HEALTH CARE/Joan Retsinas

Moral Failing or Disease?

Oh for bacteria to battle! When good health demands only a scientific search for a physical enemy, followed by a search for the cure, the battle plan against disease is clear.

But the campaign to promote the public’s health is more complicated. It often comes up smack against the public’s campaign to promote morality.

Such is the tale of government funding for needle exchanges.

Twenty years ago public health advocates recognized the merits of needle exchange programs for addicts. HIV was rising among addicts, in large measure because addicts were sharing needles, passing infection from one user to another, and from them to non-users, via sex. To stanch the spread of HIV (and hepatitis), physicians argued for programs where addicts could get clean needles. European nations had had success with those exchanges. The United States could expect the same results.

But the federal government, the chief plausible funder of that initiative, balked. Some legislators saw addiction to drugs as a moral failing; others countered that drug use, regardless of morality, was illegal. (The other health-harming addictive substances, tobacco and alcohol, are legal: they flourish in the marketplace.) So the federal government, in spite of the clear linkage between HIV, hepatitis and shared needles, said “no” to federal funds for needle exchanges.

Fast forward two decades. In the interim, 118 needle exchange programs sprang up. They are unevenly distributed, in 28 states and the District of Columbia. Many communities that might have allowed these programs faced their own morality versus public health debate, with money thrown into the discussion. Slowing the spread of diseases would save not just lives, but dollars; yet communities that were hard-pressed to marshal funds for basic services struggled to justify needle exchange programs to taxpayers, particularly taxpayers concerned that such programs might legitimize the use of illegal substances.

Public health advocates hoped for the federal government to drop its ban, allowing more communities to institute these programs. On the campaign trail, President Obama vowed to open up the federal spigots for these initiatives.

This fall Congress voted to open those spigots. Public health advocates cheered.

The cheering was short-lived.

But — there is always a but — Congress initially imposed a 1000-foot rule. No federally-funded needle exchange program could operate within 1000 feet of a school, playground, library, college or video arcade — at first glance, a politically appealing prohibition. But center directors eyeballed their neighborhoods. Some took out tape measures. One thousand feet in a city is not far. Staff in Baltimore, New York, the District of Columbia, even Bangor, Maine, feared their programs were too close. To receive federal funds, many programs would have to move away from their target populations.

Ironically, the early import of opening the federal spigot looked to be another ban, under another guise.

Happily, in late December, Congress compromised. The legislation balances our zeal to protect children against our zeal to protect the public health. Local authorities will now be the ones who can rule on the location of these programs.

Our long-standing “war on drugs” has carried the connotation that the enemy is not just the addictive substance, but everybody involved in the transaction, including the user. Public health authorities have worried about addicts’ rising rates of HIV and hepatitis; but, so long as the government defined drug addiction as a moral failing (and criminal activity), the government did not push for programs to bolster addicts’ health. Even while many physicians were talking about “harm reduction,” our policy-makers were talking “war.”

Now that Congress has relaxed the rhetoric about “fighting” drug abuse, we may at last help more addicts.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, Febuary 15, 2010

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