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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.

So enough of the pontificating, I hear you cry, what were you up to last week? Well, to start with, we hosted a meeting on Urban Drug Policy, Public Safety and Health. This brought together officials from the UN, campaigners for health-based approaches to drug problems, and Mayors and senior officials from a range of cities. Now, I’m the first to admit I am not at my best early on a Monday morning, especially when it is raining. However, the quality of the presentations and the enthusiasm of the speakers lit up the venue. From the start the focus was on what can be achieved at a city level, while acknowledging the constraints that can be imposed by national legislation and policy.

The need for action was cogently presented. Worldwide 1 in 10 cases of HIV infection are related to injecting drug use. Factoring in Hepatitis B and C- and the frightening increases in opiate deaths seen in the USA and the UK- there is a desperate need to do more. The Mayor of Lisbon set out what had been achieved there, touching upon the political struggles but also highlighting the significant health gains achieved. He was also at pains to establish that the approach in Portugal hadn’t abandoned all aspects of enforcement (a fact often overlooked by commentators). Not only could personal use still see administrative (civil) action, but there had also been improvements by law enforcement in tackling supply. Lisbon has also seen positive results from the introduction of drug consumption rooms.

Another five Mayors, drawn from three continents, then outlined the experience of their cities, and what they were doing to try to improve the situation for their citizens. This included locations where the primary problem drugs were stimulants, where national policies could be described- politely- as draconian, or those where resources were scarce, and justifying investment in drug treatment was challenging. All the approaches were grounded in the reality of the individual cities, and the desire to make communities and individuals safer. One quote stood out, “repression is aimless”. I was also very struck by the point made by a representative from one of the world’s leading cities in terms of harm reduction, Amsterdam, that “we need to educate and persuade new generations”. This is something I recognise: the knowledge and understanding built up through the 1990s and into the 2000s is now increasingly threadbare.

Here in front of me was evidence that cities can lead the responses to drug related problems and can cooperate and support each other in a way that seems difficult, or in some instances unimaginable, at a national level. Three hours of inspiring conversation and discussion. Not a bad start to the week.

Yet it was only just beginning. The reason for this group being in London was to attend the Fast Track Cities gathering. This brings together some 250 cities, agencies, and advocates who are working together to eliminate HIV by 2030. Now, this is an area where London is a world leader.  Financial resources have been found, political leadership has been provided, stigma is being tackled. More still needs to be done but the goal of ending HIV does feel achievable. I was especially pleased that the Mayor of London, Sadiq Khan, took the opportunity to highlight his wish that lessons learnt from tackling HIV should be applied to Hepatitis C. This enthusiasm for seeking to eradicate blood born viruses is something we should all cheer. Lunchtime was barely over and I was feeling unusually enthused and optimistic. Really not normal for overcast Mondays.

But there was more to come. Later that afternoon I was invited to contribute to a neighbouring borough’s deliberations on how they can improve their responses to drug problems. This brought together the local police, commissioners, health agencies, voluntary sector representatives, local politicians, and was chaired by the Mayor. Different aspects of the local drug issues were explored. My contribution was to provide some input in terms of national and regional context, which in current circumstances is something of a grey cloud (HIV rates being a welcome silver lining). I also have a steadily evolving role in terms of providing a corporate memory in terms of drug activity in London over the last 20 years. This allowed me to highlight that this particular area had been at the cutting edge of community engagement, serving as a model for others. It also provided the opportunity to highlight the central role of harm reduction in any effective approach. I can’t judge what impact my contribution had but it was clear that here we had a group determined to do what they could for their community.

And so ended the first day of the week, which left me feeling uncharacteristically optimistic. It also made me reflect that the potential within cities is immense, but we do need to work at realising this to achieve tangible benefits for all their citizens. The achievement of one city can inspire work in dozens more. There is confidence in numbers, and we should nurture the networks which allow us to share experience and encourage positive leadership. Promoting enthusiasm also matters and I am looking forward to City Health International in Melbourne in just a few weeks. Another, valuable, opportunity to be reminded that working together we can make real progress despite the barriers we all face.

 

 

 

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.