HARM REDUCTION AS A PROCESS
Scientific advances, changes in technology, or regulatory changes needed to eliminate hazards or harms can take considerable time to be achieved. Many hazards cannot be quickly eliminated because of the often slow pace of scientific, social, and political change. Too often harms prevail and actions are delayed due to challenges in securing the required new knowledge, regulations, or technology. The pervasive uncertainties and simplifying assumptions that can plague One Health create a gap between what science provides and what society demands in dealing with harms. Different standards and expectations for how much and what types of harms should be attacked can discourage actions, especially wfhen the science remains inconclusive. Harm reduction, as a process, helps inspire collective action to make incremental improvements towards a healthy situation in the presence of uncertainty and conflict. It is a perspective and a set of strategies that applies to all the determinants of health and not merely problematic risks. It involves pragmatic, multidisciplinary, approaches to remove barriers to the implementation of knowledge to protect health and promote sustainability in situations w'here the hazard or harmful situation cannot be eliminated in the near future.
Harm reduction is most associated with public health actions against persistent problems such as addiction and homelessness. Adapting harm reduction to One Health provides new tactics to overcome entrenched perspectives and inaction to ensure progress on shared goals. Harm reduction works by reducing the more immediately harmful consequences of an activity through pragmatic, realistic programs feasible under current conditions. It promotes relationships, structures, and processes to make gains towards safer situations by incrementally reducing the negative health, social and ecological consequences to individuals, communities, and ecosystems, without relying on elimination of the hazard.
The process of harm reduction is characterized by five features:
1. It is a collaborative process.
Harm reduction seeks multidisciplinary pathways to overcome barriers to implementing recommendations, fostering collaboration on shared goals, and reducing conflict. Social and organizational factors that influence actions and opportunities to prevent, mitigate, or cope with harms are targeted. A diversity of players is engaged in finding solutions throughout the chain of causation. The process does not blame or judge the participants. Collaboration involves individual who, thorough formal or informal negotiation, find ways to act together towards a shared vision that results in mutually beneficial interactions. Collaboration helps people see different aspects of the problem and, by exploring these differences, find solutions that go beyond their own perspective of the problem. Harm reduction processes build new forms of strategic collaboration and governance that allow actions while debate remains on the scope and mechanisms of harm.
2. It creates an enabling environment for collective actions.
There are four preconditions to collaboration and cooperation (Thomson and Perry, 2006; Singh and Kant, 2008). Firstly, people need to have some ownership of the problem. Rather than seeing the issue as someone else’s problem, successful collaborators need to see their role and responsibilities for helping to reduce harms that may extend beyond their interests. Some degree of negotiation will be needed to create a shared vision that will help collaborators see how working towards collective interests will meet the interests of themselves or their organization. Secondly, the collaborators need a shared goal of where they want to go and a hierarchy of achievable steps that, taken one at a time, can lead to a safer and healthier situation. Harm reduction emphasizes actions that can benefit multiple parties and lead to progress on shared goals. Thirdly, participants need to understand and endorse the process for making decisions and for moving what they know into action. Fourthly, there needs to be trust. Trust can be built by being honest in negotiations, communicating purposefully and regularly, behaving in accordance with agreements, and not taking advantage of others or event when the opportunity is available. Trust, commitment, and a deeper understanding of the value of collective action are gained by focusing on series of incremental small wins towards the long-term goal.
3. It is oriented to finding pragmatic solutions.
While not ruling out the longer prohibitions or elimination of hazardous situations, gains that are feasible within the current circumstances and state of knowledge are sought rather than relying on the creation of a preferred future before acting. The focus is on finding strengths, possibilities, and opportunities to reduce negative consequences rather than emphasizing discovery of the proximate cause of harms or attributing blame to others. It is about working with what we have and who we have today to make incremental improvements.
4. It is inclusive and local.
Whereas many forms of risk management emphasize top-down actions, harm reduction emphasizes bottom-up, locally developed planning. This reflects its focus on working with the knowledge, resources, and relationships that are currently affecting the problems of concern in the context in which they are occurring. Harm reduction recognizes that no one approach works for everyone in all situations. It emphasizes action plans that adapt generic recommendations to local circumstances to produce gains that can be built on over time to lessen present harms while preparing for tomorrows risks. Individuals, agencies, companies, and communities affected by or affecting harms and risks need to be involved in the co-creation of harm reduction strategies tailored to a specific situation. Incorporating the context in which environmental, organizational, and personal factors interact increases the likelihood of finding shared priorities.
5. It is integrative.
Social, ecological, and individual harms are interrelated and examining them together helps build consensus on goals and finds actions that may have benefits across domains. Harm reduction promotes a range of interventions but shifts the focus for change from technical and biological matters alone to include social innovations and opportunities. Seeking consensus on biological harms without accounting for social harms can increase conflict and delay actions. The usual approach of examining one type of harm in isolation from another reduces chances of finding common pathways or opportunities to reduce or eliminate risks and harms.
The pathway from knowledge to harm reduction action requires trust. People need to trust both the information provided and the information providers. To be successful in communicating and building trust, one must recognize and respect the diverse and complex value systems operating at the animal-health- society interface. Inspiring people to act in a way that addresses a suite of harms needs to do more than present the facts. The mere acquisition of new information often does little to affect risk perceptions and willingness to act (Gerrard et al., 1999). Information sharing needs to be tailored to the individual characteristics of targeted audiences, including an assessment of their readiness for change. Blending objective information with an understanding of people’s emotions, values, and personal experiences is essential when promoting ecological and interspecies harm reduction actions.
The harm reduction process is starting to be used outside of the public health realm, for example, in managing monkey-human conflicts in St. Kitts and Nevis (see Chapter 22) and in recommendations to manage salmon aquaculture in British Columbia, Canada. An expert advisory panel recommended harm reduction as a new tactic to overcome entrenched perspectives and inaction associated with salmon aquaculture (Anon, 2018). To ensure progress on sustaining healthy and abundant wild salmon, irrespective of the diverse perspectives on salmon farming, the panel emphasized finding strengths, possibilities, and opportunities to reduce harms and the development of achievable small wins to build public trust through collaboration.
The Anthropocene is bringing unprecedented changes along with more far- reaching interconnections. While significant effort is and should be directed at detecting and responding to harms arising from these changes and connections, there is room for people to create the conditions that incrementally make the world healthier by focusing on circumstances and actions that reduce the total amount and total impact of harms across the human-animal-environment interface through harm reduction processes.
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