Below is the speech given to representatives of the Red Cross about harm reduction in my role as rapporteur to the Council of Europe on the motion entitled 'For a European Convention on the Promotion of Public Health Measures in the Fight against Drugs’. The full text of the resolution can be foundbelow the speech.
• HIV/AIDS has killed more than 20 million people worldwide • 40 million people worldwide are currently infected • In 2004, approximately five million people were newly infected with the virus. • In 2004, 3.1 million people died of AIDS-related illnesses, equating to 8,500 people each day • 510,000 of those AIDS-related deaths in 2004, were children under the age of 15 • More than 13 million children under the age of 15 have been orphaned by HIV/AIDS, and this number is projected to double by 2010 • In Europe as a whole, 80% of HIV cases with a known route of transmission are due to injecting drug use. • In Russia, up to 90% of registered HIV infections have been officially attributed to injecting drug use. • In Ukraine, between 1996 and 2003, AIDS incidence increased from 3 to 37 cases per million and has now surpassed the western European average.
In June of this year, the Social Health and Family Affairs Committee of the Council of Europe voted to adopt an initiative presented to it by The Senlis Council. At its core, the initiative aims to integrate considerations of public health with considerations concerning drug policy formulation. The initiative is currently being taken forward in the Council of Europe in the form of a Resolution for which I have been appointed Rapporteur. The Resolution is entitled, ‘For a European Convention on the Promotion of Public Health Measures in the Fight against Drugs’. It aims at the eventual adoption of a legal Convention by member states’ governments, which codifies effective public health responses to problematic drug use. In recognition of the urgency of this initiative, a draft Convention has already been formulated, entitled ‘A Framework Convention on Public Health Promotion’. Next month, the Resolution, together with the draft Convention which it proposes, shall be presented to the Social Health and Family Affairs Committee for further detailed deliberation, before being presented to the Committee of Ministers at the Council of Europe in Strasbourg.
The foundation stone of this Council of Europe initiative derives from a fundamental human right; the right to health. This right was first enshrined in the 1946 Constitution of the WHO, providing that:
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
Two years later, the Universal Declaration of Human Rights laid the foundations for the international legal framework for the right to health. The right to health has since been codified in numerous international and regional human rights treaties, including the International Covenant on Economic, Social and Cultural Rights which provides the cornerstone protection of the right to health in international law, introducing legally binding provisions applicable to all individuals in the 146 ratifying States.
The right to health extends not only to the availability of health care, but also to the underlying determinants of health, such as access to a healthy environment, and access to health-related education and information. It confers freedoms – such as the right to control one’s health, as well as entitlements – such as the right to a system of health protection that provides equality of opportunity for people to enjoy the highest attainable standard of health.
The Council of Europe Convention that is being proposed aims to forge public health considerations with drug policy formulation. It has three inter-related objectives:-
To promote, as a fundamental human right, the right to health in the context of drug abuse.
To clarify the scope of the right to health as it applies to drug abuse.
To help identify good practices for the operation of the right to health as it applies to drug abuse, at the community, national and international levels.
Since the late 1960s, the public health imperative has become a major impetus for pragmatic drug policy-making in many European countries. The public health driven drug policies of many European countries have given rise to a wide socio-medical literature on responses to drug abuse and addiction. Many governments are now equipped with a more informed understanding and the key responses that have emerged are needle exchange programmes, substitution treatment, and safe injection sites.
The motion for a resolution that was passed at the Council of Europe last June constituted a firm indication of the Social Health and Family Affairs Committee’s support for these key responses. There is now an abundance of scientific evidence from around the world that easier access to needles and syringes can have a direct impact on reducing HIV transmission rates. These results are widely documented and underpin the Committee’s recognition of the urgent need to consolidate and articulate these evidenced-based public health measures in an international legal framework. It is anticipated that this, in turn, will pave the way for further empirical and scientific analysis of drug usage and risks, and facilitate information sharing between countries leading to improved best practices.
Whereas, twenty years ago, such measures were still at an experimental stage, it is clear that they have now reached maturity. The draft Convention consolidates the socio-medical knowledge concerning these responses that has evolved in past years and codifies this knowledge in a framework of best practices of drug policy responses. It recognises, for example, the importance of outreach work as well as of providing easy access, low threshold services in order to maximise the access and retention of all drug abusers. Crucially too, it urges the integration of drug policy responses with other healthcare and social services, especially those services targeting marginalised and socially disadvantaged groups. This can make an ongoing commitment to public health measures more likely and can have a marked effect on the successful long-term rehabilitation of drug users and their reintegration into society. The resultant benefits may be felt by society as a whole, through reductions in the incidence of criminal behaviour, reduced costs for health and criminal justice systems, reduced risks of transmission of HIV and other blood borne viruses, increased productivity and ultimately reduced drug use levels.
