We all know there are many factors involved in any individual’s health, there are environmental factors, the physical circumstances in which they live, their behaviours and genetics. Access to good medical services, for both prevention and treatment are also recognised as being important. But the processes by which it is decided which services are provided where, be that at a national, regional or local level are, perhaps, less frequently considered. Yet we all know there are significant variations in everything from cancer survival rates (good to be in the USA, Canada, Australia, Finland or Iceland) to access to good quality ante-natal and early years care, where Western Europe general does well as do Japan, Singapore, Hong Kong and Macau but the USA does relatively badly.
I was recently involved in a visit to London by a group from Washington DC. They were drawn from the offices of both Republican and Democrat members, and all shared an interest in learning more about UK harm reduction approaches. While my contribution was limited to illegal drugs and alcohol, they also met those involved in promoting tobacco harm reduction approaches. I am always struck by how much more difficult and complex we make harm reduction around legal substances than illegal. Providing advice on how an injecting heroin user might reduce risks to themselves and those around them is, by and large, pretty uncontroversial. Start talking about offering practical advice to those who drink above the government recommended guidelines or to those who smoke or otherwise consume nicotine (despite the efforts of Public Health England), and you can quickly find yourself in hot water.
Across the world many cities face high levels of criminal violence and murder. A quick search will reveal that in terms of global league tables, certain regions dominate with Latin America, North America and Sub Saharan Africa providing the top 50 violent cities. However, a cursory glance tells us this is a complicated picture with huge variations between and within countries. Complex factors are at play, differing social, economic and legislative environments all have an influence. A brief historical perspective tells us that improvements can be made, that nations and cities can act successfully to reduce the levels of violence experienced by their citizens.
Health sells, not just in terms of medical care or pharmaceuticals. News about health issues is a central staple of the mainstream media, all major newspapers and tv news programmes boast a health editor and provide their customers with a regular diet of stories about the latest cures, scares and developments relating to our wellbeing. The public have a great appetite for the topic, not a surprise given that all of us have a profound interest in health. Given the nature of the media they often have a particular angle. Some outlets can be relied upon to criticise almost any new government initiative as a shocking example of the “nanny state” preventing citizens going about their lives. Others tend to the opposing position that without the strong and vigilant guidance of the state citizens are all prone to making chronically bad choices with negative consequences not just for ourselves but those around us. This is often presented as being necessary not so much for the readers or viewers of the outlet in question, who are normally assumed by the writer to be wiser than the average, but for the benefit of lesser mortals. To be fair we all tend to think it’s someone else who needs to change their ways rather than ourselves. The media also love a controversy, it could be about the merits of substitute prescribing for opiates, whether people should pay to see a medic, the rights and wrongs of vaccination programmes, all these and more make great copy.