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Including harm reduction into health policies
In this video, Ernst wise from MdM talks about how to introduce Harm Reduction in a context and how to integrate this in a public health system
As a harm reduction implementer Medecins du monde or Doctor of the Worlds often works in settings where harm reduction is still a very early beginning of its journey. So sometimes there’s nothing yet in place, or perhaps only to a limited degree. As happens with new things, especially when things are obviously very controversial, we often face a lot of local and political resistance to harm reduction. So in this video, I hope to show you some of our perspective on getting harm reduction on the public agenda and then ultimately fitting it in the public health policy.
In my experience, most harm reduction programs start under a lot of pressure and resistance, and it’s only after a period of demonstration that people start to understand the benefits to the society. Now, I have the impression that as a starting point, harm reduction often begins as a patch, as a fix on a broken system. And what I mean by that is that harm reduction most often gets traction or acknowledgement as a response to a high transmission of infectious diseases. However, the main driver of the infectious diseases is often the result from parallel policies that put pressure on marginalized people who use drugs in the first place.
So sometimes it’s very difficult to understand why governments keep putting massive resources in something that isn’t working and is causing harm and patching that up with harm reduction interventions with only a fraction of the resources. We see harm reduction as much bigger than just the HIV prevention measure, and in the long term, we believe we need to counter policies that perceive harm reduction as just health intervention and drug control as a separate security issues. These issues are interrelated.
However, from a practical point of view, depending on the context, yes, you might want to see the initial HIV focus as a stepping stone or a catalyser to gain political leverage and acceptance on your way to achieve a broader harm reduction approach.
I once heard someone say on a public
health related issue : “the cost of doing nothing is not nothing.” And I think that very much applies to harm reduction as well. The reality is that not implementing harm reduction, doing nothing without question leads to costs. And in many context, it is paid for with human lives. Now, this is a message we need decision makers to understand, ignoring is not an option. Many decision makers already realized that drug use is not just going away, but putting more pressure on people. So it’s important to understand that if they can’t ignore it and they can’t get rid of it,… they will logically have to invest in an harm reduction approach. And this can be your first common ground.
Overcoming these initial reluctance or even resistance to harm reduction requires patience, flexibility, perseverance, balancing activism with diplomacy and foremost, adaptability because it will never roll out as you imagine. There is certainly no standard solution on how to put all these elements together and convince government. In fact, I’ve rarely seen a sudden breakthrough where suddenly we won and harm reduction lived happily ever after. It’s often a long and sometimes constant ongoing process. We need to find people within societies and not just politicians who will engage in a conversation. And we need to search for common ground.
Related to the health benefits of harm reduction we find it can be very helpful to bring forward that it is extremely cost efficient. This can be another powerful argument to bring forward. We can achieve a great deal even with limited resources. Now you will hear a lot more about advocating for harm reduction in the last session of the MOOC. But I just wanted to share this also from an implementing viewpoint, because I hear a lot of different context. “Yes, we understand harm reduction, but this is not Europe” or “harm reduction is not part of a culture.” Yes, but harm reduction wasn’t necessarily European culture either. It wasn’t welcomed with open arms by everyone.
It was driven by people that believed in what it stands for and only many, many years later, it has been endorsed and health policy. So don’t give up.
Harm reduction has shown time and time again its adaptability and resilience. In fact, sometimes I think that our constant exposure to swimming upstream has grown into an inherent strength of the harm reduction movement. Which reflects, in my view, already in the way harm reduction programs are constantly incredibly adaptive to crises and conflicts, constant fluctuating resources and health emergencies. We could perhaps even relate to the very early beginning of the harm reduction movement, which has been shaped a lot by the peak of the HIV / AIDS epidemic, which at that time harm reduction was already a pragmatic reaction to a major health crisis. Now, let me give you some more examples of this resilience and adaptability.
In the north of Myanmar, is a big population of people use drugs. It is very remote and very difficult to reach. This compounded by regular armed conflicts makes it very difficult to reach remote towns and villages to deliver clean syringes and needles. Now, despite these challenges, these programs have adapted over time and peer workers are now working fully independently in these remote areas. We’ve also just heard from Raheem in Afghanistan. As they report on human rights abuses you can imagine that not everyone is quite as happy to fund their amazing work. And yet, despite funding drying up regularly, he and his team keep working even without pay.
Also, during the coronavirus epidemic, we’ve seen numerous examples of the community and harm reduction programs hand in hand, adapting and innovating to maintain essential services running. In the UK and Morocco, for example, we’ve heard of lay people help deliver prescribed methadone to those who needed it but who were confined in their homes at a time when nurses were needed elsewhere. Adapting to these external challenges is not rocket science for those who work in harm reduction. It is in our DNA. We’re used to swimming upstream against opinions and circumstances and keep our focus on the needs of the people we work with.
In this video we will hear from Ernst Wisse on his perspectives on how to contribute to the introduction and scaling up of harm reduction. This video brings together some of the things you’ve learnt from this week.
How do we concretely translate all what we’ve learned so far into practise? We know the problem, we know the solution, but harm reduction faces tremendous resistance, based on morality rather than science. In the beginning of this week, we heard Anthon Basenko share his experience on the start of the first Methadone program in the Ukraine. This video provides some further concrete elements on how to introduce and scale-up a harm reduction response in a public health setting.
Can you share some of your own experiences on how you came about pushing forwards a harm reduction response? Or maybe your fellow student can help you with a problem you are facing locally?
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