Globalisation, healthism and harm reduction

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Globalisation, healthism and harm reduction

• Max Hopwood

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Globalisation

• global integration of economies and societies
• rapid economic growth
• neo-liberalism economic, social, moral
  philosophy
• states divest power to the private sector states
  have regulatory role
• individual as entrepreneur managing his/her
  life

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Healthism.

• a pre-occupation with personal health as
  the primary focus for the definition and
  achievement of wellbeing a goal which is to be
  attained primarily through the modification of
  life styles, with or without therapeutic help
• Crawford, 1980

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Healthism

• individual behaviour, attitudes etc determine
  health
• health is your choice
• ideology of consumerism/personal responsibility
• good for business, middle classes, the state

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Healthism

• A lot of viral epidemics are a function
  of personal behaviour so I think we can get a
  message out there personal behaviour does matter
  Original sin is a serious problem in our
  make-up. But the fact is we can't give up on the
  message that people need to take responsibility
  and that personal choice counts.
• Tony Abbott, 2003

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Healthism.

• overlooks constraints against choosing healthy
  practices, life-styles
• promotes individual blame for ill health
• casts some individuals/social groups as a
  health-threat
• undermines social effort to improve health

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Globalised health

• citizens governance of self and others
• state public health action negotiated mediated
  with stakeholders
• new prudentialism risk communities
• e.g., injecting drug users

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Harm reduction.

• often comes into play when certain
  individuals, groups and communities become what I
  have called target populations, i.e. populations
  that manifest high risk or are composed of
  individuals deemed at risk the object being to
  transform their status, to make them active
  citizens capable, as individuals and communities,
  of managing their own risk.
• Dean, 1992

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Harm reduction

• emphasis on self-regulation
• two pillars of harm reduction
• (i) medical harm reduction successful public
  
• health model (NSPs, pharmacotherapy etc.)
• (ii) political activism currently absent!

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Medical harm reduction.

• is characterized by a dangerous acceptance
  of the present situation of drug users, fatalism
  towards the prospect of larger change, failure to
  challenge the contradictions of licit and illicit
  drug use, and a continuation of the assumptions
  of addiction and morality that underlie
  abstinence and law enforcement
• Roe, 2005

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Medical harm reduction.

• ensures blaming and shaming of individuals
• reluctant to criticise global prohibitions
  effects on viral epidemics, poverty, drug users
  health etc.
• ignores structural determinants of problematic
  drug use, poverty, ill health

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Conclusion

• an era of individual health responsibility
• medical harm reduction
• good short-term public health fix
• BUT not a long-term solution
• onus on individuals to negotiate risk, much of
  which is state-generated
• reinvigoration of harm reduction political
  activism

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Globalisation, healthism and harm reduction

• Thank you