Looking back to my first blog of 2020, it is clear I have no future in fortune telling. Seeking to be optimistic, I spoke about the success of our Christmas alcohol campaign and my hopes for more research to help determine the use of cannabis-derived medicines. I mentioned aspirations that we would see a much greater focus on addressing harm amongst those who use drugs, to help stem increases in drug related deaths. Also, on my wish list was a closing of the gap between mental health and substance use services, greater acknowledgement of the role harm reduction should play in reducing death and illness caused by smoking, and seeing many of you at the City Health International conference planned for June in Warsaw.

Of course, about the same time the blog was issued, the media was starting to report about a new virus. Not long after this, it became clear that Covid-19 would be the dominant factor of the year. So much for the best laid plans, and hopes, of mice and men.

Now I am conscious that, for many, 2020 has been an incredibly demanding and trying year. Covid has impacted on nearly everyone’s area of work and many have had to deal with tragic consequences at a personal level. The human cost has been massive and continues to grow, and the social and economic effects will last for many years. We have seen the best in people, not least the tremendous work of front-line medical staff, who again are being asked to work above and beyond. There have also been outstanding efforts by those working across a range of sectors. I have seen first-hand the work of drug and homeless outreach workers to ensure the groups they serve were protected to the best of their abilities. Teachers and care workers, those working on public transport, people serving in shops, delivery drivers and many more have all had additional demands, and, in some cases, risk placed upon them. The past year has been a powerful reminder of just how dependent we all are on others. It has also shown the importance of partnerships: the problems and issues we face, be that a pandemic, an ageing population, or drug related deaths, do not fit into neat professional silos, so meaningful responses require us to come together.

How poor is our engagement and communication, and by extrapolation our understanding, if we need to threaten legal sanctions and punishment to boost health?

The last year has clearly demonstrated that the worlds of politics and health are not somehow separate - that calls to keep “politics out of health” are in fact nonsensical. We have also seen the importance of good communication and engagement with the public. Many countries have struggled to produce and promote clear messages. Significant numbers have doubted the existence or severity of the Covid pandemic, highlighting the lack of confidence in government and health experts. Work is clearly needed to address this, as it risks undermining vaccine programmes as well as broader health initiatives. In many countries, we have seen the blunt weapon of the law used to enforce Covid responses and there is a developing debate about the levels of compulsion that should be used to support mass vaccination. While I understand and support the desire to vaccinate as many as possible, the use of the proverbial stick against individuals to promote public health should always raise concerns, and be very much a last resort. How poor is our engagement and communication, and by extrapolation our understanding, if we need to threaten legal sanctions and punishment to boost health? What are the long-term consequences of this kind of approach? To misquote the old phrase, do we continue the beatings until morale (or compliance) improves?

I strongly believe we can and must do better to work with communities, to engage with them not just at the level of appropriate publicity campaigns but in allowing them to feed into and influence the policy and service delivery responses we make. This would help avoid the tone-deaf advice so often provided in 2020, often based on privileged life experience. Examples include assuming everyone has a garden to exercise in, or a car, or the space and ability to work from home. But this lack of understanding and empathy applies way beyond Covid issues.

So, my plea for the year ahead is two-fold. First, we should all strive to build contacts and work with those outside our professional or specialist silo. Secondly, we need to spend more time talking with those whose lives we seek to improve - this insight and understanding could well provide challenges, but the potential gains are enormous. Given the pressure on resources most of us will face in the coming years, harnessing the power of communities and partnership-working must be the way forward.

Before I finish, let me also suggest we adopt a message from the World Health Organisation’s Covid public information campaign, namely “Be Kind and Support One Another”. Not always something the public health community is good at, but a worthy aspiration.

Finally let me wish you good health (Slàinte mhath) for 2021.