April – victory month for harm reduction

For those valuing a non-dogmatic stance on health issues, one which is rooted in considering the real-life effects of science, and open to contributions from the people most affected – April presented a major success for harm reduction advocates.

For the first time in UN history the notion of harm reduction appeared in the politically negotiated UN resolution on drug policy. Until then harm reduction had only been mentioned in the context of HIV/AIDS. The resolution adopted at the 52nd session of the Human Rights Council mentions a harm reduction approach among other health responses and underlines that support for harm reduction is not qualified as being subject to national legislation.

Furthermore, it seems that including harm reduction in drug control policies is even approved of by the mighty WHO. In a recently published publication the WHO points to the fact that “harm reduction is one of the key elements of a public health promotion framework (or response) that has been proven highly effective in reducing and mitigating the harms of injecting drug use for individuals and communities”.

There is more and more evidence that the so-called “war on drugs” is failing and that new approaches, such as harm reduction, need to be considered. Experts who gathered at the International Harm Reduction Conference in Melbourne in mid-April said that the evidence is in and that it is time for the world to adopt a new approach, one which includes harm reduction solutions. Examples of harm reduction solutions include medically supervised settings for people who inject drugs and decriminalizing drug use.

In the context of the above we would like to point to the fact that the UN resolution, the WHO publication and the experts gathered in Melbourne all recognize the crucial role of civil society and affected communities. Also, that work must be done to involve and engage meaningfully with a diverse representation of civil society and affected communities in their efforts to address all aspects of the world drug problem.

[Hearing this, we allow ourselves a hollow laugh at the recent decisions to reject the participation of nicotine consumer associations in FCTC COP proceedings.]

Setting appropriate, science-based drug policies is extremely important for the affected populations. We can only dream of one day posting a COPWATCH article announcing that FCTC COP recognizes a harm reduction approach in tobacco control, one which includes recognition of the potential of products which reduce harm for people who smoke. 20 years ago the WHO Scientific Advisory Committee on Tobacco Product Regulation stated that “the major acceptable public health rationale for development of new or modified tobacco products is the potential for a reduction in the harm caused by existing tobacco products”. There is now a portfolio of such products, so why have they abandoned harm reduction?

We had a dream….

WHO loves harm reduction – but not for smokers

We had a dream… We had a dream about a comprehensive publication that would highlight best examples of risk reduction policies and approaches in non-communicable diseases (NCDs) and how they could influence tobacco control.

In this dream about NCD  best-buys was this recently published WHO report on sodium, which does not call for a ban on salt, even though excessive salt intake causes raised blood pressure and increases risk of cardiovascular disease and is associated with 1.89 million deaths each year. This publication provides policymakers with science-based alternative actions that avoid a prohibitionist approach.

There was another new WHO report in our dream. This one is about road safety. Around 1.3 million people die and millions more are injured or disabled because of road traffic accidents every year. Instead of banning cars, motorcycles, buses, and other vehicles, WHO with partners is calling to adopt policies aiming at increasing use of seatbelts and child restraints. WHO is calling for harm reduction, in other words. In the publication they reminded us of other measures aimed at reducing risks,  such as the introduction of speed limits, the creation of safer infrastructure, the enforcement of limits on blood alcohol concentration while driving, and improvements in vehicle safety.

Then our imagination, boosted by R.E.M., moved to publications that would encourage people to drop the most toxic risk factors and replace them with better alternatives. And then this WHO report on the replacement of trans-fatty acids with healthier oils and fats appeared. This provides guidance on finding the best replacement oils for industrially produced Trans Fatty Acids, and on designing and implementing strategies to promote the use of alternatives.

And then we were rudely awakened by a Twitter notification from the FCTC account inviting us to a launch of their new publication. And the spell was broken. Because we already know that we cannot expect a similar harm reduction approach when it comes to tobacco. Yet again, we will hear whining that there are no safer alternatives to smoking, and that tobacco and nicotine products should be banned. Just not the cigarettes.

Why can’t WHO just look at their own examples, as in our dream, and see that their stubborn stance on tobacco just doesn’t make sense?

In the words of Martin Luther King “we must accept finite disappointment, but never lose infinite hope”.