an example of approaches developed to help the most marginalised benefits the mainstream. Many of us when we experience ill health will have other problems and issues in tow. When we are ill our ability to cope with even the most benign bureaucracy is reduced. We are not one dimensional, we cannot be reduced to a single pathology. We could all benefit from a good navigator.









Proceed till apprehended

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.