City Health International


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.

Culture and entertainment contribute much to the fabric of a city, to their popularity as holiday destinations, and locations to set up businesses. Judged by overnight visitors Bangkok, Paris, and London are top of the global league. These three combine wonderful historic sites and a vibrant night time economy. In London, many visitors want to see St Pauls, Tower Bridge, and Buckingham Palace. Fish and chips (there are other options) in a traditional pub is also popular. But many also want to go out at night; visit the theatres, see a band, dance all night and perhaps see the sun come up over the river Thames. Not a bad way to spend a few days and most of us will have treasured memories of long nights in a big city. But maintaining a city’s vibrant Night Time Economy (NTE) while keeping visitors and residents safe can often be a source of conflict.

At their root many of these problems are linked to intoxication. This links to crime, the fear of crime, burden on ambulances and hospitals, street cleaning, noise and the impact on residents and workers. Concentrations of drunken people can be unpleasant and intimidating. Drunk people are a danger to themselves and a nuisance to those around them. In response our focus in the NTE tends to be on managing premises which sell alcohol, trying to limit drunkenness, the associated violence and anti-social behaviour. This can easily and understandably lead to responses which reduce outlets, the number of drinkers and so, hopefully, lead to a reduction in problems. However, the reality can see undesirable outcomes, especially at a time when many urban centres are already experiencing a loss of other outlets. It is also possible to close down “problem” venues and see problems worsen in totally unregulated or unlicensed settings resulting in increased harm to individuals and communities. Rundown areas with less people passing through can be just as daunting and problematic for civic authorities and residents as those filled with bars and fast food outlets. They don’t attract visitors or investment.

But as many cities have demonstrated it’s not an either/or situation. It can be helpful to recognise the NTE sector is not just about alcohol or other intoxicants. At the end of 2018 the Greater London Authority published an evidence base for a 24-hour city

This takes a deliberately broad interpretation of “night”, from 6pm to 6am, and in doing so it helps to consider those who work, not just those who socialise at night. One of the findings it highlighted was that while fear of crime is higher at night the reality is the risk is no higher, though there are, of course, peaks and troughs across any 12-hour period and certain days of the week. Since 2010/11 alcohol related offences have significantly fallen (approximately 50%), they make up just over 4% of all crime in this period (caveat about peaks and troughs repeated). Additionally, the report produces some interesting data about the levels of poor pay to be found amongst those working at night. It also highlights that those in lower income groups have the greatest concerns about crime.

A report like this raises a lot of issues, and researcher colleagues will be pleased to note the need for additional studies and more data is highlighted. But it does provide valuable context for those of us working to improve safety at night in our cities. London, like many other major cities, now has a Night Czar and this helps provide a focus as well as opportunities to share developments and ideas. This is important given London comprises 33 local authorities, which each have their own licensing and planning teams, in addition we have three police forces significantly involved in law enforcement within our NTE. Of course, some boroughs barely have anything resembling a traditional NTE centre, while others, such as Westminster, attract hundreds of thousands a year from across the globe. However, all are increasingly looking to maximise the benefits, economic, cultural and social of having a night time economy which includes, theatres, cinemas, bowling alleys, restaurants, coffee shops, sports centres, art galleries, shopping centres including well run and regulated venues offering alcohol.

Not every city or area gets its right all the time. Sometimes there are external factors which see plans go awry but my sense is London is making real progress in managing to balance the demands for, and benefits of, a vibrant night time economy with the need to keep people safe and minimise negative impacts on communities. We know that good licensing practice reduces hospital admissions. We have a developing body of good practice which demonstrates that local authorities and police can work with venues to reduce crime and other problems without having to result to closure – though this can be necessary on occasion. There is scope for improvement, health colleagues have much to offer in developing a more nuanced understanding and response to local problems. Other stakeholders should be included to ensure we have a true 360 degree understanding of NTE impacts. Better use of data should support quicker and more effective responses.

If we get it right in London, we might not take the top spot from Vienna or Melbourne next year, but it is an important part of maintaining it as a major world city, and of being a healthier place to live and visit. Meanwhile, as Melbourne and its social scene come highly recommended, I look forward to seeing it at first-hand and learning about the experience of other cities.

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.