City Health International


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.

However, since returning I have had to endure, what to me, as a long-standing hoarder of drug and alcohol policy material, has been nothing less than a disaster. Outside of a few academic institutions I reckon to have collected the largest archive of UK (and some US and European) policy documents. Alongside these were examples of various campaigns covering a wide range of drug related topics. I estimate there were some 500 different reports and publications dating back to the mid 1980’s. It has often proved useful in terms of providing some inspiration, or “recycling” of ideas. It also provided a clear path of policy change and evolution. On my return from Melbourne I was told there had been some minor water leakage in our basement store. I was dismayed to see that some documents had indeed been ruined, but relatively few and the problem was seemingly resolved. Alas attempts to repair the problem led to a major leak which saw my pride and joy reduced to little more than papier mâché. Mouldy papier mâché at that.

With my dreams of opening a drug policy museum now in tatters I worked to see what could be salvaged. While doing so it made me consider how important it is to maintain and share information, evidence and experience. From my own experience I know that while digital offers great opportunities it is also very vulnerable in terms of systems or programmes becoming redundant, or of vast swathes being deliberately deleted as happened in the UK in 2010.

Anyway, amongst what was quickly turning into a mouldy morass I did find a few salvageable items and some which were worth reading but very badly damaged. The first AIDS and Drug Misuse reports produced by the UK Advisory Council on the Misuse of Drugs survived, slightly damaged but not ruined. These provided the foundations of drugs policy which developed over the coming decades. From 1994 I have a heavily water stained copy of Across the Divide. This set the basis for how local partnerships could work together to tackle drug problems. I then discovered a series of newsletters I had almost forgotten existed, Drugs Forum Focus. This was the newsletter of the National Local Authority Forum on Drug Misuse, with its first edition being produced in Autumn 1990 with a rallying cry that local authorities needed to get involved in providing drug services. This first edition reveals that the Forum itself had been inspired following a European conference in the Hague. The benefits of international co-operation in this field are nothing new.

Edition 5 has the headline of Doomsday for Drug and Alcohol Services? Not the last time that theme has run, but possibly the first. The driving force being the apparent impending end of the Specific Grant ring fence, the threat was particularly severe toward residential rehabilitation services. The next edition trumpeted a call for Better Drug Education, this seems especially topical as we head towards the introduction of a greater statutory element within the school curriculum from this coming September (we will be hosting a conference on this subject in June 2020). In fact, many of the newsletter headlines would reappear over the years: Review of Drugs Treatment Services; New Strategies Target Crime and Youth; Politicians Shut the Door on Drugs Law Debate and, sadly, Rise in Drug Dependence and Deaths. Reading the articles, including one by Alison Chesney, reminds me of how far things have improved but also of how often lessons learnt are forgotten and how persistent certain moral and narrow professional attitudes can be. What does stand out is the vibrancy and commitment of all those concerned in helping grow what was a very new field. People were trying out new approaches, often setting up services with little in the way of high-level support and little to guide them. What they did have was a drive to help reduce the harm to individuals and communities in the face of growing drug harms. It would be fair to say that the drugs field is a much more mature area now. We have available good clinical advice and guidance on a range of topics. However, I think many of us will admit to missing the energy and enthusiasm which helped deliver massive public health and community gains.

City Health conferences have again and again demonstrated that there are still individuals and services who display tremendous commitment and drive in helping our most vulnerable. The Paolo Pertica award, now part of the City Health conference, is one way that some of these achievements are acknowledged and promoted. The Alison Chesney and Eddie Killoran lecture, another highlight of City Health conferences, provides an opportunity for a high-profile speaker to reflect on the issues and context in which we seek to help tackle some of the key problems faced by our cities. I have spent some time going through these (they can be found here – as can presentations from all the conferences). Collectively it is a great resource, go and take a look (it doesn’t involve handling wet, mouldy papers), and peering ahead into 2020 consider whether you might wish to contribute to City Health in Warsaw. We all have much to gain from sharing our knowledge and experience. And if anyone has any old UK drug policy documents, they want to get rid of, well you know where to send them.

Let me finish by saying I hope you enjoy the Christmas break and hope 2020 provides great opportunities for collaboration and success in reducing harm.

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.