Without knowledge action is useless and knowledge without action is futile

Abu Bakr

I have now worked in the drugs and alcohol policy field long enough that people have started interviewing me to provide historical context. This prompts deeply ambivalent feelings. I am reminded that I am no longer in the first flush of youth, but the opportunity to reflect on developments over the last twenty years, consider what worked and why, is something to relish. Unlike the frustration at seeing the same failed idea or approach coming around the track again (and again...)

Given the current funding climate I often end up considering the opportunities presented by the massive investment in drug treatment after 1998 with the current situation. Yet it is true that while financial resources are important there are other important ingredients in improving the health and lives of our communities. From the mid 1980’s onwards the UK made massive strides in reducing drug related harm, backed with only modest financial investment but supported by significant changes in practice.

This change itself was supported by the sharing of knowledge and experience across a range of medical and social disciplines coupled with a benign political environment. This knowledge, this education, changed not only what people knew but what they did. For over a decade we enjoyed a period where health professionals, community activists, local authority officers, service users, law enforcement professionals and others could sit together and develop new and exciting services. The success of this, and the benefits of subsequent financial investment could be demonstrated by internationally low infection rates for blood borne viruses, increased numbers of people in treatment, lower rates of drug related death and reductions in crime.

Unfortunately, recent years have seen some of these gains slip and I am convinced that while reductions in funding play a part the loss of knowledge and the reduced opportunities to share experience with colleagues has also played a part. We have less opportunity to share knowledge and learning, less time to discuss our work with colleagues from other fields. This has reduced our capacity to evolve practices to tackle new challenges. For example, we are struggling with responses for our ageing drug and alcohol using populations. More sadly we have often lost the memory of what does work. To guide health interventions, we have the wonderful Cochrane Library and Public Health England provide a repository of useful info. Unfortunately, information relating to social and community issues is often much harder to locate and those outside of particular specialist silos are often unaware of closely related resources. This too often leads to resources being misdirected on ineffective or even counter- productive activities.

Let me end on a positive. In fact, two positives. Last week I was involved in an event looking at how data sharing from hospitals could help reduce violent crime. The data in question was de-personalised but could help drive a whole range of positive activity. A wide range of partners were involved. No one agency had all the picture but together a genuinely holistic understanding could be developed, and the outcomes were of greatest benefit to some of our most deprived communities. This information is being centrally supported and is accessible by all who can benefit from it.

Open source intelligence is a popular term in law enforcement but is applicable in other settings. Basically, it can be described as sharing all you can on any particular problem to enable all parties interested to most effectively respond. It is another example of knowledge helping lead action. Good quality information and debate is valuable. Never more so than in a period of restricted funding. In terms of helping support knowledge and effective action I would suggest looking at the archives of previous City Health events. Take a lunchtime to scan through these. I would recommend choosing at least one topic you are not normally involved in to broaden your knowledge. Obviously, the live event provides much greater opportunity to engage, to develop ideas and see network, so we hope to see you in Odessa. But if you can’t join us City Health International remains committed to sharing knowledge and stimulating action.