Toward health equity - harm reduction

A position statement from Harm Reduction International

Harm reduction refers to policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs.

Trauma is not defined by the event; it’s determined by the response to it.

Sexual violence is a serious social issue. 1 in 3 women, 1 in 6 men and 1 in 2 trans people experience sexual violence in their lifetime.[Stats Canada: Sexual Assault Statistics in Canada. See also 50% of transgender people experience sexual violence. Forge: Transgender Rates of Violence, 2012.]  Such experiences inevitably leave traces on minds, emotions, and even on biology. Sexual violence causes trauma. 

Key components of trauma:

  • An experience that is sudden, unexpected and perceived as dangerous
  • A person’s physical, sexual, emotional well-being is threatened, harmed through violence or the threat of violence
  • The experience overwhelms usual coping abilities
  • Every person experiences trauma differently

The Body Keeps the Score[See Bessel van der Kolk: The Body Keeps the Score]

As trauma expert Bessel van der Kolk describes, being traumatized means continuing to organize your life as if the trauma were still going on - unchanged and immutable - as if every new encounter or event is contaminated by the past.

  • Numbing happens when alarm keeps going and we learn to ignore it. This happens on a cellular level!
  • Impaired judgment and ability to interpret situations
  • Emotional intensity and context
  • Extremes and contradictions in feelings and behaviors

Trauma literally rearranges the brain’s wiring—specifically areas dedicated to pleasure, engagement, control, and trust. These areas can be reactivated through innovative treatments including neurofeedback, mindfulness techniques, play, yoga, and other therapies.

Harm reduction is a public health approach that acknowledges people cope with trauma by engaging in what has been defined as ‘risky behaviour’ to deal with the emotional, physical, psychological pain and suffering that follows sexual violence and other kinds of traumatic events. Harm reduction recognizes that people cope with trauma in ways that can cause harm to themselves. Harm reduction focuses on reducing the harm, using a trauma and violence informed approach. 

Trauma and Violence Informed Care

  • Realizes the widespread impact of trauma and understands potential paths for recovery
  • Recognizes the signs and symptoms of trauma in youth, families, staff, and others involved with the system
  • Responds by fully integrating knowledge about trauma into policies, procedures, and practices
  • Seeks to actively resist re-traumatizing people

Harm Reduction is:[See: Harm Reduction, Positive Youth Development and Trauma-informed Care (presentation)]

  • evidence-based with a strong commitment to public health and human rights
  • focused on reducing specific risks and harms
  • grounded in the needs of the individual
  • requires professionals to accept youth as they are and to avoid being judgmental
  • requires open, honest dialogue between all stake holders
  • recognizes the value of all persons regardless of what behaviors they exhibit
  • acknowledges ANY positive change an individual makes

Youth benefit from harm reduction by:

  • Gaining skills they will need to become successful adults.
  • Creating new relationships with adults and peers, further connecting them to their community and enlarging their support network.
  • Gaining a better appreciation for adults and the multiple roles they can play.
  • Beginning to see their own potential as limitless.
  • Beginning to view the world, and their ability to affect it, in a positive way.
  • Feeling needed and useful.
  • Feeling an enhanced sense of personal power, autonomy, and self-esteem.

Adults benefit by:

  • Feeling a stronger connection with youth
  • Gaining a better understanding of the unique needs of youth
  • Feeling a renewed energy for providing support to youth
  • Gaining an expanded resource base so that they no longer feel “responsible for everything.”
  • Learning to meet people ‘where they are’ without judgement - it feels good

See: Equip Health Care - Promoting Health Equity: Harm Reduction

Why use an equity lens?[EQUIP Health Care. (2017). Promoting Health Equity - Harm Reduction: A Tool For Primary Health Care Organizations and Providers. Vancouver, BC. Retrieved from]

An equity lens helps us understand that substance use and the harms of use are increased by social conditions  such as abuse, trauma, grief, loss, and also social determinants of health such as low income and inadequate housing. For example, the harms associated with substance use (e.g. stigma, violence, overdose, malnutrition, coronary artery disease, cirrhosis, HIV, Hepatitis C, abscesses) are increased when people face challenges related to racism, poverty, housing, income or mental health.

The use of certain substances is often highly stigmatized in society, particularly for people facing social disadvantages.[Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review 24(2): 143-155.] Negative or stigmatizing experiences in accessing health care can lead people to delay or avoid seeking future care. You can prevent these harms by providing care that is of an equity-oriented and harm reduction nature.

Further Reading & Resources