Public health is front and centre of the media currently, with concerns about the coronavirus outbreak, which was first identified in the Chinese city of Wuhan, splashed across almost every front page. With confirmed cases now reported in numerous countries across the world, we face the possibility of a pandemic. As several experts and commentators have pointed out, in our modern, highly interconnected world no epidemic remains a local concern. This, of course, makes for frightening headlines- which, in turn, calls for calm and informed responses.
The World Health Organisation’s Director General has stated that misinformation was “making the work of our heroic workers even harder”. It doesn’t take long to find examples of dubious information and conspiracy theories relating to coronavirus. Whilst some may be motivated by good intentions, others seem malevolent or provide an outlet for the usual obsessions. Some of the media circulating in Russia implicates President Trump, intelligence agencies and big pharma. Elsewhere we are told it’s a bio weapon, the fault of 5G, spread by drinking Chinese red bull or fortune cookies. Of course, there is also advice: drink bleach (please don’t!); gargle with saltwater to prevent infection; take more garlic (no hardship for me); and even one online post that provides a pseudo-scientific argument for smoking to help protect you from the virus (again please do not). While some of this may raise a smile, there are also those who have not missed the opportunity to fan the flames of racism and xenophobia. The results of misinformation can be tragic and certainly hinder legitimate efforts.
Those with experience of working in the harm reduction world will recognise the truth of WHO’s Dr Tedros’ statement that “People must have access to accurate information to protect themselves and others”. The implicit corollary to this is that people need to be able to trust the agencies and institutions that provide information. Trust is hard earned, and when lost incredibly hard to regain. As our thoughts are with those directly affected, and we wish every success to the WHO and all those seeking to contain Coronavirus, we might reflect that this applies to all areas of health policy.
Turning to non-communicable health issues there is project being set up in Glasgow that I will be keeping a very interested eye on: a managed alcohol project that aims to help those members of the homeless community with an alcohol dependency. Historically, there have been a number of “wet houses” set up in different cities and countries that seek to reduce the level of risk experienced by homeless drinkers. While each has had its own starting point, they share a commitment to harm reduction. They also share criticism from those who see them as “indulging” people that make bad decisions. Alternatively, there are some who would rather see the money invested in different approaches. I have some sympathy for the latter, in that I recognise the fight for resources is intense and that we need a range of services, as one size does not fit all. But, I have seen first-hand the need for services that help those not able to give up alcohol- and who, as a result, are too often left on the street, sometimes literally to rot. In addition, there is also the impact on the community in terms of health, anti- social behaviour and crime
In Glasgow, they have been looking at work undertaken in Ottawa by the Managed Alcohol Project. Those engaged with the Canadian project are given a controlled quantity of alcohol with the aim of stabilising them prior to any other interventions. It is medically supervised, and the approach has developed over the last 19 years so that 14 such projects have been established in Canada. One of the motivations in Canada is the extreme risk of death faced by the street homeless in winter. While the UK has a much milder climate, we know our rough sleepers are incredibly vulnerable and that their death rate has risen. It is also evident that a considerable amount of resources are expended on this group, but not always to greatest effect. For example, the preliminary work in Glasgow has identified one individual who has presented at hospital over 400 times in three years. We often record individuals as not “willing to engage” but are doing all we can to make this possible?
Some fresh and courageous efforts are welcome if we are to stop avoidable deaths on our streets. As already mentioned, we do need a range of services, for example those that are abstinence based. But the stark fact is that we need to help keep people alive and as healthy as possible until they are able to engage or accept those forms of support. For many, harm reduction is a staging post, for others it is a destination, but whichever is the case, we should never lose sight of the gains that it represents.