Background

Within the framework of Human Rights Council resolution 51/21, the Special Rapporteur on the highest attainable standard of physical and mental health has identified health equity as a strategic priority, ranging from the underlying determinants of health to the need to eliminate structural and systemic barriers in accessing health care services, goods, and facilities, particularly among persons living under vulnerable or marginalised circumstances. In compliance with her mandate, in line with these priorities and to build on the report she will be presenting to the 56th session of the Human Rights Council in June 2024 on “Drug policies and responses: a right to health framework on harm reduction.”, the Special Rapporteur on the right to health has decided to devote her next thematic report to the 79th session of the General Assembly, in October 2024 to the theme of “Harm reduction for sustainable peace and development”.

Objectives

The Special Rapporteur stresses that all individuals are entitled to the enjoyment of the right to health, which includes the underlying determinants of health and timely and appropriate health care. In the present report and building on the report she will be presenting in June 2024 during the 56th session of the Human Rights Council^[1], the Special Rapporteur intends to explore the ways in which harm reduction intersects with the right to health and related human rights. Relying on the frameworks of the social, commercial^[2], and legal^[3] determinants of health, the Special Rapporteur will examine harm reduction legislations, policies and programmes linked with sustainable peace and development, as well as universal health coverage, harm reduction in situations of vulnerability.

In the forthcoming report, the Special Rapporteur intends to focus on harm reduction as key public health interventions for populations that are often stigmatised and discriminated against. The Special Rapporteur will use an intersectional, anti-racist and anti-colonial approach in her analysis related to drug use, harm reduction and the right to health and will thus examine the underlying power structures that perpetuate systems of disadvantage that determines who have acceptable, accessible, affordable, and quality services, goods and facilities.

The achievement of Universal Health Coverage is challenged by the lack of health equity and the Special Rapporteur will also examine gaps in adopting a rights-based approach to public health and harm reduction, including in contexts in which it fails to meet the needs of those who bear the brunt of punitive drug laws and policies and inadequate comprehensive support over decades.

The Special Rapporteur will explore how harm reduction is a part of reparative approaches through evidence based, stigma-free, decriminalised legislations, policies and programmes linked with universal health coverage, sustainable peace and development.

Definitions

Most commonly, harm reduction refers to policies, programmes and practices that aim to minimise the negative health, social and legal impacts associated with drug use, drug policies and drug laws^[4]. For the purposes of this report, the Special Rapporteur defines harm reduction in a broader sense, including the policies, programmes, and practices that aim to minimise the negative health, social, and legal impacts associated with various behaviours and related policies and laws, as exemplified above.

Key questions and types of input/comments sought

1. Please provide the specific challenges, or positive developments and examples of harm reduction interventions in communities, countries, or regions. If possible, please provide examples of how harm reduction support programmes in your community, country, or region were impacted by war, conflict, crisis or humanitarian settings and steps, if any, that were taken to mitigate the impact.
2. Please share the impact of criminalisation, discrimination, stereotypes and stigma in your community, country, or region on the accessibility, availability, affordability, and quality of essential medicines (e.g., pain medication or abortion pills), palliative care, comprehensive drug prevention and education, and drug treatment?
3. Please provide examples of initiatives undertaken to provide access to controlled medicines to specific groups of the population requiring them.
4. Are there resource or budgetary requirements or constraints for adopting or implementing sound harm reduction policies, programmes, and practices in your community, country, or region? How do the resources allocated to harm reduction compare to those allocated to law enforcement or the criminalisation of drug use or other behaviours? How do universal health coverage plans/implementation in your region take harm reduction resourcing into account?
5. What role do private actors (e.g., the pharmaceutical, tobacco, alcohol, food industries) play in real or apparent harm reduction policies, programmes, and practices that are available in your community, country, or region? What are the positive or negative impacts to public health, sustainable peace and development?
6. In your opinion, what constitutes comprehensive clinical guidelines/procedures? Please provide good practices in this regard implemented in your community, country, or region. Does universal health coverage implementation reflect these good practices?
7. Please provide examples of good initiatives or practice undertaken to provide comprehensive harm reduction interventions for populations that are often criminalized, stigmatized and discriminated against in the context of drug use and drug laws and policy.
8. Please provide details about the type of continuous professional training related to international human rights norms and standards provided or offered to staff working in the judiciary, law enforcement, community safety, medical practitioners, and educators.
9. Please share the redress mechanisms in place, if any, to ensure that the right to health of people who use drugs are protected.
10. In view of anti-colonial and anti-racist approaches to harm reduction related to drugs, please provide some examples of reparative approaches that protect and promoted the dignity of people.

How inputs will be used?

Please note that all responses will be published on the official webpage of the Special Rapporteur by default.

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1. see Call for input: Drug policies and responses: a right to health framework on harm reduction
2. see www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health
3. see: https://www.who.int/health-topics/health-law#tab=tab_1 and https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30233-8/fulltext
4. see A/65/255 para. 50