Skip to main content

Advertisement

Log in

Public Health Understandings of Policy and Power: Lessons from INSITE

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Drug addiction is a major public health problem, one that is most acutely felt in major cities around the globe. Harm reduction and safe injection sites are an attempt to address this problem and are at the cutting edge of public health policy and practice. One of the most studied safe injection sites is INSITE located in Vancouver, British Columbia. Using INSITE as a case study, this paper argues that knowledge translation offers a limited framework for understanding the development of public health policy. This paper also argues that the experience of INSITE suggests that science and social justice, the meta-ideas that lie at the core of the public health enterprise, are an inadequate basis for a theory of public health policy making. However, on a more positive note, INSITE also shows the value of concepts drawn from the ways in which political science analyzes the policy process.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Debeck K, Kerr T. The use of knowledge translation and legal proceedings to support evidence-based drug policy in Canada: opportunities and ongoing challenges. Open Med. 2010; 4(3).

  2. Kerr T, Montaner J, Wood E. Supervised injecting facilities: time for scale-up? Lancet. 2008; 372(9636): 354–355.

    Article  PubMed  Google Scholar 

  3. Hathaway AD, Tousaw KI. Harm reduction headway and continuing resistance: insights from safe injection in the city of Vancouver. Int J Drug Policy. 2008; 19(1): 11–16.

    Article  PubMed  Google Scholar 

  4. Hwang SW. Science and ideology. Open Med. 2007; 1(2): 99–101.

    Google Scholar 

  5. Dooling K, Rachlis M. Vancouver’s supervised injection facility challenges Canada’s drug laws. Can Med Assoc J. 2010; 182(13): 1440–1444.

    Article  Google Scholar 

  6. Cain J. Report of the task force into illicit narcotic overdose deaths in British Columbia. Victoria: Ministry of Attorney General; 1994.

    Google Scholar 

  7. Campbell L, Boyd N, Culbert L. A thousand dreams: Vancouver’s Downtown Eastside and the fight for its future. Vancouver: Greystone Books; 2009.

    Google Scholar 

  8. McCann EJ. Expertise, truth, and urban policy mobilities: global circuits of knowledge in the development of Vancouver, Canada’s “four pillar” drug strategy. Environ Plann A. 2008; 40(4): 885–904.

    Article  Google Scholar 

  9. Kerr T, MacPherson D, Wood E. Establishing North America’s first safer injection facility: lessons from the Vancouver experience. In: Stevens A, ed. Crossing frontiers: international developments in the treatment of drug dependence. Brighton: Pavilion Publishing; 2008: 109–129.

    Google Scholar 

  10. Martin L. Harperland: the politics of control. Toronto: Viking Canada; 2010.

    Google Scholar 

  11. Wells P. Harper swings and misses on Insite. Macleans. 2011. Available at: http://www2.macleans.ca/2011/10/10/swing-and-a-miss/#.TpNZ-OjrJMQ. Accessed October 10, 2011

  12. Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009; 181: 165e8.

    Google Scholar 

  13. Murphy K, Fafard P. Knowledge translation and social epidemiology: taking power, politics, and values seriously. In: O’Campo P, Dunn R, eds. Rethinking social epidemiology: towards a science of change. New York: Springer; 2011. http://www.springer.com/biomed/book/978-94-007-2137-1. Accessed March 27, 2012

    Google Scholar 

  14. Uchtenhagen A. Heroin-assisted treatment in Switzerland: a case study in policy change. Addiction. 2010; 105(1): 29–37.

    Article  PubMed  Google Scholar 

  15. Kerr T, Stoltz J-A, Tyndall M, et al. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. BMJ. 2006; 332(7535): 220–222.

    Article  PubMed  Google Scholar 

  16. Hathaway A. Ushering in another harm reduction era? Discursive authenticity, drug policy and research. Drug Alcohol Rev. 2005; 24(6): 549–550.

    Article  PubMed  Google Scholar 

  17. Jenson J. Getting to sewers and sanitation: doing public health within nineteenth-century britain’s citizenship regimes. Polit Soc. 2008; 36(4): 532–556.

    Article  Google Scholar 

  18. Tilson H, Berkowitz B. The public health enterprise: examining our twenty-first-century policy challenges. Health Aff (Millwood). 2006; 25(4): 900–910.

    Article  Google Scholar 

  19. Bernier NF, Clavier C. Public health policy research: making the case for a political science approach. Heal Promot Int. 2011; 26(1): 109–116.

    Article  Google Scholar 

  20. Fafard P. Evidence and healthy public policy: insights from health and political sciences. Montreal: National Collaborating Centre on Healthy Public Policy/Canadian Policy Research Networks; 2008.

