Harm reduction - six insights
•Download as PPTX, PDF•
1 like•172 views
This document outlines six insights on harm reduction: 1. Policies should focus on actual harm rather than products themselves. Harm from smoking, alcohol, drugs, gambling, etc. should be the focus. 2. Policies themselves can cause unintended harm, such as bans on e-cigarettes increasing smoking rates in some cases. The potential harms of policies must be considered. 3. Context is important when considering harm reduction policies. What works in one situation may not be effective in another due to differing contexts. 4. Policies should consider who is actually at risk rather than entire populations. For issues like obesity and salt, not all groups face the same degree of risk. 5. Appro
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Harm reduction - six insights
Similar to Harm reduction - six insights (15)
More from Clive Bates
More from Clive Bates (13)
Recently uploaded
Recently uploaded (20)
Harm reduction - six insights
- 1. Harm reduction – six insights Briefing at the Hyatt Hotel, Johannesburg 12 April 2017 Clive Bates Counterfactual www.clivebates.com
- 2. Six insights 1. Focus on the harm
- 3. Insight 1: focus on harm • Smoking • Alcohol • Drugs • Gambling • Underage sex • Obesity • Fighting
- 4. Insight 1: focus on harm • Smoking • Alcohol • Drugs • Gambling • Underage sex • Obesity • Fighting
- 5. Harm reduction • Smoking • Alcohol • Drugs • Gambling • Underage sex • Obesity • Fighting
- 6. Unheated nicotine products Smokeless tobacco Heated tobacco products “Heat-not-burn” Vaping products Tobacco basedPure nicotine based HeatedaerosolUnheated Items are not shown to scale Reduced-risk consumer nicotine market
- 7. Royal College of Physicians – on relative risk "Although it is not possible to precisely quantify the long-term health risks associated with e- cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure". (Section 5.5 page 87)
- 8. Insight 1: focus on the harms - alcohol
- 9. Six insights 1. Focus on the harm 2. Focus on the harm caused by the policy
- 10. Insight 2: focus on the harms of policies The failed war on drugs has empowered organised crime, destabilised governments, violated human rights and devastated human lives everywhere. Fernando Henrique Cardoso, former President of Brazil
- 12. Insight 2: unintended consequences • Friedman AS. How does Electronic Cigarette Access affect Adolescent Smoking? J Health Econ October 2015 “Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group” • Pesko MF, Hughes JM, Faisal FS. The influence of electronic cigarette age purchasing restrictions on adolescent tobacco and marijuana use. Prev Med (Baltim), February 2016 “We document a concerning trend of cigarette smoking among adolescents increasing when ENDS become more difficult to purchase.” • Tuchman A. Advertising and Demand for Addictive Goods: The Effects of E-Cigarette Advertising, Stanford University, Working Paper. September 2015 “I find that in the absence of e-cigarette advertising, demand for traditional cigarettes would increase, suggesting that a ban on e-cigarette advertising may have unintended consequences”
- 13. Regulatory concept Possible unintended consequence? Ban e-cigarette use in public places ? Ban advertising, promotion and sponsorship ? Product design restrictions and requirements ? Ban flavours ? Ban flavours that appeal to kids ? Ban open systems because they may be used for drugs ? Impose large scary health warnings ? Ban e-cigarette sales to under-18s ? Prohibit health claims ? Raise taxes on e-cigarettes ? Insight 2: consider the harms of the policies
- 14. Six insights 1. Focus on the harm 2. Focus on the harm caused by the policy 3. The context matters
- 15. Insight 3: the context matters
- 16. Insight 3: the context matters – pill testing
- 17. Insight 3: the context matters – pill testing "The safety of people attending the event is our number one priority. "The work of this charity focuses on harm reduction and provides important drug safety messages to festival-goers.”
- 18. Six insights 1. Focus on the harm 2. Focus on the harm caused by the policy 3. The context matters 4. Who is really at risk?
- 19. Insight 4: who is at risk? The case of obesity Source: Hughes V. The big fat truth. Nature. 2013 May 22;497(7450):428–30.
- 20. Insight : who is at risk? The case of salt Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population)… …while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets Mente A, O’Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet. 2016 Jul;388(10043):465–75.
- 21. Six insights 1. Focus on the harm 2. Focus on the harm caused by the policy 3. The context matters 4. Who is really at risk? 5. Risk minimisation or utility maximisation?
- 22. Insight 5: risk minimisation or utility maximisation? Example of relationship between alcohol consumption and Coronary Heart Disease. Corrao G, Bagnardi V, Zambon A, et al. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med. 2004;38:613–19 Lowest Protective Personal choice?
- 23. Six insights 1. Focus on the harm 2. Focus on the harm caused by the policy 3. The context matters 4. Who is really at risk? 5. Risk minimisation or utility maximisation? 6. The citizen and the state
- 24. Insight 6: citizen and the state – adult free will The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant. John Stuart Mill On Liberty, 1859
- 25. Insight 6: citizen and the state – playing the kids card
- 26. Insight 6: citizen and the state – playing the kids card
- 27. Insight 6: citizen and the state – playing the kids card
- 28. Six insights 1. Focus on the harm 2. Focus on the harm caused by the policy 3. The context matters 4. Who is really at risk? 5. Risk minimisation or utility maximisation? 6. The citizen and the state
Editor's Notes
- Vaping products Top row shows: 1st generation cig-a-likes 2nd generation ego or ‘pen’ type devices 3rd generation tanks / mods type Bottom row shows Large electronic hookah Small shisha pipes Electronic pipe … there are many other configurations Heated tobacco products – sometimes referred to as heat-not-burn to distinguish between combustible products Shows the iQOs, Ploom and Glo products Novel nicotine products - shows Nicoccino – a nicotine containing film Zonnic – a range of nicotine products – lozenges, gum etc Voke – a cold aerosol (approved but not marketed) Niorette – cross-over NRT Smokeless tobacco Snus Moist snuff Tobacco-based lozenge
- Prohibitions have a range of undesirable social consequences… no-one would claim the war on drugs or prohibition to be a great success. Criminal networks get a new source of revenue The trade is ultimately regulated by violence People and suppliers are criminalised – often causing far greater harm than the prohibited product The law falls into disrepute
- My summary…