City Health International


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.

Australia played a vital role in the development of harm reduction in the 1980s and 1990’s. Melbourne has shown it retains an appetite for exploring fresh approaches with its recently opened Medically Supervised Injecting Facility. Talking to politicians, researchers, practitioners and members of the public there was an energy and enthusiasm about tackling drug issues that is in rather short supply within much of the UK. We will see if we might use some of that Australian energy and experience to fire things up a little in London, it may not just be English rugby that can benefit from such input.

A central theme of the event was how effective and humane approaches, informed by harm reduction principles, have a great deal to offer beyond the established confines of illegal drugs. When it comes to alcohol, gambling, prescribed drugs or smoking there is so much we could do to reduce harm for millions of people. That’s one of the great assets of harm reduction approaches; it provides an opportunity to make an impact at scale. I was taken by the comment made by Adam Drake, who works as an advocate for young people in the justice system, that we should “deal with people at the point of need not at the point of crisis”. Many of us will be able to think of cases where individuals and communities are clearly struggling but intervention only occurs when a threshold of significant harm is reached. Often harm that is hugely costly in financial as well as human terms. As numerous City Health presenters demonstrated we do have an increasing evidence base for a range of effective interventions, many of which require modest financial commitment but do require a willingness to challenge established and occasionally entrenched views.

Fiona Patten, in delivering the Alison Chesney and Eddie Killoran lecture that concluded the conference, reminded the audience that the great achievements of the eighties and nineties were built on radical approaches, that within the establishment and media there had been great opposition to initiatives which have been proved to save lives. Times have changed but challenges and opportunities remain if the courage to take on entrenched positions is found. As Fiona said, if we have identified ways to reduce harm its not an option to implement them, it becomes a duty. I think for the UK there are some real opportunities to apply Australian experience as a step toward reducing drug related deaths. We might repay the favour by sharing our practical and evidence-based experiences around tobacco harm reduction. Viewed from afar this is an area where the UK still does lead the world.

Oddly enough it was during a visit to Melbourne’s historic gaol that I came across an example of a pragmatic response to smoking related harms. Now this is an imposing but inevitably rather grim visitor attraction. It is full of reminders of the horrors of imperialism, savage punishment and miscarriages of justice. In the 1930’s the prison was being decommissioned but was brought back into use during the Second World War to serve as detention centre for military prisoners. During this period, to improve their health and enhance the punishment of those who had gone Absent Without Leave, it was decided to cease the supply of cigarettes. This led to a black market and ingenious smuggling methods, often aided and abetted by locals who would tie individual cigarettes to strands of cotton hanging from cell windows. While this no doubt displeased the prison authorities it was not this which led to a reversal of the decision to ban cigarettes. Rather it was concerns that prisoners were smoking homemade cigarettes, using vegetable matter and any other vaguely smokable substance. There were concerns about the harms this could cause and so the ban was over turned. It’s a reminder of the unintended consequences that can arise from seeking to ban things, without considering safer alternatives, especially in populations experiencing hardship. It must be hoped that others can show the mental flexibility exhibited by the Australian military authorities some 75 years ago!

City Health in Melbourne provided some powerful messages, great food for thought and fire for the belly. For those unable to attend its well worth looking at I will certainly be following up new contacts and friends to explore opportunities for further collaboration. Hopefully we will see some of these, and many of you, in Warsaw next year for our 10th anniversary event.

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.