City Health International


I write this on a day when London is experiencing, what is for us, exceptional temperatures. Overhead power lines and train tracks have warped. On some routes passengers have been advised to avoid travelling if possible, and many employers have encouraged staff to work from home. I suspect many who did travel to their workplaces were drawn by the prospect of effective air conditioning as much as personal work ethic. This great City was unusually quiet, apart from the pubs and bars who were doing a roaring trade. Who would begrudge people a pint of beer or a glass of wine when it’s so damn warm, especially when by delaying travelling an hour or two, the journey home may be made a little more tolerable?

This set me to thinking about what we do- and what we don’t do- in terms of engaging with people, managing alcohol sales, and the consequences to our cities. I have been involved in many campaigns that have sought to reduce the negative consequences of excessive alcohol consumption. With the exception of a few drink driving campaigns, these have all been run over the Christmas party period. Whilst we do see big spikes in the demands placed on the ambulance service, police, and Accident and Emergency departments on peak party days in the weeks running up to Christmas and the New Year, it’s not the time of year when we see the highest level of alcohol consumption. No- that’s summer, when it’s warmer, when there are more weddings, BBQs, and outdoor parties; when the opportunity for a drink after work is often just too good to resist. Once we are home that bottle chilled in the fridge can also seem much more desirable (when exactly did it become normal for domestic fridges to have special sections for wine bottles?).

More people drinking, and those consuming more than usual, provide challenges for both health messaging and the management of venues and outlets selling alcohol. On the former it remains the case that our advice lacks nuance. Not regularly drinking more than 14 units per week, so about six pints of average strength beer, or less than two bottles of wine, is clearly advisable. We are also advised to spread this out over three or more days which, while valid, presents a significant challenge to the reality and culture of how many drink.

Drinking more than two pints in one evening may elevate risk, but in terms of engaging with the drinking public it’s not very helpful. Most people in the UK will have personal experience, or know someone, where the booze has caused problems; be that the occasional “hangover from hell”; an accident or incident when intoxicated; seeing or being the person who makes an idiot of themselves at the work party; losing a driving license; acquiring a criminal record; the misery caused by alcohol dependency or the serious health consequences and death that alcohol can cause. But alcohol is also an important part of how we socialise, celebrate, and enjoy life for many people. We can and should develop more nuanced messages, such as countering the idea that eating is cheating or that non-alcoholic drinks ruin a good night out. Both can clearly contribute to a much more pleasant night and certainly day after.

Around the world countries and cities struggle to strike a balance between measures and regulations to reduce harm, and allowing people to indulge. And, of course, the alcohol industry is an important sector of the economy- especially at a time when many of our urban centres are under pressure- generating tax revenue and providing employment. It is not a simple policy arena in which to operate, as adverse unintended consequences can lurk around the best-intentioned legal changes. Nor can we leave the market to its own devices. In London and the UK improvements in licensing policy and enforcement have shown demonstrable improvements in terms of health and crime outcomes. However, we have also seen isolated examples where problems have been displaced and outcomes worsened. We also need to remain agile as behaviours and fashions change. Concerns and measures to deal with high strength beers that were valid 8 years ago are not necessarily fit for purpose when managing the global craft beer revolution.

Despite the harms directly caused and linked to alcohol it does remain our favourite drug. City Health 2019 in Melbourne is looking at this issue in the session entitled Glass Half Full and I know that as much as London has to share there, we also have much to learn from. Not least in how to survive, and drink moderately, when it’s hot!

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!



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.