I was recently involved in a visit to London by a group from Washington DC. They were drawn from the offices of both Republican and Democrat members, and all shared an interest in learning more about UK harm reduction approaches. While my contribution was limited to illegal drugs and alcohol, they also met those involved in promoting tobacco harm reduction approaches. I am always struck by how much more difficult and complex we make harm reduction around legal substances than illegal. Providing advice on how an injecting heroin user might reduce risks to themselves and those around them is, by and large, pretty uncontroversial. Start talking about offering practical advice to those who drink above the government recommended guidelines or to those who smoke or otherwise consume nicotine (despite the efforts of Public Health England), and you can quickly find yourself in hot water.
Returning to our American friends:, as well as being a great opportunity to learn about their experiences, their visit also provided an opportunity to reflect on the political differences in terms of delivering public health. I have been fortunate to work with Ministers and Mayors of differing political complexions. Now, while there are numerous studies which indicate how best the healthcare needs of a population can be met, and I am not going to contest these, my experience tends to highlight the vital role individuals play, regardless of whatever political party they belong to. While issues of ideology- not least how they impact healthcare funding- are clearly important, so is the willingness to challenge, champion and empathise with particular groups. These attributes do not conform to simplistic left/right demarcations. For example, while there are right wing examples where approaches to HIV are clearly anti-scientific and anti-human rights, let’s not forget South Africa, under the ANC Presidency of Thabo Mbeki. The ANC was, and remains, a part of the Socialist International. Mbeki supported the view that AIDS was not caused by HIV. This led directly to delays in making best use of anti-retroviral treatments. Exactly how many deaths resulted from this is open to debate, but is somewhere in the hundreds of thousands. This occurred in the context of a desire to tackle poverty and improve public health, a tragic example perhaps of the road to hell being paved with good intentions. We should note that South Africa has since made significant progress in improving access to HIV treatments, and that access to clean water and effective sanitation continues to improve in what is a challenging environment.
Two earlier adopters of drug harm reduction approaches in the mid 1980s were Australia and the UK. In Australia the left of centre government was led by Bob Hawke, an individual who developed a long-standing popularity with the electorate. In addition to extending general health care access he established the drug summit which saw Australia become a global leader in harm reduction and responses to HIV. Impetus to this approach was provided by the personal experience of heroin addiction within his family. At the same time the UK conservative government led by Margaret Thatcher was moving toward adopting harm reduction approaches to counter concerns around AIDS. Ministers Norman Fowler and Tony Newton led a sea change in how government engaged with the public about sex and how the state responded to challenges of drug use. This might have been led by the fear of an AIDS related apocalypse, but it is a demonstrable fact that many of those who supported the expansion of needle exchanges and improving access to methadone supported other progressive public health and social causes throughout their political careers. The role of key individuals such Dame Ruth Runciman and indeed CHI’s Professor Gerry Stimson were vitally important in guiding politicians and policy. But so were those who invited Ministers and officials to visit clinics and services. Creating opportunities to humanise the issue is vitally important in engaging and retaining support for issues which are not immediately popular.
Regardless of their ideological baggage most politicians genuinely want to help improve society. Those of us who want to help improve public health should take every opportunity to provide opportunities for politicians to see services in action and meet the individuals they serve. This doesn’t mean running special events and redecorating in the hope of getting a Minister or Mayor along, it should see every service have some contact with local councillors and member of parliament – and don’t forget the officials. Keep them updated on your work, provide an open invitation to visit. Giving them an insight will help counter negative attitudes, and should be seen as an essential investment. We should be taking the positive story of what we do to politicians before bad news, or hostile financial environments, see politics coming to us.