Tobacco Harm Reduction and the right to health

8 Harm reduction, health and human rights The everyday world of harm reduction Harm reduction is a range of pragmatic policies, regulations and actions that either reduce health risks by providing safer forms of products or substances, or encourage less risky behaviours. Harm reduction does not focus exclusively on the eradication of products or behaviours. In the course of everyday life, we all use or do things which could be dangerous. Many products or activities have been modified to reduce that risk. Modifications may come from manufacturers, regulators or be led by consumers. Consider road safety. Many countries now have rules about wearing seat belts. Modern cars are designed with airbags which protect us in the event of a crash. Many riders wear cycle and motorbike helmets. Roads have speed limits. We don’t ban cars and bikes in case they cause harm to us or others. We adopt these measures to reduce harm, although they are called ‘health and safety’ rather than ‘harm reduction’. Harm reduction as social justice Harm reduction has another important aspect: a role in championing social justice and human rights for people who are often among the most marginalised in society. Proponents of harm reduction argue that people should not forfeit their right to health if they are undertaking potentially risky activities, like drug or alcohol use, sexual activity or smoking. The more political dimension to harm reduction grew out of the HIV/AIDs epidemic of the 1980s. At-risk and marginalised members of the gay and drug using communities in the USA and Europe acted in support of their own right to health, providing condoms and clean injecting equipment to their communities. harm reduction champions social justice and human rights for the most marginalised Over time, the benefits to public health were evidenced and more interventions of this kind were officially introduced by some governments. Eventually, they were endorsed by international health agencies. And it worked; those countries which embraced harm reduction as an important health strategy saw significant falls in HIV rates among affected communities. High risk populations benefitted, but so too did the general population. When applied to these areas of human activity, there are several key principles in play. Harm reduction responses should: » Be pragmatic , accepting that substance use and sexual behaviour are part of our world and choosing to work to minimise harmful outcomes rather than simply ignore or condemn them; » Focus on and target potential harms rather than trying to eradicate the product or the behaviour; » Be non-judgmental , non-coercive and non-stigmatising ; » Acknowledge that some behaviours are safer than others and offer healthier alternatives ; » Facilitate changes in behaviour by provision of information, services and resources; » Ensure that affected individuals and communities have a voice in the creation of programmes and policies designed to serve them – encapsulated in the slogan ‘nothing about us without us’; » Recognise that the realities of poverty, class, racism, social isolation and other social inequalities affect people’s vulnerability to and capacity for dealing with health-related harms . The intersection of harm reduction and human rights While harm reduction as a social movement is relatively new, what affected communities have always been fighting for – the right to health, with nobody left behind – has long been enshrined in international conventions and continues to be so. Harm reduction sits at the intersection between public health and human rights.