Marcus Grant

Cities and health: An evolving global conversation

Abstract The Cities and Health journal sees its launch in 2017. Looking back over half a century of growth and global expansion in economic activity, although there have been societal benefits, negative impacts are starting to take their toll on planetary resources and human health. As we enter what is being termed The Anthropocene, the city is becoming the preferred habitat for humanity. The imprint of city lifestyles, in terms of both resource use and waste, is found across the globe, threatening the ecosystem services that support our health. In cities themselves, due to risks and challenges to health, we are witnessing a rise in non-communicable disease, twinned with infectious disease for the many who live increasingly in informal or slum urban development. High levels of health inequity are found within urban populations. The resultant health problems are placing increasing strain on health services, with pressure only set to increase due to continuing urbanization and ageing populations. Evidence increasingly demonstrates that many aspects of city and neighbourhood form, urban and transport design, and residential environments play an important role in mediating health and health equity outcomes. The new journal Cities & Health is being launched to support political, academic and technical leadership and transdisciplinarity in this field. For this endeavour we will need to re-examine the nature of evidence required before we act; to explore how academics, policy-makers, practitioners and communities can best collaborate using the city as a laboratory for change; and to develop capacity building for healthier place-making at professional and community levels.

Research Priorities for Drug and Alcohol Studies: The Next 25 Years

This paper identifies likely important research directions in drug and alcohol studies during the next quarter century. The discussion focuses first on several emergent trends in contemporary research which have the potential to make crucial contributions both to our general understanding of psychoactive substance use and associated disorders, and to the promotion of international public health. Implications of these developments for future research agendas are discussed, including the study of drugs, alcohol, and AIDS; prevention strategies; problem rates; and the study of traditional and modern uses of psychoactive substances.

Elusive Goals and Illusory Targets: A Comparative Analysis of the Impact of Alcohol Education in North America and Western Europe

Even within industrialized countries, such as those of North America and Western Europe, educational opportunities are not equally available to all sections of the population. Nor, let it be said, is the desire to take up such opportunities as are presented equally distributed among all individuals in these countries. Some sections of the population have enhanced educational opportunities and some individuals are particularly eager to optimize the benefits that these opportunities bring. Other sections of the population are presented with very restricted educational opportunities and some individuals are resistent to becoming involved in formal education of any kind. This inequality of opportunity and disparity in demand, evident even in relation to the most basic skills such as literacy, are all the more striking when comparatively marginal educational areas, such as alcohol education, are considered. Alcohol education is marginal, not in the sense of being irrelevant to the lives of those who might receive it, but in the sense of being perceived as distant from the more formal academic concerns which dominate, for example, curriculum design in the school system. Increasingly, however, issues to do with health, with personal relationships, and with social functioning are edging their way into the main body of what is being taught. Indeed, alcohol education has a longer tradition than do some other health-related topics. It is therefore important to assess whether, given the obstacles it has to overcome, there are lessons that can be learned from previous attempts at alcohol education that may be relevant to future planning. One way of exploring this issue is through an examination of the impact of alcohol education programs in different countries. Young people have traditionally been the favorite target for alcohol education and there is no sign of this trend being reversed at present. indeed, statements by international bodies, by individual governments, by trade associations and by alcohol researchers all indicate an increase rather than a dilution of interest in young people as the most frequent target for most alcohol education. This trend is confirmed by

Current World Health Organization Activities on the Control and Prevention of Alcohol‐Related Problems

Ever since the First World Health Assembly in 1948, the World Health Organization (WHO) has recognized its role as a focal point for international concern about alcoholrelated problems. Within WHOs Seventh General Program of Work, a major objective for the Division of Mental Health is “to cooperate with Member States in preventing and controlling the problems related to alcohol and drug abuse” (WHO, 1982). This objective reflects a number of Assembly resolutions which have directed and guided WHO’S efforts over the years. It also reflects increasing concern from countries throughout the world about the seriousness of trends in alcohol consumption and alcohol-related problems. The range and severity of alcohol-related problems vary considerably, from country to country as well as within countries. Nevertheless, the accumulated research evidence of recent years demonstrates that there is generally a positive association between trends in alcohol consumption and trends in alcohol-related problems. This needs to be understood both from an individual and a social perspective. The relationship between consumption and problems is certainly complex, since, even within a single country, it cannot be assumed that drinking behavior is evenly spread throughout the population. It is also important to be aware that there may be groups who are particularly at risk. In many countries, increases in alcohol consumption by women and young people have already been noted. Even without increases, problems might worsen at current levels of consumption because of the increased complexity of modern life. Protracted high levels of alertness are, for example, required in traffic, in factories, and on construction sites. At the same time, however, great care has to be taken in extrapolating from one group of countries to another. There is a great difference in approach needed if, for example, in one country the great majority of the population drinks a relatively small amount of alcohol on a regular daily basis compared with another country where only 15% of the population drinks alcohol at all. An increase in per capita consumption in such a country would therefore mean something very different from a comparable increase in a country where everybody drinks, since it would lead to quite different patterns of alcohol-related problems. Recent decades have witnessed considerable increases in alcohol consumption and in alcohol-related problems in countries in all regions of the world. Within the WHO

Alcohol and drug use — A world perspective

The current world situation with regard to alcohol and other drug abuse is summarised, and the implications of the trends in use are considered from a public health perspective.

From Contemplation to Action

The purpose of this chapter is to review current activities within the World Health Organization’s (WHO) global program on the prevention of alcohol-related problems and to explore the extent to which these activities reflect the comprehensive model of change that underpins this volume. In particular, because the majority of the other chapters focus on the enhancement of clinical practice, work in two linked areas will be emphasized—advocacy of the public health interest, and the development of national policies.