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!
There was also evidence of a growing interest in drug policy. There was significant media interest in the potential of cannabis derived medicines and of changes to the law around its use. CBD it seems is everywhere, as food supplement, shampoo, make-up and more. Its apparent utility seems to know no bounds. But before I slip into cynicism, it is important to acknowledge that there seems to be significant clinical benefits from some cannabis derived products. Hopefully, the processes and mechanisms to identify their efficacy and support prescribing can be put in place rapidly. There is scope here to learn from other countries, notably Denmark. In terms of recreational use, many British eyes are on Canada and elsewhere in North America. It will be fascinating to see how this influences UK policy and law, and my sense is things could move quite quickly.
What is more important to me though, is the growing interest around what can be done to reduce drug related deaths. At times over the last few years, it has seemed that the increasing numbers were just not impacting on policy development or political thought. Sometimes portrayed as something inevitable given “the cohort”, or pushed into the too-complicated pile, there is now real interest in looking at how services can be shaped and delivered to reduce this tragic loss of life. At all levels of government there is now discernible interest in what can be done. Reinvigorating harm reduction, improving the use of peers to boost outreach, and ensuring access to good quality prescribing would be a good start. We need a strong focus on the most vulnerable. The City of London is piloting a scheme where mobile GPs go out and engage with rough sleepers, providing a wide range of services. There have also been improvements in the use of mental health nurses with these and other vulnerable populations. Grounds for optimism certainly.
Mental health continues to move into the mainstream of the health debate, with policy makers, commissioners, and the public now much more engaged and better informed. It's great to see the anti-stigma campaigns working, and a wide-spread acceptance that mental ill health can, and does, happen to anyone. Perhaps in 2020 we will also see progress in providing effective, joined up treatment for those with dual diagnosis. Well, we can hope.
And while expressing hopes, maybe the media might improve its coverage of issues around harm reduction, especially the relative risks of vaping. In too many cases it replicates the very worst examples of the ill-informed journalism we have often seen relating to drug use. The harms of misleading articles themselves are not insignificant. I doubt any drug user was ever scared off their substance of dependence because of a lurid column in the press, although at times they may have hampered the delivery of effective substitute prescribing. Indeed, there is evidence that sensationalist news stories serve to promote some drugs. But when it comes to vaping, I am dismayed by the number of individuals I know who have gone back to smoking, as they have read that vaping is “no safer” or even “riskier”. Of course, there is a very important debate to be had about the risks of different routes of administration of nicotine, regulation and appropriate controls. However, the key message is surely that cigarettes are the most harmful way of obtaining nicotine. More research on vaping, identifying how risks could be further reduced etcetera is vitally important but can we please stop shooting ourselves in our public health foot over this? At one level it's really simple. It should never be easier to buy a packet of cigarettes than it is to vape or obtain other, reduced harm products. Honestly at times, it’s almost enough to drive me back to smoking….
I can’t finish without referring to what I am sure will be a highlight of 2020. I mean of course the annual City Health conference, although last year there managed to be two! That means come June, in Warsaw, it will be the 10th of these events. I may be biased, having hosted the first, but City Health really does promote fresh thinking and alliances in a way no other event I have attended manages. This year the theme is compassionate public health policies for compassionate societies. I have no doubt we will attract some outstanding examples of great work from across the globe that reinforce the fact that compassionate policies are also effective and pragmatic. Supporting each other we can make real progress and improve the lives of individuals and communities in 2020 and beyond. Take care and hope to see you in Warsaw!
