Reducing the Harm Associated with Injection Drug Use in Canada
4. The Context For Comprehensive Action
Comprehensive actions to address injection drug use rest on the foundation of a number of key perspectives, initiatives and partnerships that already exist and are vital to long-term positive outcomes. The foundation for comprehensive action on injection drug use is formed by a population health perspective, the broader context of Canada's Drug Strategy, the Canadian Strategy on HIV/AIDS, and the Hepatitis C Prevention, Support, and Research Program, and the commitment to a long-term, multisectoral and nationally coordinated approach.
A Population Health Perspective
It is widely accepted in Canada that the health of the individual cannot be separated easily from the health of society.36 Governments at all levels can facilitate and create conditions within the social and physical environment that support and enhance health.
A population health approach, aimed at addressing those determinants of healthi, whose lack may precede and/or exacerbate drug misuse, is a necessary component of a comprehensive drug strategy. Strategies should be based on a population health approach and address the range of factors, that determine health and well being, and consider the underlying reasons and conditions that put people at risk of misusing drugs, such as marginalization, inadequate support networks, lack of access to effective health services and addiction programs, poor coping skills, unhealthy child development, and mental health problems. A comprehensive strategy to reduce the harm associated with injection drug use includes measures to address the underlying factors associated with drug misuse as well as measures to address the more immediate risk factors among those who are injecting drugs.
Canada's Drug Strategy
Canada's Drug Strategy addresses drug misuse first and foremost as a health issue. The strategy has the long-term goal to reduce the harm associated with alcohol and other drugs to individuals, families and communities. The ongoing work of Canada's Drug Strategy to support a continuum of intervention from prevention to treatment and rehabilitation is vital to the success of the injection drug use initiatives put forth in this report. Also, specific initiatives to address injection drug use in Canada are in a position to complement and build upon the broader work and strengthen the harm reduction approach of Canada's Drug Strategy.
Canadian Strategy on HIV/AIDS
The Canadian Strategy on HIV/AIDS has six goals: prevent the spread of HIV infection in Canada; find a cure; find and provide effective vaccines, drugs and therapies; ensure care, treatment and support for Canadians living with HIV/AIDS, their families, friends, and caregivers; minimize the impact of HIV/AIDS on individuals and communities; and minimize the social and economic factors that increase individual and collective risk for HIV. These goals and the three policy directions which guide implementation of the Canadian Strategy on HIV/AIDS - enhanced sustainability and integration, increased focus on those most at risk, and increased accountability - are consistent with the approach taken in this paper.
Hepatitis C Prevention, Support, and Research Program
The Hepatitis C Prevention, Support and Research Program is a federally-funded, $50 million dollar initiative spanning 1999/2000 to 2003/2004. The Program was developed in consultation with a range of stakeholders and intends to increase awareness, promote positive prevention behaviours, expand research activity, and augment the government's capacity to respond to this health threat. There are five components: Prevention; Care and Treatment Support; Research; Community-Based Support; and Management. The goals of the Program are to contribute to the prevention of hepatitis C infection, promote the development and availability of tools and mechanisms in support of persons infected with or affected by hepatitis C, expand research availability and capacity, and strengthen the response of the Canadian population to hepatitis C through increased awareness.
Coordinated and Long-Term Action
Successful programs to reduce the harm associated with drugs require consistent action over time. Commitments should be adequate and sustained to establish, implement, coordinate and ultimately evaluate realistic and long-term plans and programs.
There is strong support for a multi-sectoral, coordinated and long-term strategy to address injection drug use and its related health and social problems. The importance of collaboration is paramount, requiring involvement of addictions, justice, health and social services, law enforcement officers, correctional services, Aboriginal peoples, community stakeholders, those involved in injection drug use and others. Action at all levels is essential to build synergies, overcome tensions, avoid duplication and provide a comprehensive long-term response to injection drug use.
i Evidence indicates that the key factors that influence population health are income and social status, social support networks, education, employment and working conditions, physical environments, biology and genetic make-up, personal health practices and coping skills, healthy child development, health services, gender and culture. Health Canada. Strategies for Population Health: Investing in the Health of Canadians. 1994.
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