18 November 2010

The advocacy of science and the science of advocacy in harm reduction


This is an excellent lecture and well worth reading in full. The download link is provided below. It raises issues that HIA practitioners also grapple with in their interactions with policy and decision-makers. Can HIA practitioners play a role in developing the science of advocacy?

At a lecture yesterday at the London School of Hygiene and Tropical Medicine (where I did my MSc and PhD) Prof. Stimson made the case for a revolution in Public Health, shifting the focus from the 'bad behaviour' of individual to the 'bad  behaviour' of policy makers who ignore the powerful scientific evidence  behind harm reduction

Prof. Stimson was a member of the first group of researchers to evaluate needle exchange programmes in the United Kingdom in the mid 1980´s at the beginning of the HIV/AIDS epidemic. He was also on the Advisory Council on the Misuse of Drugs committee that designed the United Kingdom harm reduction response. That was a public health success, and emulated in other countries. Stimson says that public health policy requires a new revolution that starts to look at why policy makers continue to behave “badly” and ignore all the consistent scientific evidence presented to them when it came to decision making.


“For too long, public health has focused on the powerless, trying to get drug users, and drinkers and smokers to change their risky behaviour,...Why are there so many studies of the knowledge, attitudes and behaviours of drug users and so few studies of the knowledge, attitudes and behaviours of policy makers when it is the behaviours of the latter that are a much more important problem?”

He argues there are a number of reasons behind this “bad” behaviour of policy makers. Key among them is that drugs policy has to fit with the current ‘big political idea’.

In the lecture Prof. Stimson traces the history of science and advocacy in the field of Harm Reduction from his early days as a researcher, his time as a consultant to the World Health Organisation through to his period as head of the International Harm Reduction Association. He argues that science has been important in the development of harm reduction policy and cite examples where its take up has been both broadly implemented in many countries (drink driving, needle exchange) and marginalised (alternatives to smokeable tobacco). He concludes by suggesting that here have been major successes in advocating for harm reduction, but that the science of advocacy is underdeveloped.