Evidenced-based drug responses are, however, woefully inadequate in scale and coverage globally and the growing HIV/AIDS pandemic has given this public health imperative a renewed urgency. The 6th United Nations Millennium Development Goal sends a call to “halt and begin to reverse the spread of HIV/AIDS”. In Eastern Europe, rising incidences of opiate abuse are reported alongside rates of HIV/AIDS infection which are the fastest growing in the world. In 2004, 210,000 new infections were recorded - bringing the total number of HIV-positive people in the region to approximately 1.4 million. As the threat of the spread of blood-borne diseases such as Hepatitis C and HIV/AIDS linked to intravenous drug use rises, there is an overwhelming need for a clear signal from the international community that gives legal credibility to public health responses and that encourages countries to create the right conditions in which the dignity of vulnerable drug users may be restored. In some central European countries, where evidenced-based HIV interventions have, to varying degrees, been adopted, HIV epidemics have been controlled or averted. In Poland, by mounting a strong national response, including targeting interventions at injecting drug users, the Government successfully contained the epidemic among injecting drug users and, to date, have averted more widespread epidemics in non-injecting populations. In the Czech and Slovak republics and Slovenia, well-designed national HIV/AIDS programmes are thought to have contributed to low prevalence among IDUs and low incidence in non-injecting populations.
The current UN drug Conventions regime provides a broad mandate for the implementation of public health responses. The primary aims of the Conventions include preventing and combating abuse of narcotic drugs and psychotropic substances and addressing the health and social problems which such abuse engenders. To achieve these ends, the initiative now under discussion in the Council of Europe seeks to incorporate the current state of socio-medical knowledge in the formulation of drug policy responses. In so doing, the Council of Europe initiative sets out to create a new paradigm, enabling states to formulate public-health orientated responses to global trends and structural forces.
It is clear that the promotion of public health responses to drug abuse is not the exclusive responsibility of the Council of Europe. Today’s seminar offers an invaluable opportunity to re-emphasize the public health imperative amongst other key organizations represented here today. The support and actions taken by such organizations as those present today will play a vital part in stimulating the political momentum required to bring about much needed change in drug policy responses.
For a European drug convention on promoting public health policy in drug control
Motion for a resolution presented by Mr Flynn and others
The public health imperative has become a major impetus for drug policy-making in many European countries. Key responses to the problems of drug abuse have emerged, most notably: needle exchange programmes, and substitution/maintenance treatment.
Where these responses have been implemented as integral to a country’s overall drug prevention and treatment policies, especially those services targeting marginalised and socially disadvantaged groups, this has had a marked effect on the successful long-term rehabilitation of drug users and their reintegration into society.
The resultant benefits are felt by society as a whole, through reductions in the incidence of criminal behaviour, reduced costs for health and criminal justice systems, reduced risks of transmission of HIV and other blood borne viruses, increased productivity and ultimately reduced drug use levels.
The growing HIV/AIDS pandemic is in many countries chiefly attributable to growing rates of drug abuse. The Assembly considers that this demands a renewed urgency for a clear signal from the international community granting legal status to key public health responses.
Over the past twenty years, a wide socio-medical literature has emerged on appropriate and effective responses to drug abuse and addiction. The British Institute of International and Comparative Law drafted a Framework Convention on Public Health Promotion which has been presented to the Assembly. The Convention represents this scientific and medical knowledge in a transnational policy document and consolidates existing effective practices. It is designed to complement existing legal frameworks in the areas of Human Rights, Public Health and Drug Control.
The key tenet of international law on which the Convention is built, is the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. To this end, the Convention has three inter-related objectives:
a. to promote the right to health in the context of drug abuse as a fundamental human right;
b. to clarify the scope of the right to health as it applies to drug abuse;
c. to help identify good practices for the operationalization of the right to health as it applies to drug abuse, at the community, national and international levels.
The right to health extends across a broad range of issues and the Convention is premised on the recognition that the adverse health effects of drug abuse take place at the social and environmental levels and at the level of individual and collective, physical and mental health. The Convention is thus aimed at promoting the right to health in three key areas:
a. individual physical and mental health – granting a clear and comprehensive legal status to public health responses highlighted above;
b. prevention and education – emphasising non-discrimination and the special needs of the marginalised and vulnerable groups in society;
c. environmental harm and alternative development – enabling substantial, real and sustained improvements in the quality of life of the inhabitants of drug-crop growing regions.
Accordingly, the Assembly resolves to debate the Convention with a view to the adoption of a recommendation to the Committee of Ministers, asking them to develop a recommendation to the governments of the member states or a convention establishing the criteria according to which effective public health responses to problematic drug use should be implemented.
Signed : FLYNN, Paul, United Kingdom, SOC ALAY FERRER, Vicenç, Andorra, SOC CHERNYSHENKO, Igor, Russia, EDG CORREIA, Telmo, Portugal, EDG COUSIN, Alain, France, EPP/CD COX, Thomas, United Kingdom, SOC DUPRAZ, John, Switzerland, ALDE FERNÁNDEZ-CAPEL, Blanca, Spain, EPP/CD GLESENER, Marcel, Luxembourg, EPP/CD HANCOCK, Michael, United Kingdom, ALDE HURSKAINEN, Sinikka, Finland, SOC HUSS, Jean, Luxembourg, SOC KOCHARYAN, Shavarsh, Armenia, ALDE LALOY, Marie-José, Belgium, SOC LINDINGER, Ewald, Austria, SOC MARQUET, Bernard, Monaco, ALDE McCAFFERTY, Chris, United Kingdom, SOC OSKINA, Vera, Russia, EDG WOHLLEBEN, Verena, Germany, SOC