David’s blog #49.9: An Art that Requires Attention Over Talent, Spirit Over Ego, Others Over Self

I hope this finds everyone coping in the environment of ongoing restrictions and exceptional circumstances we find ourselves in. The challenges we are all dealing with are significant and for some they are incredibly demanding, even tragic. I am very conscious that my gripes about not another online meeting or the challenges of working from home over a prolonged period are petty, but I do miss meeting people face to face (if not meetings themselves), the interactions and stimulus that groups can generate, and the physical exposure to different experiences, viewpoints and ideas. 

Normally, I get to benefit from attending and being involved in a range of conferences and seminars over the course of a year, and it is undoubtedly one of the most enjoyable aspects of my work. Clearly Covid has put a stop to most of this, but I have been able to catch a number of online offerings, and was absolutely delighted that we still managed to produce City Health International 2020. As anyone who watched will know, my skills as Chair of this type of event could do with some development, but the presentations were of tremendous quality and we managed to facilitate some good interaction with the audience, despite the challenges of bandwidth, time zones, and ill-timed deliveries. For those who didn’t see it, you can still view it at https://cityhealthinternational.org/conferences/2020-programme. Even in a pandemic, City Health International remains committed to supporting access to material that can assist colleagues around the world. 

The programme provides an excellent overview of harm reduction approaches, their development, key elements, and their potential beyond just the traditional sphere of illegal drugs. The insights into the impacts of austerity on communities were powerful. I also particularly liked the concept of “political wisdom” as described by Cinzia Brentari. 

Several strands ran through the event: compassion (naturally, given the conference theme), the importance of science, and engagement with those communities whose lives we seek to improve. There was also attention focussed on the dangers posed when new approaches and ideas are marginalised, pilloried or refused a platform by structures rooted in narrow orthodoxy. Over my working life I have often had my approaches and views challenged or criticised. It has sometimes been uncomfortable, but it has always been valuable. Sometimes evidence and circumstances change, supporting a change in approach: things that have worked for a time, or with one group, don’t always continue to deliver and sometimes outright fail. There are people whose views on drug and alcohol policy I fundamentally disagree with, but I don’t believe that makes them, their work, or their viewpoint invalid. It is utterly dismaying to see this approach applied in the field of tobacco harm reduction. We should test (and contest) the science, discuss impacts, and argue by all means– but let’s do it a way that builds learning and doesn’t lose sight of the millions who could benefit. 

This brings me to recent developments in approaches to the Coronavirus pandemic. In England we have often failed to communicate effectively to the public. We have regularly had government ministers saying there were no plans to introduce mandatory regulations or closures just before these have come into effect, most recently on face coverings. A lot of the messaging has been painfully tone deaf, seeming to ignore those who don’t have gardens, can’t work from home, live where people have to share rooms, or don’t have their own private transport. There has been a failure to speak to communities in a way that engages them and relates the threat to their lives and supports them in dealing with this threat. This is just now beginning to be addressed. And this makes me think about a fundamental flaw in the approaches often taken by Public Health How much time do we take talking to those communities and groups whose lives we wish to improve? Now, I am not opposed to well-considered and applied regulations or laws, which can clearly reduce harms and provide protection. Nor am I against the intelligent use of taxes or charges to encourage and support people to make positive choices. But I do have real concerns about imposing these without consultation with the communities in questions, and without explaining what we hope to achieve. It also goes further: it’s not just about carrying communities with us, it is listening to what they want, what would help them in their lives. We need to have the humility to realise that professionals don’t have all the answers.

 Looking ahead, we are working on plans for City Health International 2021, which hopefully will be able to combine elements of an actual conference with the reach of an online event. We are also looking to build and expand our networks. There is much to gain by listening to each other and our communities. Stay safe and stay in touch.


Watch City Health 2020 Online Conference