    Google Scholar 

  21. Bowen S, Zwi AB. Pathways to “evidence-informed” policy and practice: a framework for action. PLoS Med. 2005; 2(7): e166.

    Article  PubMed  Google Scholar 

  22. Lomas J, Brown AD. Research and advice giving: a functional view of evidence-informed policy advice in a Canadian Ministry of Health. Milbank Q. 2009; 87(4): 903–926.

    Article  PubMed  Google Scholar 

  23. Mitton C, Adair CE, McKenzie E, Patten SB, Waye Perry B. Knowledge transfer and exchange: review and synthesis of the literature. Milbank Q. 2007; 85(4): 729–768.

    Article  PubMed  Google Scholar 

  24. Kerner JF. Integrating research, practice, and policy: what we see depends on where we stand. J Publ Health Manag Pract. 2008; 14(2): 193–199.

    Google Scholar 

  25. Hawe P, Potvin L. What is population health intervention research? Rev Can Sante Publique. 2009; 100(1): I8–I14.

    Google Scholar 

  26. Levy B, Sidel V. Social injustice and public health. Oxford: Oxford University Press; 2006.

    Google Scholar 

  27. Edwards N. Revisiting our social justice roots in population health intervention research. Rev Can Sante Publique. 2009; 100(6): 405–406.

    Google Scholar 

  28. Gostin LO, Powers M. What does social justice require for the public’s health? Public health ethics and policy imperatives. Heal Aff. 2006; 25(4): 1053–1060.

    Article  Google Scholar 

  29. Alderman J, Dollar KM, Holtz TH. Commentary: understanding the origins of anger, contempt, and disgust in public health policy disputes: applying moral psychology to harm reduction debates. J Public Health Pol. 2010; 31(1): 1–16.

    Article  Google Scholar 

  30. Powers M, Faden R. Social justice: the moral foundations of public health and health policy. New York: Oxford University Press; 2008.

    Google Scholar 

  31. Fry CL, Khoshnood K, Power R, Sharma M. Harm reduction ethics: acknowledging the values and beliefs behind our actions. Int J Drug Pol. 2008; 19(1): 1–3.

    Article  Google Scholar 

  32. Pauly B. Harm reduction through a social justice lens. Int J Drug Pol. 2008; 19(1): 4–10.

    Article  Google Scholar 

  33. Cash C. Insite, foresight, hindsight. Macleans.ca. 2010. Available at: http://www2.macleans.ca/2010/01/19/insite-foresight-hindsight/#idc-container. Accessed January 21, 2010

  34. Weinstock D. The political ethics of health. Les ateliers de l’éthique. 2010; 5(1): 15.

    Google Scholar 

  35. Bayoumi A, Guta A. Values and social epidemiological research. In: Rethinking social epidemiology: towards a science of change. New York: Springer; (in press)

  36. Rawls J. A theory of justice: revised edition. Cambridge: Belknap Press of Harvard University Press; 1999. Revised edition.

    Google Scholar 

  37. Nozick R. Anarchy, state, and utopia. New York: Basic Books; 1974.

    Google Scholar 

  38. Cohen GA. Rescuing justice and equality. 1st ed. Cambridge: Harvard University Press; 2008.

    Google Scholar 

  39. Sen A. The idea of justice. 1st ed. Cambridge: Belknap Press of Harvard University Press; 2009.

    Google Scholar 

  40. Beaglehole R, Bonita R. Public health at the crossroads: which way forward? Lancet. 1998; 351(9102): 590–592.

    Article  PubMed  CAS  Google Scholar 

  41. Breton E, Richard L, Gagnon F, Jacques M, Bergeron P. Health promotion research and practice require sound policy analysis models: the case of Quebec’s Tobacco Act. Soc Sci Med. 2008; 67(11): 1679–1689.

    Article  PubMed  Google Scholar 

  42. Exworthy M. Policy to tackle the social determinants of health: using conceptual models to understand the policy process. Health Pol Plann. 2008; 23(5): 318–327.

    Article  Google Scholar 

  43. Kübler D. Understanding policy change with the advocacy coalition framework: an application to Swiss drug policy. J Eur Publ Pol. 2001; 8(4): 623–641.

    Article  Google Scholar 

Download references

Acknowledgments

This work has been funded in part by the Canadian Institutes of Health Research (CIHR) under grant #101693, entitled “Power, Politics, and the Use of Health Equity Research.”

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patrick Fafard.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fafard, P. Public Health Understandings of Policy and Power: Lessons from INSITE. J Urban Health 89, 905–914 (2012). https://doi.org/10.1007/s11524-012-9698-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-012-9698-2

Keywords

Navigation