Health promotion and harm reduction

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About

Health promotion and harm reduction are prevention and intervention services and activities. They foster health-promoting behaviors and reduce the negative impact of behaviors, such as alcohol and drug use, physical inactivity and risky sexual activity. They include regulating systems, advocating for policies, conducting health education, monitoring wellness and disease, and connecting individuals and communities to services for prevention, treatment and recovery.

Relationship to health and equity

Health promotion and harm reduction considers a complex set of individual, community and societal factors that hinder or support health-promoting behaviors.

Groups who have been historically marginalized by society often experience more barriers to engaging in health-promoting behaviors. For example, residents in communities with few to no grocery stores (food deserts) are more likely to face higher food costs, travel further to purchase healthy food and have more access to unhealthy foods compared to those who live in well-resourced communities. People in these communities tend to have lower incomes and more often are people of color. Relatedly, rates of Type 2 diabetes are higher in American Indian, Black, Hispanic and Asian populations. These disparities suggest a complex interplay of environmental and socioeconomic factors as well as health care providers’ potential unconscious bias and prejudices.

Relationship to systems and structures

The choices available to individuals are determined by people who lead larger structures in society, including public and private institutions, governments, employers and corporations. Public health agencies and advocates have an important role to play in monitoring, passing policy, educating and countering these structural forces to enable opportunities to make healthful choices.

For example, food deserts are not a natural result of communities that are too poor or sparsely populated to support a profitable grocery store. In the 1980’s, the Reagan administration abandoned a law that for 50 years had leveled the playing field between large grocery store chains and independent grocers. The law made it illegal for suppliers to charge large grocery store chains less for products which enabled independent grocery stores to compete on prices. Prior to 1982, almost every small town had at least one grocery store and low-income communities of color, like their higher income neighbors, had multiple large and independent retail grocery stores. When we see a broader view of the systemic nature of the problem, it means we can better see what solutions are needed. In this example, health promotion would include advocating for enforcement of the original law.

We can change systems. Smoking rates in the U.S. declined after state legislatures passed laws and policies that increased tobacco taxes, mass media campaigns challenged culture and norms around tobacco use, and cessation treatment programs became more widely available.

Additional Reading

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Measures